Assessing the impact of the Royal Canadian Mounted Police (RCMP) protocol and Emotional Resilience Skills Training (ERST) among diverse public safety personnel

BACKGROUND

Public safety personnel (PSP; e.g., border services personnel, correctional workers, firefighters, paramedics, police, public safety communicators) are frequently exposed to potentially psychologically traumatic events. Such events contribute to substantial and growing challenges from posttraumatic stress injuries (PTSIs), including but not limited to posttraumatic stress disorder.

METHODS

The current protocol paper describes the PSP PTSI Study (i.e., design, measures, materials, hypotheses, planned analyses, expected implications, and limitations), which was originally designed to evaluate an evidence-informed, proactive system of mental health assessment and training among Royal Canadian Mounted Police for delivery among diverse PSP (i.e., firefighters, municipal police, paramedics, public safety communicators). Specifically, the PSP PTSI Study will: (1) adapt, implement, and assess the impact of a system for ongoing (i.e., annual, monthly, daily) evidence-based assessments; (2) evaluate associations between demographic variables and PTSI; (3) longitudinally assess individual differences associated with PTSI; and, (4) assess the impact of providing diverse PSP with a tailored version of the Emotional Resilience Skills Training originally developed for the Royal Canadian Mounted Police in mitigating PTSIs based on the Unified Protocol for the Transdiagnostic Treatment of Emotional Disorders. Participants are assessed pre- and post-training, and then at a follow-up 1-year after training. The assessments include clinical interviews, self-report surveys including brief daily and monthly assessments, and daily biometric data. The current protocol paper also describes participant recruitment and developments to date.

DISCUSSION

The PSP PTSI Study is an opportunity to implement, test, and improve a set of evidence-based tools and training as part of an evidence-informed solution to protect PSP mental health. The current protocol paper provides details to inform and support translation of the PSP PTSI Study results as well as informing and supporting replication efforts by other researchers.

TRIAL REGISTRATION

Hypotheses Registration: aspredicted.org, #90136. Registered 7 March 2022-Prospectively registered.

TRIAL REGISTRATION

ClinicalTrials.gov, NCT05530642. Registered 1 September 2022-Retrospectively registered. The subsequent PSP PTSI Study results are expected to benefit the mental health of all participants and, ultimately, all PSP.

Assessing the Relative Impact of Diverse Stressors among Canadian Coast Guard and Conservation and Protection Officers

Public Safety Personnel (PSP), including members of the Canadian Coast Guard (CCG) and Conservation and Protection (C&P) officers, are regularly exposed to potentially psychologically traumatic events (PPTEs) and other occupational stressors (organizational and operational stressors). The current study quantified occupational stressors among CCG and C&P and assessed relationships with PPTEs and mental health disorders. Participants (n = 341; 58.4% male) completed an online survey assessing self-reported occupational stressors, PPTEs, and mental health disorder symptoms. CCG and C&P Officers reported significantly lower mean overall and item-level organizational and operational stress scores compared to other Canadian PSP. Mean operational stress scores were statistically significantly associated with increased odds of screening positive for all mental disorders and organizational stress scores were statistically significantly associated with increased odds of screening positive for all mental disorders except social anxiety disorder. Participants reported several item-level occupational stressors associated with screening positive for posttraumatic stress disorder, general anxiety disorder, major depressive disorder, social anxiety disorder, panic disorder, and alcohol use disorder, even after accounting for diverse PPTE exposures. Exposure to PPTEs may be a regular part of employment for CCG and C&P PSP; however, bureaucratic red tape, staff shortages, excessive administrative duties, physical conditioning, healthy eating, and fatigue are occupational stressors that appear significantly related to mental health. Ongoing mental health efforts are needed to mitigate and manage the impact of occupational stressors among CCG and C&P.

Suicidal Ideation, Planning, and Attempts among Canadian Coast Guard and Conservation and Protection Officers

The current study provides estimates of suicidal ideation, planning, and attempts among Canadian Coast Guard personnel and Canadian Conservation and Protection Officers. Participants (n = 385; 59% men) completed a self-report survey that collected past-year and lifetime estimates of suicidal ideation, planning, attempts, sociodemographic information, and symptoms related to mental health disorders. Within the sample, participants reported lifetime suicidal ideation (25.7%), planning (10.9%), and attempts (5.5%). Participants reported past-year suicidal ideation (7.5%), planning (2.1%), and the percentage of attempts was too marginal to report due to ethical considerations. Canadian Coast Guard personnel and Conservation and Protection Officers reported higher percentages of past-year and lifetime suicidal ideation, planning, and attempts than the Canadian general population, but the percentages reported are comparable to other Canadian PSP sectors. No statistically significant results were observed for the sociodemographic covariates within the past-year, whereas, statistically significant results were observed for the lifetime sociodemographic covariates of age, province of residence, and previous work experience. There were statistically significant associations between past-year suicidal ideation and positive screens for major depressive disorder (MDD) and general anxiety disorder (GAD); as well, past-year suicidal planning was associated with social anxiety disorder (SAD). There were also statistically significant associations between lifetime suicidal ideation, planning, and attempts and positive screens for posttraumatic stress disorder (PTSD), MDD, and SAD. Lifetime suicidal ideation and planning were associated with panic disorder (PD). The current estimates provide valuable information for clinicians and stakeholders involved in prevention programs, treatment, or future research.

Mental Health Training, Attitudes toward Support, and Screening Positive for Mental Disorders among Canadian Coast Guard and Conservation and Protection Officers

Public Safety Personnel (PSP) including members of the Canadian Coast Guard (CCG) and Conservation and Protection (C&P) officers, are regularly exposed to potentially psychologically traumatic events (PPTEs) and other occupational stressors. Several mental health training programs (e.g., critical incident stress management [CISM], critical incident stress debriefing [CISD], peer support, mental health first aid, Road to Mental Readiness [R2MR]) exist as efforts to minimize the impact of exposures. To help inform on the impact of several categories of mental health training programs (i.e., CISM, CISD, mental health first aid, Peer Support, R2MR) for improving attitudes toward support and willingness to access supports among CCG and C&P officers, the current study assessed CCG and C&P Officers perceptions of access to professional (i.e., physicians, psychologists, psychiatrists, employee assistance programs, chaplains) and non-professional (i.e., spouse, friends, colleagues, leadership) support, and associations between training and mental health. Participants (n = 341; 58.4% male) completed an online survey assessing perceptions of support, experience with mental health training and symptoms of mental health disorders. CCG and C&P Officers reported access to professional and non-professional support; however, most indicated they would first access a spouse (73.8%), a friend (64.7%), or a physician (52.9%). Many participants would never, or only as a last resort, access other professional supports (24.0% to 47.9%), a CCG or C&P colleague (67.5%), or their leadership (75.7%). Participants who received any mental health training reported a lower prevalence of positive screens for all mental health disorders compared to those who did not received training; but no statistically significant associations were observed between mental health training categories and decreased odds for screening positive for mental disorders. The current results suggest that the mental health training categories yield comparable results; nevertheless, further research is needed to assess the shared and unique content across each training program. The results highlight the need to increase willingness to access professional and non-professional support among CCG and C&P Officers. Revisions to training programs for leadership and colleagues to reduce stigma around mental health challenges and support for PSP spouses, friends, and physicians may be beneficial.

Psychological interventions for post-traumatic stress injuries among public safety personnel: a systematic review and meta-analysis

BACKGROUND

Public safety personnel (PSP) are exposed to potentially psychologically traumatic events (PPTE) far more often than the general public, which increases the risk for various post-traumatic stress injuries (PTSIs). While there are many evidence-based psychological interventions for PTSI, the effectiveness of each intervention for PSP remains unclear.

OBJECTIVES

The current study assessed the effectiveness and acceptability of psychological interventions for PTSI among PSPs.

METHODS

A systematic review and random-effects meta-analysis were performed on the effectiveness and acceptability of psychotherapies for PTSIs (i.e., symptoms of depression, anxiety, post-traumatic stress disorder) among PSP. The review adhered to the PRISMA reporting guidelines and used standardized mean differences (Cohen's d), rate ratios (RR), and their 95% confidence intervals (95% CI) to measure pooled effect sizes across studies; negative d values and RR values less than one indicated a reduction in symptoms compared to baseline or control groups. In addition, heterogeneity was quantified using I², and publication bias was evaluated using Egger's test.

RESULTS

The analyses included data from eight randomized controlled trials representing 402 PSP (79.4% male, 35.3 years). Psychological interventions included narrative exposure therapy (n = 1), cognitive behavioral therapy (n = 2), eclectic psychotherapy (n = 2), eye-movement desensitization and reprocessing (n = 1), supportive counseling (n = 2), and group critical incident stress debriefing (n = 1). The interventions were associated with statistically significant reductions in symptoms associated with PTSD (d = - 1.23; 95% CI - 1.81, - 0.65; 7 studies; I² = 81%), anxiety (- 0.76; 95% CI - 1.28, - 0.24; 3 studies; I² = 47%), and depression (d = - 1.10; 95% CI - 1.62, - 0.58; 5 studies; I² = 64%). There were smaller but statistically significant improvements at follow-up for symptoms of PTSD (d = - 1.29 [- 2.31, - 0.27]), anxiety (d = - 0.82 [- 1.20, - 0.44]), and depression (d = - 0.46 [- 0.77, - 0.14]). There were no statistically significant differences in dropout rates (RR = 1.00 [0.96, 1.05]), suggesting high acceptability across interventions.

CONCLUSIONS

There is preliminary evidence that psychotherapies help treat PTSIs in PSP; however, the shortage of high-quality studies on PSP indicates a need for additional research into treating PTSI among PSP.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO: CRD42019133534.

Mental Health Disorder Symptoms among Canadian Coast Guard and Conservation and Protection Officers

Canadian public safety personnel (PSP) screen positive for one or more mental health disorders, based on self-reported symptoms, at a prevalence much greater (i.e., 44.5%) than the diagnostic prevalence for the general public (10.1%). Potentially psychologically traumatic event (PPTE) exposures and occupational stressors increase the risks of developing symptoms of mental health disorders. The current study was designed to estimate the mental health disorder symptoms among Canadian Coast Guard (CCG) and Conservation and Protection (C&P) Officers. The participants (n = 412; 56.1% male, 37.4% female) completed an online survey assessing their current mental health disorder symptoms using screening measures and sociodemographic information. The participants screened positive for one or more current mental health disorders (42.0%; e.g., post-traumatic stress disorder, major depressive disorder, generalized anxiety disorder, social anxiety disorder, panic disorder, alcohol use disorder) more frequently than in the general population diagnostic prevalence (10.1%; p < 0.001). The current results provide the first information describing the prevalence of current mental health disorder symptoms and subsequent positive screenings of CCG and C&P Officers. The results evidence a higher prevalence of positive screenings for mental health disorders than in the general population, and differences among the disorder-screening prevalence relative to other Canadian PSP. The current results provide insightful information into the mental health challenges facing CCG and C&P PSP and inform efforts to mitigate and manage PTSI among PSP. Ongoing efforts are needed to protect CCG and C&P Officers' mental health by mitigating the impacts of risk factors and operational and organizational stressors through interventions and training, thus reducing the prevalence of occupational stress injuries.

Exposures to Potentially Psychologically Traumatic Events among Canadian Coast Guard and Conservation and Protection Officers

Canadian Public Safety Personnel (PSP) (i.e., municipal/provincial police, firefighters, paramedics, Royal Canadian Mounted Police, correctional workers, dispatchers) report frequent and varied exposures to potentially psychologically traumatic events (PPTEs). Exposure to PPTEs may be one explanation for the symptoms of mental health disorders prevalent among PSP. The objective of the current study was to provide estimates of lifetime PPTE exposures among Canadian Coast Guard (CCG) and Conservation and Protection (C&P) Officers and to assess for associations between PPTEs, mental health disorders, and sociodemographic variables. Participants (n = 412; 55.3% male, 37.4% female) completed an online survey assessing self-reported PPTE exposures and self-reported symptoms of mental health disorders. Participants reported higher frequencies of lifetime exposures to PPTEs than the general population (all ps < 0.001) but lower frequencies than other Canadian PSP (p < 0.5). Several PPTE types were associated with increased odds of positive screens for posttraumatic stress disorder, major depressive disorder, general anxiety disorder, social anxiety disorder, panic disorder, and alcohol use disorder (all ps < 0.05). Experiencing a serious transportation accident (77.4%), a serious accident at work, home, or during recreational activity (69.7%), and physical assault (69.4%) were among the PPTEs most frequently reported by participants. The current results provide the first known information describing PPTE exposures of CCG and C&P members, supporting the growing evidence that PPTEs are more frequent and varied among PSP and can be associated with diverse mental health disorders.

Peer Support for Public Safety Personnel in Canada: Towards a Typology

Public safety personnel (PSP) are frequently exposed to potentially psychologically traumatic events (PPTEs) which can impact mental health. To help mitigate the negative effects of PPTEs, PSP commonly rely on peer support. Peer support generally refers to a wide variety of mental health resources that offer social or emotional assistance to a peer, and in some cases professional assistance. Despite the use of and demand for peer support, there is relatively little empirical evidence regarding effectiveness. The evidence gaps regarding peer support effectiveness may be due, in part, to inadequate guidelines and standards of practice that are publicly supported by a consensus among peer support providers. The current study was designed to explore the current conceptualization and implementation of peer support among Canadian PSP using a document analysis. The results indicate that peer support can be conceptualized via three models (i.e., peer-enabled, peer-led, peer-partnership) and implemented via two delivery methods (i.e., program, service). The research team proposed a novel diagram towards a typology of peer support to highlight the diversity in peer support conceptualization and implementation and provide a foundation for the development of mutually agreed-upon language and a shared framework. Overall, the current study can help inform peer support resources within and beyond PSP communities.

Coping among public safety personnel: A systematic review and meta–analysis

Public safety personnel (PSP) are routinely exposed to potentially psychologically traumatic events (PPTEs) that, in turn, can result in posttraumatic stress injuries (PTSI), including burnout and increased symptoms of depression and anxiety. However, the longitudinal impact of PPTEs on PSP coping remains unclear. Coping can be operationalized as various strategies (i.e., behaviours, skills, thought and emotion regulation) for dealing with stressors, which are broadly categorized as either approach (adaptive, positive, social support) or avoidant coping strategies (maladaptive withdrawal, avoidance, substance use). This systematic review and meta-analysis aims to evaluate longitudinal coping outcomes among PSP. Thirteen eligible repeated-measures studies explicitly evaluated coping in 1854 police officers, firefighters, and rescue and recovery workers. Study designs included randomized-control trials, within-subject interventions and observational studies. Effect sizes (Cohen's d) at follow-up were described in 11 studies. Separate meta-analyses reveal small (d < 0.2) but non-significant improvements in approach and avoidant coping. Studies were of moderate quality and low risk of publication bias. Heterogeneity in outcome measures, follow-up durations, and study types precluded subgroup analyses. The current findings can inform the development and evaluation of organizational training programs that effectively promote sustained adaptive coping for PSP and mitigate PTSIs.

Mental health and social support among public safety personnel

BACKGROUND

Social support may be a protective factor for the mental health of public safety personnel (PSP), who are frequently exposed to potentially psychologically traumatic events and report substantial post-traumatic stress disorder (PTSD) and major depressive disorder (MDD) symptoms. Research examining perceived social support and its association with PTSD and MDD in different PSP categories (e.g. firefighters, paramedics) is limited.

AIMS

To examine differences in perceived social support across PSP and determine whether perceived social support is associated with differences in rates of MDD and PTSD.

METHODS

We asked Canadian PSP, including correctional workers and officers, public safety communications officials, firefighters, paramedics, municipal and provincial police officers, and Royal Canadian Mounted Police (RCMP) officers, to complete an online anonymous survey that assessed socio-demographic information (e.g. occupation, sex, marital status, service years), social supports and symptoms of mental disorders, including PTSD and MDD. Analyses included ANOVA and logistic regression models.

RESULTS

Perceived social support differed by PSP occupation. RCMP officers reported lower social support than all other PSP except paramedics. For most PSP categories, PSP who reported greater social support were less likely to screen positive for PTSD (adjusted odds ratios [AORs]: 0.90-0.93). Across all PSP categories, greater perceived social support was associated with a decreased likelihood of screening positive for MDD (AORs: 0.85-0.91).

CONCLUSIONS

Perceived social support differs across some PSP categories and predicts PTSD and MDD diagnostic status. Studies involving diagnostic clinical interviews, longitudinal designs and social support interventions are needed to replicate and extend our results.

Building Personal Resilience following an Online Resilience Training Program for BScN Students

The purpose of this study was to investigate the effectiveness of a self-paced online resilience training program on promoting personal resilience and positive coping styles, while reducing the severity of anxiety- and depression-related symptoms, in a sample of BScN students (N = 70) studying to become registered nurses. Using a repeated-measures research design, results indicate that scores on the measure of personal resilience significantly improved from baseline to post-training follow-up assessment. While scores on measures of positive coping and anxiety/depression shifted in the expected direction, these findings were not statistically significant. This study presents evidence to suggest that a self-paced online resilience training program may be an effective strategy for promoting personal resilience among nursing students.

Proactive psychological programs designed to mitigate posttraumatic stress injuries among at-risk workers: a systematic review and meta-analysis

BACKGROUND

Public safety personnel and frontline healthcare professionals are at increased risk of exposure to potentially psychologically traumatic events (PPTE) and developing posttraumatic stress injuries (PTSI, e.g., depression, anxiety) by the nature of their work. PTSI are also linked to increased absenteeism, suicidality, and performance decrements, which compromise occupational and public health and safety in trauma-exposed workers. Evidence is lacking regarding the effectiveness of "prevention" programs designed to mitigate PTSI proactively. The purpose of this review is to measure the effectiveness of proactive PTSI mitigation programs among occupational groups exposed to PPTE on measures of PTSI symptoms, absenteeism, and psychological wellness.

METHODS

Five electronic databases were searched per PRISMA guidelines for English or French peer-reviewed studies from 2008 to 2019 evaluating PTSI and psychological wellness in adults exposed to occupational PPTE. The risk of bias was assessed using the Newcastle-Ottawa Scale.

RESULTS

We identified 42 studies evaluating 3182 public safety and frontline healthcare professionals, PPTE-exposed educational staff, and miners. Significant overlap was found across program themes that included mindfulness, psychoeducation, resilience promotion, and stress management strategies. Post-program effect sizes were small (SMD < 0.5) to moderate (SMD < 0.8) for reductions in PTSI symptoms and for promoting measures of well-being as indicated by a meta-analysis on 36 studies. There was no evidence for significant reductions in substance use, absenteeism, or biomarkers of distress except for heart rate. Subgroup analyses indicated that multimodal programs effectively improved general psychological health, while resilience programs improved measures of depression, burnout, coping, and resilience. Effect sizes for resilience, depression, and general psychological health improvements were greatest immediately or 1-month post-training, while improvements in PTSD symptoms and coping were larger at longer follow-up. Studies were of moderate quality and risk of bias.

CONCLUSIONS

The current results showcase modest evidence for time-limited reductions in PTSI following participation in holistic programs that promote resilience, stress, and emotion regulation among at-risk workers. Implications for organizational implementation of proactive PTSI mitigation programs and areas of future research are discussed.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO (CRD42019133534).

Mental disorders, suicidal ideation, plans and attempts among Canadian police

BACKGROUND

Recent investigations have demonstrated a significant prevalence of mental health disorders, including post-traumatic stress disorder (PTSD), and suicidal ideation, plans and attempts among Canadian public safety personnel, including police officers. What remains unknown is the relationship between mental disorders and suicide among sworn police officers, and the prevalence of both among civilian police workers.

AIMS

To examine the relationship between suicidal ideation, plans and attempts and positive mental health screens for depression, anxiety, panic disorder, alcohol abuse and PTSD among Canadian sworn and civilian police employees.

METHODS

Participants completed an online survey that included self-report screening tools for depression, anxiety, panic disorder, alcohol abuse and PTSD. Respondents were also asked if they ever contemplated, planned or attempted suicide. Between-group (Royal Canadian Mounted Police [RCMP], provincial/municipal police and civilians) differences on mental health screening tools were calculated using Kruskal-Wallis analyses. The relationship between mental disorders and suicidal ideation, plans and attempts was evaluated with a series of logistic regressions.

RESULTS

There were 4236 civilian and sworn officer participants in the study. RCMP officers reported more suicidal ideation than other police and scored highest on measures of PTSD, depression, anxiety, stress and panic disorder, which were significantly associated with suicidal ideation and plans but not attempts. Relative to provincial and municipal police, civilians reported more suicide attempts and scored higher on measures of anxiety.

CONCLUSIONS

The results identify a strong relationship between mental health disorders and increased risk for suicidal ideation, plans and attempts among sworn and civilian Canadian police employees.

Peer Support and Crisis-Focused Psychological Interventions Designed to Mitigate Post-Traumatic Stress Injuries among Public Safety and Frontline Healthcare Personnel: A Systematic Review

Public safety personnel (PSP) and frontline healthcare professionals (FHP) are frequently exposed to potentially psychologically traumatic events (PPTEs), and report increased rates of post-traumatic stress injuries (PTSIs). Despite widespread implementation and repeated calls for research, effectiveness evidence for organizational post-exposure PTSI mitigation services remains lacking. The current systematic review synthesized and appraised recent (2008-December 2019) empirical research from 22 electronic databases following a population-intervention-comparison-outcome framework. Eligible studies investigated the effectiveness of organizational peer support and crisis-focused psychological interventions designed to mitigate PTSIs among PSP, FHP, and other PPTE-exposed workers. The review included 14 eligible studies (n = 18,849 participants) that were synthesized with qualitative narrative analyses. The absence of pre-post-evaluations and the use of inconsistent outcome measures precluded quantitative meta-analysis. Thematic services included diverse programming for critical incident stress debriefing, critical incident stress management, peer support, psychological first aid, and trauma risk management. Designs included randomized control trials, retrospective cohort studies, and cross-sectional studies. Outcome measures included PPTE impacts, absenteeism, substance use, suicide rates, psychiatric symptoms, risk assessments, stigma, and global assessments of functioning. Quality assessment indicated limited strength of evidence and failures to control for pre-existing PTSIs, which would significantly bias program effectiveness evaluations for reducing PTSIs post-PPTE.

Sleep Quality and Mental Disorder Symptoms among Canadian Public Safety Personnel

Poor sleep quality is associated with numerous mental health concerns and poorer overall physical health. Sleep disturbances are commonly reported by public safety personnel (PSP) and may contribute to the risk of developing mental disorders or exacerbate mental disorder symptoms. The current investigation was designed to provide estimates of sleep disturbances among PSP and explore the relationship between sleep quality and mental health status. PSP completed screening measures for sleep quality and diverse mental disorders through an online survey. Respondents (5813) were grouped into six categories: communications officials, correctional workers, firefighters, paramedics, police officers, and Royal Canadian Mounted Police (RCMP). Many PSP in each category reported symptoms consistent with clinical insomnia (49-60%). Rates of sleep disturbances differed among PSP categories (p < 0.001, ω = 0.08). Sleep quality was correlated with screening measures for post-traumatic stress disorder (PTSD), depression, anxiety, social anxiety disorder, panic disorder, and alcohol use disorder for all PSP categories (r = 0.18-0.70, p < 0.001). PSP who screened positive for insomnia were 3.43-6.96 times more likely to screen positive for a mental disorder. All PSP reported varying degrees of sleep quality, with the lowest disturbances found among firefighters and municipal/provincial police. Sleep appears to be a potentially important factor for PSP mental health.

Assessing the Relative Impact of Diverse Stressors among Public Safety Personnel

Public Safety Personnel (PSP; e.g., correctional workers and officers, firefighters, paramedics, police officers, and public safety communications officials (e.g., call center operators/dispatchers)) are regularly exposed to potentially psychologically traumatic events (PPTEs). PSP also experience other occupational stressors, including organizational (e.g., staff shortages, inconsistent leadership styles) and operational elements (e.g., shift work, public scrutiny). The current research quantified occupational stressors across PSP categories and assessed for relationships with PPTEs and mental health disorders (e.g., anxiety, depression). The participants were 4820 PSP (31.7% women) responding to established self-report measures for PPTEs, occupational stressors, and mental disorder symptoms. PPTEs and occupational stressors were associated with mental health disorder symptoms (ps < 0.001). PSP reported substantial difficulties with occupational stressors associated with mental health disorder symptoms, even after accounting for diverse PPTE exposures. PPTEs may be inevitable for PSP and are related to mental health; however, leadership style, organizational engagement, stigma, sleep, and social environment are modifiable variables that appear significantly related to mental health.

The Impact of Acute Stress Physiology on Skilled Motor Performance: Implications for Policing

Investigations of police performance during acutely stressful situations have primarily focused on higher-order cognitive processes like attention, affect or emotion and decision-making, and the behavioral outcomes of these processes, such as errors in lethal force. However, behavioral outcomes in policing must be understood as a combination of both higher-order processes and the physical execution of motor skills. What is missing from extant police literature is an understanding of how physiological responses to acute stress contribute to observed decrements in skilled motor performance at the neuromuscular level. The purpose of the current paper is to fill this knowledge gap in the following ways: (1) review scientific evidence for the physiological (i.e., autonomic, endocrine, and musculoskeletal) responses to acutely stressful exposures and their influence on skilled motor performance in both human and animal models, (2) review applied evidence on occupationally relevant stress physiology and observed motor decrements in performance among police, and (3) discuss the implications of stress physiology for police training and identify future directions for applied researchers. Evidence is compelling that skill decay is inevitable under high levels of acute stress; however, robust evidence-informed training practices can help mitigate this decay and contribute to officer safety.

Mental health training, attitudes toward support, and screening positive for mental disorders

Public Safety Personnel (PSP; e.g. correctional workers, dispatchers, firefighters, paramedics, police) are frequently exposed to potentially traumatic events (PTEs). Several mental health training program categories (e.g. critical incident stress management (CISM), debriefing, peer support, psychoeducation, mental health first aid, Road to Mental Readiness [R2MR]) exist as efforts to minimize the impact of exposures, often using cognitive behavioral therapy model content, but with limited effectiveness research. The current study assessed PSP perceptions of access to professional (i.e. physicians, psychologists, psychiatrists, employee assistance programs, chaplains) and non-professional (i.e. spouse, friends, colleagues, leadership) support, and associations between training and mental health. Participants included 4,020 currently serving PSP participants. Data were analyzed using cross-tabulations and logistic regressions. Most PSP reported access to professional and non-professional support; nevertheless, most would first access a spouse (74%) and many would never, or only as a last resort, access professional support (43-60%) or PSP leaders (67%). Participation in any mental health training category was associated with lower (p < .01) rates for some, but not all, mental disorders, with no robust differences across categories. Revisions to training programs may improve willingness to access professional support; in the interim, training and support for PSP spouses and leaders may also be beneficial.

A longitudinal assessment of the road to mental readiness training among municipal police

Police agencies increasingly implement training programs to protect mental health. The Road to Mental Readiness (R2MR) program was designed by the Canadian military to increase mental health resilience. A version of R2MR was adapted for municipal police by the Mental Health Commission of Canada (MHCC). The current research was designed to assess the R2MR program, as adapted and delivered by the MHCC, in a municipal police sample. Participants were 147 Canadian police agency employees (57% women) who received a single R2MR training session. Participants completed pre- and post-training self-report questionnaires, and follow-ups at 6 and 12 months. The questionnaires assessed mental health symptoms, work engagement, resiliency, mental health knowledge, and stigma. Multilevel modeling analyses assessed for within-participant changes over time. The results were consistent with other single session interventions; specifically, there were no significant changes in mental health symptoms, resilience, or work engagement (p > .05). There were small, but significant (p < .05), reductions in stigma at post-training that may facilitate help-seeking among police; relatedly, in open-ended response fields, participants commonly described the training as helpful for changing attitudes and improving communication. More engagement with the material may produce larger, sustained gains, but more published research is critically needed.

Four dimensions of paramedic practice in Canada: Defining and describing the profession

IntroductionThis article presents a framework for describing four dimensions of paramedic practice: Practitioners, Practice Setting, Care and Patient Disposition. The framework emerged from a qualitative study conducted to identify potential research directions and opportunities to advance paramedicine and paramedic education at Justice Institute of British Columbia in Canada. MethodsResearchers conducted semi-structured interviews with 17 stakeholders in Canadian paramedicine to explore the current state and emerging expectations of paramedic practice and paramedic education. ResultsThe study found no consensus, and little agreement, on what term or terms best describe the profession. Participants agreed that the core of paramedic practice involves an advanced care paramedic responding by ambulance to the patient’s side in an emergency to assess and treat urgent medical and traumatic conditions, then transport the patient to further medical care – most often an emergency physician at an emergency department. However, participants also described paramedics as healthcare providers who are increasingly taking on varied operational roles to improve patient care and address gaps in an evolving and stressed healthcare system. Four dimensions emerged for describing key characteristics of paramedic practice: the Practitioners, Practice Settings, Care and Patient Disposition. DiscussionThe framework described in this article may be useful for examining and better understanding both traditional and evolving paramedic roles. This, in turn, informs the efforts of paramedic educators, regulators, employers, and professional associations to support practitioners in the field. The article uses the framework to contrast two distinctly different community paramedic programs.

Building personal resilience in paramedic students

The present study examined the impact of a 6- to 8-hour, self-paced online resiliency training program to help students training to be Primary Care Paramedics (PCP) mitigate the risks associated with working in a trauma informed work setting. Of the 138 participants, 88 were male and 30 were female, with a mean age of 25.5 years. Of these, 81 students participated in the experimental group (who took the course), and 57 in the control group. Baseline demographic results were examined using bivariate comparisons between the control and experimental, and all were found to be statistically insignificant at p < 0.05 which suggests that there were no differences between the two groups on the pre-test demographic variables. Prior to the intervention there were no significant differences in total resilience or any of the sub-scales (selfreliance, meaningfulness, equanimity, perseverance, and existential aloneness). Following the resiliency training and the practicum experience, the experimental group scored better in total resilience and each of the sub-scores (p < 0.05) except meaningfulness. Results suggest that developing skills to mitigate and manage workplace trauma can reduce or help mitigate the negative impact of exposure to trauma and potentially reduce the risk of developing trauma related mental health problems which may impact the well-being and quality of life of students once employed as a paramedic.

Building resilient communities: A facilitated discussion

The Building Resilient Communities Workshop was hosted and organized by the Justice Institute of British Columbia, with the support of Emergency Management British Columbia and the Canadian Safety and Security Program, Defence Research and Development Canada, Centre for Security Science. Thirty-four participants from multiple levels of government, senior practitioners, policy makers, academia, community members, and a variety of agencies disseminated knowledge and developed concrete strategies and priority actions areas for supporting ongoing and emerging initiatives in community and disaster resilience planning. Identified strategies included development of an integrated national strategy and finding ongoing sustainability funding; increasing community engagement through information sharing, giving context-specific examples of anticipated outcomes, and demonstrating return on investment; as well as the need to engage and support local champions and embedding disaster resilience within other processes. A key message was that communities should be encouraged to use ANY tool or process, rather than struggling to find the perfect tool. Any engagement with disaster resilience planning increases community resilience.

Towards best practice in physical and physiological employment standards

While the scope of the term physical employment standards is wide, the principal focus of this paper is on standards related to physiological evaluation of readiness for work. Common applications of such employment standards for work are in public safety and emergency response occupations (e.g., police, firefighting, military), and there is an ever-present need to maximize the scientific quality of this research. Historically, most of these occupations are male-dominated, which leads to potential sex bias during physical demands analysis and determining performance thresholds. It is often assumed that older workers advance to positions with lower physical demand. However, this is not always true, which raises concerns about the long-term maintenance of physiological readiness. Traditionally, little attention has been paid to the inevitable margin of uncertainty that exists around cut-scores. Establishing confidence intervals around the cut-score can reduce for this uncertainty. It may also be necessary to consider the effects of practise and biological variability on test scores. Most tests of readiness for work are conducted under near perfect conditions, while many emergency responses take place under far more demanding and unpredictable conditions. The potential impact of protective clothing, respiratory protection, load carriage, environmental conditions, nutrition, fatigue, sensory deprivation, and stress should also be considered when evaluating readiness for work. In this paper, we seek to establish uniformity in terminology in this field, identify key areas of concern, provide recommendations to improve both scientific and professional practice, and identify priorities for future research.

Planning for disaster resilience in rural, remote, and coastal communities: moving from thought to action

Disaster resilience is the cornerstone of effective emergency management across all phases of a disaster from preparedness through response and recovery. To support community resilience planning in the Rural Disaster Resilience Project (RDRP) Planning Framework, a print-based version of the guide book and a suite of resilience planning tools were field tested in three communities representing different regions and geographies within Canada. The results provide a cross-case study analysis from which lessons learned can be extracted. The authors demonstrate that by encouraging resilience thinking and proactive planning even very small rural communities can harness their inherent strengths and resources to enhance their own disaster resilience, as undertaking the resilience planning process was as important as the outcomes.The resilience enhancement planning process must be flexible enough to allow each community to act independently to meet their own needs. The field sites demonstrate that any motivated group of individuals, representing a neighborhood or some larger area could undertake a resilience initiative, especially with the assistance of a bridging organization or tool such as the RDRP Planning Framework.

Photochemically generated elemental selenium forms conjugates with serum proteins that are preferentially cytotoxic to leukemia and selected solid tumor cells

The objective of this study was to determine if and how photoproducts contribute to the antitumor effect of merocyanine-mediated PDT. A panel of barbituric, thiobarbituric and selenobarbituric acid analogues of Merocyanine 540 was photobleached, and the resulting photoproducts were characterized by absorption, fluorescence emission, mass, energy dispersive X-ray, and X-ray photoelectron spectroscopy and tested for cytotoxic activity against tumor cell lines and freshly explanted bone marrow cells. While all dyes were readily photobleached, only photoproducts of selone dyes showed cytotoxic activity. One-hour incubations with micromolar concentrations of selone-derived photoproducts were sufficient to reduce leukemia/lymphoma cells ≥10 000 fold, whereas preserving virtually all normal CD34-positive bone marrow cells. Of six multidrug-resistant tumor cell lines tested, five were as sensitive or more sensitive to photoproducts than the corresponding wild-type lines. Physicochemical characterizations of the cytotoxic activity indicated that it consisted of conjugates of subnano particles of elemental selenium and (lipo)proteins. The discovery of cytotoxic Se-protein conjugates provides a rare example of photoproducts contributing substantially to the antitumor effect of PDT and challenges the long-held view that Se in oxidation state zero is biologically inert. Agents modeled after our Se-protein conjugates may prove useful for the treatment of leukemia.

First aid skill retention of first responders within the workplace

Background

Recent literature states that many necessary skills of CPR and first aid are forgotten shortly after certification. The purpose of this study was to determine the skill and knowledge decay in first aid in those who are paid to respond to emergency situations within a workplace.

Methods

Using a choking victim scenario, the sequence and accuracy of events were observed and recorded in 257 participants paid to act as first responders in large industrial or service industry settings. A multiple choice exam was also written to determine knowledge retention.

Results

First aid knowledge was higher in those who were trained at a higher level, and did not significantly decline over time. Those who had renewed their certificate one or more times performed better than those who had learned the information only once. During the choking scenario many skills were performed poorly, regardless of days since last training, such as hand placement and abdominal thrusts. Compressions following the victim becoming unconscious also showed classic signs of skill deterioration after 30 days.

Conclusions

As many skills deteriorate rapidly over the course of the first 90 days, changing frequency of certification is not necessarily the most obvious choice to increase retention of skill and knowledge. Alternatively, methods of regularly "refreshing" a skill should be explored that could be delivered at a high frequency - such as every 90 days.

Electromyographic activity of the trunk stabilizers during stable and unstable bench press

The purpose of this study was to investigate the effectiveness of instability training in the recruitment of core stabilizing muscles during dynamic multijoint movement. Surface electromyography (EMG) was measured from 6 muscles (latissimus dorsi, rectus abdominus, internal obliques, erector spinae, and soleus) while subjects performed a 9.1-kg bench press on stable and unstable surfaces. There were 4 exercises in total: (a) stable surfaces for shoulders and feet, (b) upper-body instability, (c) lower-body instability, and (d) dual instability. Five seconds of EMG were recorded during each bench press and were subsequently smoothed with root mean squares calculated for the entire time-series. A repeated-measures analysis of variance (ANOVA) was used to test overall differences between exercise conditions for each muscle. Paired equal variance t-tests with a stepwise Bonferroni correction for multiple contrasts (alpha = 0.05/total number of contrasts) were performed for muscles with significant repeated-measures ANOVA results. The results show significant increases in EMG with increasing instability. Specifically, the dual instability bench press resulted in the greatest mean muscle activation of the 3 stability conditions, with single instability conditions being significantly greater than the stable condition. This pattern of results is consistent with the position that performing the bench press in a progressively unstable environment may be an effective method to increase activation of the core stabilizing musculature, while the upper- and lower-body stabilizers can be activated differentially depending on the mode of instability.

ELEMENTAL SELENIUM GENERATED BY THE PHOTOBLEACHING OF SELENOMEROCYANINE PHOTOSENSITIZERS FORMS CONJUGATES WITH SERUM MACROMOLECULES THAT ARE TOXIC TO TUMOR CELLS

Elemental selenium generated by the photobleaching of selenomerocyanine dyes forms conjugates with serum albumin and serum lipoproteins that are toxic to leukemia and selected solid tumor cells but well tolerated by normal CD34-positive hematopoietic stem and progenitor cells. Serum albumin and lipoproteins act as Trojan horses that deliver the cytotoxic entity (elemental selenium) to tumor cells as part of a physiological process. They exploit the fact that many tumors have an increased demand for albumin and/or low-density lipoprotein. Se(0)-protein conjugates are more toxic than selenium dioxide, sodium selenite, selenomethionine, or selenocystine. They are only minimally affected by drug resistance mechanism, and they potentiate the cytotoxic effect of ionizing radiation and several standard chemotherapeutic agents. The cytotoxic mechanism of Se(0)-protein conjugates is not yet fully understood. Currently available data are consistent with the notion that Se(0)-protein conjugates act as air oxidation catalysts that cause a rapid depletion of intracellular glutathione and induce apoptosis. Drugs modeled after our Se(0)-protein conjugates may prove useful for the local and/or systemic therapy of cancer.

Determining physical activity patterns of suburban British Columbia residents

BACKGROUND

Physical activity is well recognized for its role in disease prevention. Public health surveillance and action is warranted to combat the escalating economic and human costs associated with physical inactivity.

METHODS

This study examined the proportion of the population who were physically active at intensities, durations and frequencies specified as the minimum to accrue health benefit as per Canada's Physical Activity Guidelines. Data were collected from 769 suburban residents via a telephone survey, and analyzed using three methods: Individual Assessment (IA) where individuals met the required frequency, intensity and duration through a combination of activities; Categorical Assessment (CA) where individuals met the required frequency, intensity and duration in one or more categories leading to duplicated head-counts; and, Time-based Assessment (TA) where individuals met the required time per week (recommended frequency x duration) in a category through some combination of activity. Z-scores were used to test the null hypothesis that the proportion of people meeting the criteria in more than one category was zero.

RESULTS

The number of people meeting the guidelines in more than one category (CA) is significantly different (p < 0.01) from zero for adults and the combined population, but not for children. Enough people are meeting the guidelines in more than one category to significantly influence the percentage calculated if one is not careful to avoid counting duplicates. Furthermore, significant differences were found between IA and TA for children, adults and the combined population with the time-based assessment significantly over-predicting the IA results.

INTERPRETATION

While 75% of the respondents reported they had been physically active during the previous week, only 39% of respondents reported enough physical activity to meet the guidelines for health benefits. This number varies widely depending on the method of classification. Canadians should be reminded of the physical activity guidelines by their health care providers to insure that those who are active are active frequently enough to accrue health benefit.

Esophageal Stents: Findings on Esophagography in 46 Patients

OBJECTIVE

The purpose of this report is to assess the findings on esophagography in patients with esophageal stents for palliation of malignant tumors involving the esophagus.

CONCLUSION

Radiologists should be familiar with findings of little importance (stent narrowing, flow of contrast medium around stent, stent kinks, and apparent esophageal narrowing below stent because of incompletely distended hiatal hernias) versus more important findings (polypoid defects above or below stent, narrowing within or below stent, delayed stent emptying, esophageal-airway fistulas, stent migration, and abutting of distal stent against greater curvature of stomach) on esophagography after stent placement to guide endoscopists regarding the need for stent revision.

Influence of moderate prophylactic compression on sport performance

This study examined the impact of using elasticized compression shorts on performance measures and proprioception at the hip. Thirteen healthy subjects completed 2 randomized testing sessions-one while wearing the Coreshorts compression shorts and one while not wearing the shorts. During each trial, active range of motion at the hip; joint angle replication during hip flexion, abduction, and hyperextension; leg power; agility; speed; and aerobic endurance were measured, and subjective information pertaining to the fit of the shorts was collected. The use of the prophylactic brace did not limit performance on any measure except active range of motion during hip flexion (p < 0.05). Subjective data revealed 93.3% of subjects felt the shorts were supportive, although proper fit was an issue. The present results support the use of moderate compression at and around the hip for the purpose of injury prevention. Continued research is necessary to determine the efficacy of hip bracing within an injured population and their potential prophylactic benefit for active individuals.

Decomposition of carrion in the marine environment in British Columbia, Canada

Decomposition of carrion in the marine environment is not well understood. This research involved the decomposition of pig carcasses in Howe Sound in British Columbia. Freshly killed pigs were submerged at two depths, 7.6 m and 15.2 m. The carcasses were tethered so that they could float or sink, but not drift away. Observations were made from May until October. Decomposition was more greatly influenced by sediment type of the sea floor and whether the carcass remained floating, than by depth. Decomposition stages were modified in the marine environment from that seen on land, or in freshwater and were similar to those reported in human death investigations in the marine environment.

Determining time of death using blow fly eggs in the early postmortem interval

A forensic entomology case is presented which is interesting for two reasons; firstly, it uses egg development, but secondly, it involves a case which is over 20 years old, and was recently re-opened. The only entomological evidence was in the form of photographs. Usually, it is not possible to make any determinations from photographs alone, as species and age cannot be determined. However, this case was particularly unusual, as close up photographs taken by police at the crime scene showed the first egg eclosion. Weather records, developmental data and degree day accumulations, together with a knowledge of local species and their habitats, allowed determination of the time since death. Time of death was affirmed when the defendant was convicted of first degree murder more than 20 years after the killing.

Paraneoplastic encephalitis associated with cystic teratoma is detected by fluorodeoxyglucose positron emission tomography with negative magnetic resonance image findings

The role of fluorodeoxyglucose (FDG) positron emission tomography (PET) as a functional imaging technique used in the evaluation of a variety of malignancies has been well known. Paraneoplastic encephalitis is a rare central nervous complication, which has been reported in some tumors. Traditionally, magnetic resonance imaging of the brain is performed to aid in its diagnosis. The authors report a case of paraneoplastic encephalitis, associated with cystic teratoma, which had positive FDG-PET findings but appeared normal on magnetic resonance imaging.

FDG positron emission tomography in the surveillance of hepatic tumors treated with radiofrequency ablation

PURPOSE

Radiofrequency thermal ablation (RFA) is an emerging technique in the treatment of focal hepatic tumors. Magnetic resonance imaging (MRI) and computed tomography (CT) are currently used to monitor hepatic tumors after RFA for residual disease and recurrence. Fluorodeoxyglucose (FDG) positron emission tomography (PET) is an excellent imaging method for the detection of liver metastases, but it has not been thoroughly evaluated as an alternative to anatomic imaging in the surveillance of liver tumors treated with RFA. The purpose of this investigation was to determine the role of FDG-PET imaging in the surveillance of liver tumors treated with RFA.

METHODS

Thirteen patients with histories of malignant tumors of the liver treated with RFA and who had received post-treatment FDG-PET scans were assessed retrospectively. One patient had two post-RFA FDG-PET scans, eight patients had concurrent MRI scans, and six patients had concurrent CT scans. Imaging findings were compared with the results of clinical follow-up.

RESULTS

There were either recurrent tumors at the ablation site (8 patients) or new metastases (3 patients) in 11 patients. FDG-PET identified all 11 cases and did not misidentify any cases. Of the seven patients with positive PET findings who received an MRI scan, three were also positive on MRI (42.9%); the other four cases were either negative or equivocal. Of the four patients with positive PET findings who received a CT scan, only two had positive CT scan findings (50%). All recurrences diagnosed by PET were confirmed on clinical follow-up.

CONCLUSION

In this preliminary study, FDG-PET was superior to anatomic imaging in the surveillance of patients treated with RFA for malignant hepatic tumors.

Comparison of I-123 and I-131 for whole-body imaging after stimulation by recombinant human thyrotropin: a preliminary report

PURPOSE

Many studies have established I-123 whole-body scanning (WBS) as an alternative to I-131 WBS in the evaluation of differentiated thyroid cancer. Similarly, recombinant human thyroid-stimulating hormone (rhTSH) has been shown to be an effective alternative to thyroid hormone withdrawal in the stimulation of TSH levels for WBS. The purpose of the current investigation was to compare the ability of rhTSH-stimulated I-123 WBS to that of rhTSH-stimulated I-131 WBS in the evaluation of thyroid cancer.

METHODS

The reports of 101 consecutive I-123 WBS and 101 consecutive I-131 WBS were analyzed. All patients had undergone near-total thyroidectomy, were considered to have a low risk for recurrence, and had rhTSH-stimulated serum thyroglobulin levels measured at the time of imaging. Findings of an examination were considered positive if either residual thyroid tissue was detected on imaging or the serum thyroglobulin level was greater than 2 ng/dl.

RESULTS

The results of rhTSH-stimulated I-123 scans and thyroglobulin levels were concordant in 91 (90%) cases, whereas the results of rhTSH-stimulated I-131 scans and thyroglobulin levels were concordant in 85 (84%) cases. I-123 WBS detected 9 foci of disease in 6 patients, whereas I-131 WBS detected 10 foci of disease in 9 patients.

CONCLUSION

The results of this preliminary investigation are promising regarding the utility of rhTSH-stimulated I-123 WBS as an alternate approach to rhTSH-stimulated I-131 WBS in patients at low risk for recurrence.

Preferential inactivation of paediatric solid tumour cells by sequential exposure to Merocyanine 540-mediated photodynamic therapy and Edelfosine: implications for the ex vivo purging of autologous haematopoietic stem cell grafts

Paediatric solid tumours exhibit steep dose-response curves to alkylating agents and are therefore considered candidates for high-dose chemotherapy and autologous stem cell support. There is growing evidence that autologous stem cell grafts from patients with solid tumours are frequently contaminated with live tumour cells. The objective of this study was to perform, in a preclinical purging model, an initial assessment of the safety and efficacy of a two-step purging procedure that combined Merocyanine 540-mediated photodynamic therapy (MC540-PDT) with a brief exposure to the alkyl-lysophospholipid, Edelfosine. Human and murine bone marrow cells and Neuro-2a murine neuroblastoma, SK-N-SH human neuroblastoma, SK-ES-1 and U-2 OS human osteosarcoma, G-401 and SK-NEP-1 human Wilms' tumour, and A-204 human rhabdomyosarcoma cells were exposed to a fixed dose of MC540-PDT followed by a brief incubation with graded concentrations of Edelfosine. Survival was subsequently assessed by in vitro clonal assay or, in the case of CD34-positive haematopoietic stem cells, by an immunohistochemical method. Combination purging with MC540-PDT and Edelfosine depleted all tumour cells by >4 log while preserving at least 15% of murine granulocyte/macrophage progenitors (CFU-GM), 34% of human CFU-GM, and 31% of human CD34-positive cells. The data suggest that combination purging with MC540-PDT and Edelfosine may be useful for the ex vivo purging of autologous stem cell grafts from patients with paediatric solid tumours.

Anti-tumor effect of Merocyanine 540-mediated photochemotherapy combined with Edelfosine: potential implications for the ex vivo purging of hematopoietic stem cell grafts from breast cancer patients

High-dose chemotherapy combined with autologous stem cell support has improved response rates in high-risk and metastatic breast cancer, but has failed to improve long-term survival. Breast cancer has a tendency to metastasize to the bone marrow, and live tumor cells are known to circulate in the peripheral blood of breast cancer patients. Sensitive immunohistochemical, culture-based, and reverse transcriptase polymerase chain reaction (RT-PCR)-based methods have shown that about 50% of histologically normal stem cell grafts from breast cancer patients are contaminated with occult tumor cells, which may cause or contribute to tumor recurrences. Merocyanine 540 (MC540)-mediated photodynamic therapy (PDT) inactivates a wide range of leukemia and lymphoma cells and is well tolerated by normal hematopoietic stem and progenitor cells. Unfortunately, most solid tumor cells (including breast cancer cells) are only moderately sensitive or refractory to MC540-PDT. We report here that if MC540-PDT is followed by a 1-h incubation with the alkyl-lysophospholipid, Edelfosine (ET-18-OCH(3)), the depletion of murine and human breast cancer cells is greatly enhanced whereas the recovery of normal hematopoietic stem and progenitor cells is only minimally degraded. When used under conditions that reduce CD34-positive human bone marrow cells only 5.1-fold, and murine and human granulocyte/macrophage progenitors 6.8- and 3-fold, respectively, combination purging with MC540-PDT and Edelfosine depletes murine (Mm5MT) and human (MDA-MB-435S) breast cancer cells >17,000- and >125,000-fold, respectively. These data suggest that combination purging with MC540-PDT and Edelfosine may offer a simple, safe and effective method for the ex vivo purging of autologous stem cell grafts from breast cancer patients.

Simple method for developing percentile growth curves for height and weight

The present paper demonstrates the ease of use of method I by Preece and Baine ([1978] Ann Hum Biol 5:1-24) in generating smoothed growth curves for both height and weight. Using the National Center for Health Statistics (NCHS) growth curve data, smoothed curves were developed and compared to those produced using the least-squares-cubic-spline method. Based on the lower sum of squares and better fit of shape as indicated by residual examination, it was concluded that the method I curve fitting procedure by Preece and Baine ([1978] Ann Hum Biol 5:1-24) fit centile growth curves for height and weight in 2-18-year-old male and female children as well as, if not better than, the least-squares-cubic-spline method used in developing the 1979 NCHS growth curves. Further, as this paper demonstrates, smoothed curves can be generated on a desktop computer using readily available software (the SOLVER function within Microsoft EXCEL).

Postirradiation hyperthermia selectively potentiates the merocyanine 540-sensitized photoinactivation of small cell lung cancer cells

Lung cancer has long been considered a disease that might benefit from the dose escalation of radio/chemotherapy afforded by a stem cell transplant. However, the clinical experience with high-dose chemotherapy and autologous bone marrow transplantation in lung cancer has been disappointing, with most trials showing little or no improvement in long-term survival. Unfortunately, lung cancer has a tendency to metastasize to the bone marrow, and lung cancer cells are known to circulate in the peripheral blood. Therefore, there is concern that autologous stem cell grafts from lung cancer patients may reinoculate recipients with live tumor cells. Photochemical purging of stem cell grafts with Merocyanine 540 (MC540) is highly effective against a wide range of leukemia and lymphoma cells and is well tolerated by normal hematopoietic stem and progenitor cells. Most solid tumor cells (including lung cancer cells), however, are only moderately sensitive or refractory to MC540-mediated photodynamic therapy (PDT). We report here that postirradiation hyperthermia (< or = 42 degrees C, 3 h) potentiates the MC540-mediated photoinactivation of both wild-type (H69) and cisplatin-resistant mutant (H69/CDDP) small cell lung cancer cells by several orders of magnitude, while only minimally enhancing the depletion of normal human granulocyte/macrophage progenitor cells. Our data suggest that postirradiation hyperthermia provides a simple and effective means of extending the utility of MC540-PDT to the purging of stem cell grafts contaminated with lung cancer and possibly other solid tumor cells.

Minimum and maximum development rates of some forensically important Calliphoridae (Diptera)

Blow fly development rates are frequently used to estimate elapsed time since death in homicide investigations in the first few weeks after death. However, in order to make more precise estimates of time since death, accurate developmental data must be generated for all carrion species, and at temperatures that are comparable with those found at crime scenes. This paper presents developmental rates determined for five forensically important species in British Columbia, Phormia regina (Meigen), Phaenicia sericata (Meigen), Eucalliphora latifrons (Hough), Lucilia illustris (Meigen), and Calliphora vicina Robineau-Desvoidy, at several temperatures.

Effect of molecular structure on the performance of triarylmethane dyes as therapeutic agents for photochemical purging of autologous bone marrow grafts from residual tumor cells

Extensively conjugated cationic molecules with appropriate structural features naturally accumulate into the mitochondria of living cells, a phenomenon typically more prominent in tumor than in normal cells. Because a variety of tumor cells also retain pertinent cationic structures for longer periods of time compared with normal cells, mitochondrial targeting has been proposed as a selective therapeutic strategy of relevance for both chemotherapy and photochemotherapy of neoplastic diseases. Here we report that the triarylmethane dye crystal violet stains cell mitochondria with efficiency and selectivity, and is a promising candidate for photochemotherapy applications. Crystal violet exhibits pronounced phototoxicity toward L1210 leukemia cells but comparatively small toxic effects toward normal hematopoietic cells (murine granulocyte-macrophage progenitors, CFU-GM). On the basis of a comparative examination of chemical, photochemical, and phototoxic properties of crystal violet and other triarylmethane dyes, we have identified interdependencies between molecular structure, and selective phototoxicity toward tumor cells. These structure-activity relationships represent useful guidelines for the development of novel purging protocols to promote selective elimination of residual tumor cells from autologous bone marrow grafts with minimum toxicity to normal hematopoietic stem cells.

Human morphology and temperature regulation

For nearly a century individuals have believed that there is a link between human morphology and one's thermoregulatory response in adverse environments. Most early research was focussed on the rate of core cooling in a male adult population and the role of subcutaneous adipose tissue, surface area and the surface-area-to-mass ratio in one's ability to withstand varying degrees of cold stress. More recently research has addressed heat tolerance in various populations, exploring the role of subcutaneous adipose tissue, surface area and the surface-area-to-mass ratio in one's ability to maintain thermal equilibrium in warm and hot, dry and humid environments. Since the late 1970s an emphasis has been placed on the role of muscle and muscle perfusion in total-body thermal insulation. Yet, despite the history of research pertaining to human morphology and temperature regulation there is little consensus as to the impact of variations in human morphology on thermoregulatory responses. Individuals differing in body size, shape and composition appear to respond quantitatively differently to variations in both ambient and core temperatures but the interrelations between morphological components and temperature regulation are complex. It is the purpose of this paper to examine the literature pertaining to the impact of variations in muscularity, adipose tissue thickness and patterning, surface area and the surface-area-to-mass ratio on thermoregulation and thermal stability in response to both heat and cold stress.

Human bites and the risk of human immunodeficiency virus transmission

The risk of human immunodeficiency virus (HIV) transmission following a bite injury is important to many groups of people. The first are those who are likely to be bitten as an occupational risk, such as police officers and institutional staff. Another group are represented by the victims and perpetrators of crimes involving biting, both in attack and defense situations. The possibility of these bites transmitting a potentially fatal disease is of interest to the physicians who treat such patients and the legal system which may have to deal with the repercussions of such a transmission. Bite injuries represent 1% of all emergency department admissions in the United States, and human bites are the third most common following those of dogs and cats. The worldwide epidemic of HIV and acquired immunodeficiency syndrome (AIDS) continues, with >5 million new cases last year and affecting 1 in 100 sexually active adults. A review of the literature concerning human bites, HIV and AIDS, HIV in saliva, and case examples was performed to examine the current opinion regarding the transmission of HIV via this route. A bite from an HIV-seropositive individual that breaks the skin or is associated with a previous injury carries a risk of infection for the bitten individual.