Long-Term Psychological and Physiological Effects of Male Sexual Trauma.

Male sexual trauma presents multiple clinical challenges. Although the topic has received increased attention in the last couple decades, male sexual trauma continues to be underreported and underrecognized. This study aimed to investigate the long-term effects of sexual trauma for men who were victimized within an institutional environment by a person in a position of power. This study included data from 47 adult men who were victims of sexual abuse or misconduct by an assigned physician at a higher education academic institution between 1966 and 2003. A primary finding was elevated rates of intimacy and sexual problems and erectile dysfunction, which started shortly after the abuse and persisted over time. We found that there was an association between intimacy and sexual problems and difficulty maintaining employment, drug addiction, erectile dysfunction, and loss of meaningful and romantic relationships. Levels of potential psychopathology were prominently linked to loss of sexual interest or pleasure, intimacy concerns, and loss of intimate and other personal relationships. Men who experienced sexual abuse as adults within an institutional environment developed long-standing patterns of interpersonal and professional problems. This study emphasizes the need for nuanced screening, evaluation, and treatment for male sexual trauma.

Murdered Native and Indigenous Women: A Comparison Study of Victim and Perpetrator Patterns and Characteristics.

INTRODUCTION: The rate of violent crimes against Indigenous people, including murder and rape, is significantly higher than national averages. Even more concerning, Indigenous women and girls represent a large proportion of murdered and missing individuals in the United States. In addition to the murder rate of Indigenous women being higher than the national average, they are significantly more likely to experience rape or other types of sexual violence. The main goal of this study was to gain a better understanding of cases involving the homicide of Indigenous women and identify patterns associated with the violence committed against them. METHODS: Cases of Indigenous women between the ages of 18 and 55 years were pulled from the database. Cases were coded and analyzed for information pertaining to victim, perpetrator, and crime characteristics. Descriptive analysis and test of association were performed. RESULTS/FINDINGS: There was a statistical association between the nature of the relationship between perpetrators and victims and whether the crime occurred on a reservation, the race/ethnicity of the perpetrator, a victim's history of domestic violence, and the method and motive of murder. DISCUSSION/CONCLUSION: Indigenous women are at an increased risk of victimization, including intimate partner violence and homicide. They also represent a group that has been marginalized, receiving little attention from the media, clinicians, researchers, and policy makers. The findings in this study highlight specific factors that may help to mitigate risk factors and/or enhance culturally competent clinical and forensic nursing practice.

The Nurse-Police Assistance Crisis Team (N-PACT): A new role for nursing.

AIM: This study aimed to gain insights into forensic nurses' perspectives and approaches to behavioural crisis situations, comparing them to disciplines traditionally involved in first-line behavioural crisis response. DESIGN: This study used a descriptive, qualitative exploratory design and was informed by Systems Theory. METHODS: The study was carried in the United States, between 2022 and 2023. Data were gathered through four focus groups: police officers (n = 12), co-response (mental health) clinicians (n = 13), sexual assault nurse examiners (n = 6) and correctional nurses (n = 4). Thematic analysis was performed. REPORTING METHOD: The Standards for Reporting Qualitative Research (SRQR) guidelines were used. RESULTS: Findings revealed temporal themes in crisis response: (1) Searching for Historical Information; (2) Safety and Acting at the Present Scene; and (3) Future Strategies and Interventions. Common priorities (e.g. safety and de-escalation) were identified across groups. Notably, nurses demonstrated a comprehensive approach, addressing physical and mental health assessments, substance involvement, and physical injury evaluation. CONCLUSION: This study proposes the creation of a novel nursing role within first-line multidisciplinary teams (MDTs) for crisis response-the Nurse-Police Assistance Crisis Team (N-PACT). Nurses bring expertise and comprehensive assessment skills to enhance crisis responses, particularly in cases involving mental health emergencies, medical crises, and drug-related incidents. IMPLICATIONS: Forensic nurses, with their diverse competencies and comprehensive training, are highly valuable assets within MDTs. Their expertise extends to proficiently conducting mental and physical assessments, ensuring safety and adeptly navigating situations that intersect with the legal system. IMPACT: The N-PACT concept can improve outcomes and streamline the allocation of resources, particularly considering the number of police calls involving behavioural crises. PATIENT OR PUBLIC CONTRIBUTION: No patient or public contribution.

Ramifications of the COVID-19 Pandemic on Nursing Students' Transition to Practice.

As the COVID-19 pandemic altered the course of nursing education worldwide, it disrupted efforts to transition nursing students to professional practice. The investigators examined clinical nursing faculty members' assessment of senior students' practice strengths and challenges compared to graduates of prior years. Findings demonstrated COVID-19's wide-ranging impacts on nursing students' transition to practice and offered suggestions about the implications for nursing professional development practitioners.

Manual and instrument asphyxiation/strangulation: Examining perpetrator and victim characteristics.

Asphyxiation and strangulation are predominant murder methods, with ligature and hands being common weapons in such attacks. This study examines a broad sample with the goal of establishing statistical significance between manual and instrument asphyxiation/strangulation and both victim and offender characteristics. Two hundred cases of perpetrators who strangled or asphyxiated at least one victim on or after 1970 were randomly selected from the Radford-FGCU Serial Killer Database. Descriptive analysis and association tests were performed for characteristics of the perpetrators, victims and crimes. In 68% of the cases, perpetrators only targeted women. The primary murder motives were sadism (36%) and intense emotions (22%), which were statistically associated with the perpetrators' relationship with their victims, serial killing and motive of asphyxiation. There was a relationship between the perpetrators' favoring the use of manual or ligature strangulation/asphyxiation and their ethnicity, prior history of abuse and the victims' racial/ethnic group. Findings highlight the variety of contexts in which strangulation takes place, ranging from sexually or sadism motivated homicide and intimate partner violence. Moreover, the predominance of manual or ligature asphyxiation/strangulation among different racial/ethnic groups may have implications in legal processes, as well as in risk and threat assessments.

A Review of Neural Data and Modelling to Explain How a Semicircular Canal Dehiscence (SCD) Causes Enhanced VEMPs, Skull Vibration Induced Nystagmus (SVIN), and the Tullio Phenomenon.

Angular acceleration stimulation of a semicircular canal causes an increased firing rate in primary canal afferent neurons that result in nystagmus in healthy adult animals. However, increased firing rate in canal afferent neurons can also be caused by sound or vibration in patients after a semicircular canal dehiscence, and so these unusual stimuli will also cause nystagmus. The recent data and model by Iversen and Rabbitt show that sound or vibration may increase firing rate either by neural activation locked to the individual cycles of the stimulus or by slow changes in firing rate due to fluid pumping ("acoustic streaming"), which causes cupula deflection. Both mechanisms will act to increase the primary afferent firing rate and so trigger nystagmus. The primary afferent data in guinea pigs indicate that in some situations, these two mechanisms may oppose each other. This review has shown how these three clinical phenomena-skull vibration-induced nystagmus, enhanced vestibular evoked myogenic potentials, and the Tullio phenomenon-have a common tie: they are caused by the new response of semicircular canal afferent neurons to sound and vibration after a semicircular canal dehiscence.

A review of the geometrical basis and the principles underlying the use and interpretation of the video head impulse test (vHIT) in clinical vestibular testing.

This paper is concerned mainly with the assumptions underpinning the actual testing procedure, measurement, and interpretation of the video head impulse test-vHIT. Other papers have reported in detail the artifacts which can interfere with obtaining accurate eye movement results, but here we focus not on artifacts, but on the basic questions about the assumptions and geometrical considerations by which vHIT works. These matters are crucial in understanding and appropriately interpreting the results obtained, especially as vHIT is now being applied to central disorders. The interpretation of the eye velocity responses relies on thorough knowledge of the factors which can affect the response-for example the orientation of the goggles on the head, the head pitch, and the contribution of vertical canals to the horizontal canal response. We highlight some of these issues and point to future developments and improvements. The paper assumes knowledge of how vHIT testing is conducted.

Female murderers who mutilate or dismember their victims: An exploration of patterns and sex differences.

Attributes and behavioral patterns of female homicide offenders have been less explored than those of males, particularly in crimes that involve aggravating factors such as dismemberment and mutilation. This study explored the patterns of female murderers who engage in postmortem dismemberment and/or mutilation of victims, contrasting these with the patterns of males who display these same behaviors. Cases were obtained from Radford-Florida Gulf Coast University Database and public sources, and then analyzed for specific characteristics of the crimes. An informational form was used to derive quantitative parameters. Statistical significance between sex and variables such as motive, dismemberment/mutilation style, and level of organization during the crime were examined. The majority of the cases were consistent with a defensive style. However, 23% of the cases involving females followed an offensive style compared to 33% among males. The nature of prior relationships between offenders and their victims was noteworthy, with the victims of males being largely strangers and the victims of females being primarily known to them. In comparison to males, females were markedly organized. These differences may emphasize aspects of psychological drives and pleasure-seeking that was more commonly seen among men, who often targeted strangers and were motivated by sadism in 25% of the cases. Dismemberment perpetrated by women primarily followed a defensive style that aimed to dispose of evidence, which would be congruent with the assumption that the murder occurred within a prior background of interpersonal partner violence toward the female perpetrator or other family members.

A Single Fast Test for Semicircular Canal Dehiscence-oVEMP n10 to 4000 Hz-Depends on Stimulus Rise Time.

As previously reported, a single test measuring oVEMP n10 to 4000 Hz stimuli (bone-conducted vibration (BCV) or air-conducted sound (ACS)) provides a definitive diagnosis of semicircular canal dehiscence (SCD) in 22 CT-verified patients, with a sensitivity of 1.0 and specificity of 1.0. This single short screening test has great advantages of speed, minimizing testing time, and the exposure of patients to stimulation. However, a few studies of the 4000 Hz test for SCD have reported sensitivity and specificity values which are slightly less than reported previously. We hypothesized that the rise time of the stimulus is important for detecting the oVEMP n10 to 4000 Hz, similarly to what we had shown for 500 and 750 Hz BCV. We measured oVEMP n10 in 15 patients with CT-verified SCD in response to 4000 Hz ACS or BCV stimuli with rise times of 0, 1, and 2 ms. As a result, increasing the rise time of the stimulus reduced the oVEMP n10 amplitude. This outcome is expected from the physiological evidence of guinea pig primary vestibular afferents, which are activated by sound or vibration. Therefore, for clinical VEMP testing, short rise times are optimal (preferably 0 ms).

Distinguishing everyday evil: Towards a clinical inventory of extreme and outrageous behaviors, actions and attitudes.

Everyday evil is seen in a broad range of scenarios of intended behaviors that are often not violations of criminal law, but nevertheless cause significant and enduring personal and emotional harm. For this reason, the manifestations of everyday evil have pressing psychiatric import. Here, we propose the Welner Inventory of Everyday Extreme and Outrageous (WIEEO) for use as a screening inventory in clinical settings. The WIEEO contains 14 items within four categories: Physical and Emotional Damage, Exploitation, Extending Damage, and Extinguishing Goodness. Five items of "Physical and Emotional Damage" account for enduring life impact from said damage, and material effects that amplify emotional impact as well. Three items of "Exploitation" highlight the significance of not merely the actor's exploitation itself, but also the defenseless vulnerability of the victim. Four items that comprise the "Extending Suffering" category lengthen the impact, involve unusual dimensions, reflect creative social deviance in intent, or extend to additional parties. The two items of "Extinguishing Goodness" focus on the impact of decaying the otherwise prosocial or benevolent character of another and spawning everyday outrageousness in someone who would not have otherwise acted as such. These items have assumed relevance to the WIEEO through research and clinical settings that reveal their significant impact and psychological morbidity. The WIEEO serves as a marker for behaviors that warrant closer clinical attention to intervene, treat and detoxify such situations and the motivations of such malignant behavior before it further traumatizes or damages others.

Vestibular semicircular canal function as detected by video Head Impulse Test (vHIT) is essentially unchanged in people with Parkinson's disease compared to healthy controls.

BACKGROUND: Parkinson's disease (PD) is a common multi-system neurodegenerative disorder with possible vestibular system dysfunction, but prior vestibular function test findings are equivocal. OBJECTIVE: To report and compare vestibulo-ocular reflex (VOR) gain as measured by the video head impulse test (vHIT) in participants with PD, including tremor dominant and postural instability/gait dysfunction phenotypes, with healthy controls (HC). METHODS: Forty participants with PD and 40 age- and gender-matched HC had their vestibular function assessed. Lateral and vertical semicircular canal VOR gains were measured with vHIT. VOR canal gains between PD participants and HC were compared with independent samples t-tests. Two distinct PD phenotypes were compared to HC using Tukey's ANOVA. The relationship of VOR gain with PD duration, phenotype, severity and age were investigated using logistic regression. RESULTS: There were no significant differences between groups in vHIT VOR gain for lateral or vertical canals. There was no evidence of an effect of PD severity, phenotype or age on VOR gains in the PD group. CONCLUSION: The impulsive angular VOR pathways are not significantly affected by the pathophysiological changes associated with mild to moderate PD.

Fetal abduction by maternal evisceration: A planned homicide.

OBJECTIVE: Fetal abduction by maternal evisceration (FAMAE) cases are statistically rare but warrant closer scrutiny as planned homicides. This study reports lessons regarding abductor modus operandi, motivation, intent, planning, and the dynamics in the attack to inform public safety. METHODS: The fifteen FAMAE cases reported to the National Center for Missing and Exploited Children from 1987 to 2011 were reviewed. Court documents for the cases were retrieved, and investigators and attorneys were called to verify information where necessary. RESULTS: All abductors were female, between 19 and 40 years of age. Seven stages of the structure of the crime were identified: targeting and making contact with a pregnant woman, securing weapons, determining the location, subduing the mother, securing the newborn, disposing of the victim mother's body, and informing others that they birthed a child. CONCLUSION: The case histories analyzed demonstrate how FAMAE perpetrators target an unsuspecting pregnant woman, and entrap and murder her in the service of fetal kidnapping. Awareness of FAMAE promotes public safety from those who would do anything to claim they have borne a child.

Psychiatric and legal considerations in cases of Fetal Abduction by Maternal Evisceration.

Fifteen cases of Fetal Abduction by Maternal Evisceration (FAMAE) reported to the National Center for Missing and Exploited Children during 1987-2011 outline the findings from a review of the forensic psychiatric considerations and legal course of each of the cases. Most offenders confessed to law enforcement within a short time of being placed under arrest in statements reflecting a continued effort to manage impressions and minimize culpability. Psychiatric assessment is invariably central to the legal disposition of FAMAE cases, as the defendant's goal is to diminish the perception of culpability/criminal responsibility and mitigate sentencing. Of those sentenced in the United States, nine defendants received life without parole, two received the death penalty (one executed), and one received a minimum of 30 years. Two abductors committed suicide and were not sentenced. Proffered diagnoses at trial included psychogenic amnesia, pseudocyesis, dissociative disorder, and delusional disorder; however, these rarely stood up to court scrutiny. Psychiatric experts showed the greatest variance in diagnosis over what to call the feigned pregnancy. In addition to delusional disorder and dissociative disorder, pseudocyesis, factitious disorder/pregnancy, pseudopregnancy, schizophrenia, and PTSD were among the various diagnoses proposed. A differential diagnosis for many FAMAE offenders may also include borderline personality disorder. Future research accounting for those women claiming false pregnancy who do not become homicidal will clarify whether FAMAE is the extreme endpoint of a fertility identity disorder.

Enhanced Eye Velocity in Head Impulse Testing-A Possible Indicator of Endolymphatic Hydrops.

Introduction: On video head impulse testing (vHIT) of semicircular canal function, some patients reliably show enhanced eye velocity and so VOR gains >1.0. Modeling and imaging indicate this could be due to endolymphatic hydrops. Oral glycerol reduces membranous labyrinth volume and reduces cochlear symptoms of hydrops, so we tested whether oral glycerol reduced the enhanced vHIT eye velocity. Study Design: Prospective clinical study and retrospective analysis of patient data. Methods: Patients with enhanced eye velocity during horizontal vHIT were enrolled (n = 9, 17 ears) and given orally 86% glycerol, 1.5 mL/kg of body weight, dissolved 1:1 in physiological saline. Horizontal vHIT testing was performed before glycerol intake (time 0), then at intervals of 1, 2, and 3 h after the oral glycerol intake. Control patients with enhanced eye velocity (n = 4, 6 ears) received water and were tested at the same intervals. To provide an objective index of enhanced eye velocity we used a measure of VOR gain which captures the enhanced eye velocity which is so clear on inspecting the eye velocity records. We call this measure the initial VOR gain and it is defined as: (the ratio of peak eye velocity to the value of head velocity at the time of peak eye velocity). The responses of other patients who showed enhanced eye velocity during routine clinical testing were analyzed to try to identify how the enhancement occurred. Results: We found that oral glycerol caused, on average, a significant reduction in the enhanced eye velocity response, whereas water caused no systematic change. The enhanced eye velocity during the head impulses is due in some patients to a compensatory saccade-like response during the increasing head velocity. Conclusion: The significant reduction in enhanced eye velocity during head impulse testing following oral glycerol is consistent with the hypothesis that the enhanced eye velocity in vHIT may be caused by endolymphatic hydrops.

Neurobiology of Female Homicide Perpetrators.

Neurobiology of female homicide perpetrators is not well understood. Data from private interviews and examinations of females were re-analyzed comparing those who committed homicide (n = 9); other violent crimes, no known homicide (n = 51); nonviolent crimes, no known violent convictions (n = 49); and noncriminals (n = 12). Homicide perpetrators suffered the most childhood sexual abuse (CSA); most recent abuse; had the most neurological histories, mainly traumatic brain injuries (TBIs); most health care access for abuse-related injuries; lowest AM and PM salivary cortisol; and greatest proportion who committed crime under the influence of alcohol. Only CSA, years since last abuse, TBI, neurological histories, and health care access for abuse-related injuries were significant. Those who committed homicide under the influence of alcohol suffered the most recent abuse and had the lowest AM cortisol and flattest diurnal cortisol slope (DCS) compared with others; though the n precludes determining significance. Amount of time since last abuse, AM cortisol and DCS progressively decreased as crime severity increased; other variables progressively increased as crime severity increased. These preliminary findings suggest that low AM cortisol, flat DCS, greater CSA frequency and severity, recent abuse, TBIs, and health care access for abuse-related injuries could be risk factors for females committing homicide. Further study is needed due to the small n of homicide perpetrators. Abuse victims may be at greater risk for alcohol use and cortisol dysregulation associated with perpetrating violence, especially homicide. Frontal lobe damage from TBIs may decrease ability to control behaviors associated with emotions from the limbic system. Health care providers released these women when their abuse-related injuries were not life-threatening; yet, they were life-threatening for victims of their subsequent homicides. Females accessing health care for abuse-related injuries present a critical opportunity for violent crime prevention interventions.

Activation of Guinea Pig Irregular Semicircular Canal Afferents by 100 Hz Vibration: Clinical Implications for Vibration-induced Nystagmus and Vestibular-evoked Myogenic Potentials.

HYPOTHESIS: Bone-conducted vibration (BCV) at 100 Hz causes endolymph displacement at hair cell stereocilia in semicircular canal (SCC) ducts of the intact bony labyrinth resulting in activation of irregularly discharging afferent neurons. BACKGROUND: Suprathreshold 100 Hz BCV is employed in the clinic to evoke skull vibration-induced nystagmus, an indicator for peripheral vestibular asymmetry. Recently, this stimulus has also been used in vestibular-evoked myogenic potentials, a selective test for otolithic function. METHODS: We performed extracellular recordings from utricular and SCC afferents in guinea pigs during application of suprathreshold BCV stimuli (100-500 Hz) to the animal's skull. Vibration was administered in a way that the animal, the vibrator, and the recording electrode moved as one. RESULTS: In summary, 19 of 43 recorded SCC afferents displayed a stimulus- and phase-locked increase in firing during stimulation at 100 Hz BCV with no perstimulatory adaptation and no poststimulatory silencing. All of the 19 activated SCC afferents had an irregular resting discharge. Neuronal activation of SCC afferents was less pronounced at 200 Hz and largely absent at 500 Hz. On the contrary, a stimulus- and phase-locked increase in firing was observed for irregularly discharging utricular neurons at all frequencies tested. CONCLUSIONS: At intensities usually applied in the clinic, 500 Hz BCV is a largely selective otolithic stimulus, while 100 Hz BCV can activate both otolith and SCC afferents. Therefore, while 100 Hz BCV is ideally suited for evoking skull vibration-induced nystagmus in peripheral vestibular asymmetry, it is not recommended for vestibular-evoked myogenic potentials, as it lacks otolithic specificity.

Computing Endolymph Hydrodynamics During Head Impulse Test on Normal and Hydropic Vestibular Labyrinth Models.

Hypothesis: Build a biologic geometry based computational model to test the hypothesis that, in some circumstances, endolymphatic hydrops can mechanically cause enhanced eye velocity responses during clinical conditions of the head impulse test. Background: Some recent clinical and experimental findings had suggested that enhanced eye velocity responses measured with the video head impulse test could not only be caused by recording artifacts or central disfunction but also could be directly caused by the mechanical effect of endolymphatic hydrops on horizontal semicircular canal receptor. Methods: Data from clinical video head impulse test was computed in three biologic-based geometry models governed by Navier-Stokes equations; six head impulses of incrementally increasing peak head velocity were computed in each one of the three different geometric models, depending on absence, canal or utricular hydrops. Results: For all computed head impulses an increased endolymphatic pressure was measured at the ampullar region of the horizontal semicircular canal on both canal and utricular hydrops models. The mean of aVOR gain was 1.01 ± 0.008 for the no-hydrops model, 1.14 ± 0.010 for the canal hydrops model was, and 1.10 ± 0.007 for the utricular hydrops model. Conclusion: The results of the physical computation models support-the hypothesis that in endolymphatic hydrops conditions, which are affecting horizontal semicircular canal and utricular region on moderate dilatations, the eye velocity responses output-by the aVOR will be enhanced by a 1.14 factor and aVOR gain values will be enhanced by over 1.1 for impulses to the right side.

Dismemberment and Mutilation: A Data-Driven Exploration of Patterns, Motives, and Styles.

Classification of violent behavior, including dismemberment and mutilation, has become increasingly more significant. This study uses a data-driven classification system based upon knowledge drawn from the pertinent literature, and examination of cases of offenders who have dismembered or mutilated their victims. The latter were extracted from the Serial Killer Database, as well as media sources, and assessed for characteristics of the perpetrators and victim(s). An informational form was developed and used to establish quantitative parameters and objectively extract pertinent information that could be used for comparison and pattern analysis. Motives and styles, as well as the organized/disorganized dichotomy for murder and dismemberment/mutilation, were examined for each case. The majority of cases demonstrated defensive styles (60%), with the second most common being offensive styles (26%), which differs from previous studies that do not exclude older cases. Additionally, 68% of cases reflected organized patterns for both murder and the acts of dismemberment or mutilation. The results support a data-driven classification system that may serve as a foundational model for the investigation of specific motives of this type of deviant behavior in future research.