Positional Asphyxia in Opioid-Related Deaths: Is It Being Overlooked?

The contribution of positional asphyxia in opioid-related deaths is currently unknown. Diagnostic criteria for positional asphyxia include finding the decedent in a position that does not allow for adequate respiration and an inability to extricate themselves from the position due to various conditions. Our primary objective was to assess whether positional asphyxia and the resulting airway compromise were a contributing factor to death due to the toxic effects of opioids. We evaluated 225 deaths where the death scene investigation contained adequate information to evaluate for positional asphyxia and performed a Pearson chi-square test to determine if the proportion of deaths found in an airway compromising position was higher when opioid(s) caused the death. The proportion of decedents found in a potential airway compromising position was greater when the death was related to opioid use (p < 0.0001). Further, narrowing the dataset to decedents who were definitely in an airway compromising position [Yes (24.49%) vs. No (11.02%)] showed a statistically significant association between positional asphyxia and deaths related to opioid use (p = 0.0021). Carefully documenting the position in which the decedent was initially found may be a significant factor in accurate reporting and in harm reduction efforts to decrease the opioid mortality rate.     

Differentiation of Antemortem and Postmortem Appendicular Fractures Using Magnetic Resonance Imaging Signal Intensity Changes in Bone and Soft Tissues,

Intraosseous T1-weighted (T1W) and short-tau inversion recovery (STIR) magnetic resonance imaging (MRI) signal intensity changes—so-called bone marrow edema—may be able to differentiate antemortem and postmortem fractures in human forensic imaging. The primary objective of this study was to investigate this hypothesis using an animal model. Three juvenile Landrace pigs were anesthetized and underwent MRI of both tibiae and both radii using a 1.5 T magnet. T1W, T2-weighted (T2W), STIR, and T2* sequences were included. Antemortem fractures were induced in both tibiae and postmortem fractures in both radii, and MRI was repeated. Two board-certified radiologists blinded to fracture group jointly evaluated the images for intraosseous and soft tissue signal intensity changes. Sensitivity (Se) and specificity (Sp) in identifying antemortem fractures were calculated based on intraosseous, soft tissue, and combined intraosseous and soft tissue signal intensity changes. Intraosseous and soft tissue signal intensity changes, when present, were hyperintense in all sequences. Intraosseous hyperintensity in T1W and T2W sequences yielded Sp of 100% for antemortem fractures. Regardless of sequence, soft tissue hyperintensity was comparatively more sensitive than intraosseous hyperintensity. Sensitivity for each sequence could be maximized by assessment of soft tissue and intraosseous hyperintense signals together; for the T1W sequence, such assessment optimized diagnostic utility yielding a Se of 100% and Sp of 83%. In summary, MRI—particularly the T1W sequence—can differentiate antemortem and postmortem fractures and may be a useful adjunct to the forensic analyses of fractures.     

Empowering women through the positive birth movement

Childbirth has been positioned as a life changing event that has profound long-term psychological effects upon women. This paper adopts a community psychology approach to explore the role that the Positive Birth Movement (PBM) may have in tackling negative birth experiences by supporting women before and after birth. Six women who all regularly attend UK-based PBM meetings and had given birth to at least one child participated in one to one semi-structured interviews designed to explore the support they received before, during and after their birth, as well as their experiences with the PBM. A Foucauldian inspired discourse analysis explores themes relating to the lack of support and information provided by the NHS and the function of the PBM as a transformative community space which offers social support and information. Within these themes a focus on neoliberalism, choice and the woman’s position as an active consumer of health care is critically discussed. It is argued that the PBM has the potential to prepare women for positive birth experiences but more attention needs to be paid to the wider contexts that limit women’s ability to make ‘free’ choice.     

Masculinities and emotional expression in UK servicemen: ‘Big boys don’t cry’?

Dominant discourses of military servicemen position them as more prone to psychological damage than the general population, but as reluctant to seek psychological assistance, because of the military culture of ‘toughness’, a military masculinity, that values stoicism, emotional control and invulnerability and implicitly excludes ‘feminine’ characteristics like emotionality. This is seen as a barrier to military personnel seeking help, by implicitly discouraging emotional disclosure and expression. This article presents an analysis of semi-structured interviews with six male military and ex-military personnel, focused on their experience and understandings of emotion, emotional expression and ‘mental health’ in the military. The dominant construction of military masculinity certainly renders some forms of emotion inexpressible within certain contexts. However, we argue that the construct is more complex than a simple exclusion of the ‘feminine’ and the ‘emotional’. We explore how the highly masculine notions of military solidarity and ‘brotherhood’ create a ‘safe’ masculine space within which men could share their emotional experiences, but also highlight how this space for emotional expression is relatively constrained. We argue that these notions of solidarity and brotherhood open a space for emotional connection and expression that must be respected and worked with creatively, in therapeutic and other interventions.     

Diagnostic Bias and Conduct Disorder: Improving Culturally Sensitive Diagnosis

Disproportionately high rates of Conduct Disorder are diagnosed in African American and Latino youth of color. Diagnostic bias contributes to overdiagnosis of Conduct Disorder in these adolescents of color. Following a diagnosis of Conduct Disorder, adolescents of color face poorer outcomes than their White counterparts. These negative outcomes occur within mental health and juvenile justice settings. The aims of this article are to: (a) identify the factors that contribute to overdiagnosis of Conduct Disorder in adolescents of color, (b) discuss the associated negative outcomes, and (c) provide recommendations for culturally sensitive diagnosis of adolescents of color with conduct problems in order to reduce overdiagnosis. Clinical and research implications will also be presented.     

Beneath the surface: the masculine self and body in Sheridan Le Fanu’s ‘Green Tea’

This article examines the relationship between the masculine self and male body in Sheridan Le Fanu’s short story ‘Green Tea’ (1872), using a masculinity studies lens to analyze Mr Jennings’ destabilized masculinity within the parameters of Victorian male gender norms. I highlight the interwoven relationship between the masculine self and the body through looking at the physical depiction of Jennings, arguing that Jennings’ masculinity, his masculine self, is imprisoned as a reflection of the physical body; a relationship echoing Victorian gender norms regarding masculinity and the body. In the story, a demon follows and watches Jennings, appearing when Jennings is engaged in activity. Focusing on the relationship between the demon’s manifestation and Jennings’ activity, I show that the demon’s presence results from Jennings’ nonconformity to traditional notions of the masculine self. Le Fanu’s emphasis on the demon’s gaze serves to criticize Jennings’ masculinity as Jennings becomes submissive to the demon’s presence; as a result, this submission is mirrored in Jennings’ deteriorating physical body and health. By positing the masculine self within the body, the story acts to highlight Victorian society’s rigid male gender norms and the penalization of bodies that undermine those ideals.     

THE INTERNAL AND EXTERNAL VALIDITY OF THE REGRESSION DISCONTINUITY DESIGN: A META‐ANALYSIS OF 15 WITHIN‐STUDY COMPARISONS

Theory predicts that regression discontinuity (RD) provides valid causal inference at the cutoff score that determines treatment assignment. One purpose of this paper is to test RD's internal validity across 15 studies. Each of them assesses the correspondence between causal estimates from an RD study and a randomized control trial (RCT) when the estimates are made at the same cutoff point where they should not differ asymptotically. However, statistical error, imperfect design implementation, and a plethora of different possible analysis options, mean that they might nonetheless differ. We test whether they do, assuming that the bias potential is greater with RDs than RCTs. A second purpose of this paper is to investigate the external validity of RD by exploring how the size of the bias estimates varies across the 15 studies, for they differ in their settings, interventions, analyses, and implementation details. Both Bayesian and frequentist meta‐analysis methods show that the RD bias is below 0.01 standard deviations on average, indicating RD's high internal validity. When the study‐specific estimates are shrunken to capitalize on the information the other studies provide, all the RD causal estimates fall within 0.07 standard deviations of their RCT counterparts, now indicating high external validity. With unshrunken estimates, the mean RD bias is still essentially zero, but the distribution of RD bias estimates is less tight, especially with smaller samples and when parametric RD analyses are used.     

Immunocognitive Model of Depression Secondary to Anxiety in Adolescents

There is evidence that anxiety precedes the onset of depression and that rumination contributes to this risk pathway in adolescence. This study examined inflammatory biomarkers as mediators in a risk model of depressive symptoms secondary to anxiety symptoms among adolescents who ruminate. A sample of 140 adolescents (52% female, 54% African American, 40% Caucasian, 6% biracial, mean age at T1?=?16.5 years, SD?=?1.2 years) provided blood samples on two visits (T1 and T2; mean time between T1 and T2?=?13.5 months, SD?=?5.9 months). Self-report anxiety, depression, and rumination measures were given at T1 and the depression measure was given again at a third visit (T3, mean months since T1?=?26.0 months, SD?=?9.0 months). Higher anxiety predicted more interleukin-6, but not more C-reactive protein, for adolescents with high levels of rumination. Moderated mediation analyses (N for analysis after removing cases with missing data and outliers?=?86) indicated that interleukin-6, but not C-reactive protein, at T2 mediated the relationship between anxiety symptoms at T1 and depressive symptoms at T3, conditional on rumination. Anxiety and rumination interacted such that, as rumination increased, anxiety predicted greater inflammation and depressive symptoms. These results demonstrate that established cognitive vulnerabilities for the development of depressive symptoms secondary to anxiety symptoms in adolescence might indirectly operate though biological mechanisms such as inflammation. In addition to highlighting risk factors and potential treatment targets for depression, this study suggests a potential biological mechanism underlying the effects of psychotherapies that reduce rumination on negative affect (e.g., cognitive behavioral therapy).