Use of expiratory change in bladder pressure to assess expiratory muscle activity in patients with large respiratory excursions in central venous pressure.

BACKGROUND: Expiratory muscle activity may cause the end-expiratory central venous pressure (CVP) to greatly overestimate right atrial transmural pressure. METHODS: We recorded CVP and expiratory change in intra-abdominal pressure (ΔIAP) in 39 patients who had a respiratory excursion in CVP from end-expiration to end-inspiration (CVP(ee)-CVP(ei)) ≥ 8 mmHg. Uncorrected CVP was measured at end-expiration, and corrected CVP was calculated as uncorrected CVP-ΔIAP. In 13 patients measurements were repeated during relaxed breathing. RESULTS: The CVP(ee)-CVP(ei) was 15.2 ± 6.3 mmHg (range 8-34 mmHg), and ΔIAP was 7.4 ± 6.0 mmHg (range 0-30 mmHg). Uncorrected CVP was 18.3 ± 6.1 mmHg, and corrected CVP was 10.9 ± 3.9 mmHg. There was a significant positive correlation between CVP(ee)-CVP(ei) and ΔIAP (r = 0.814). However, some patients with a large CVP(ee)-CVP(ei) had negligible ΔIAP. In a subset of 13 patients with active expiration who had a relaxed CVP tracing available for comparison, the difference between uncorrected CVP and relaxed CVP was much greater than the difference between corrected CVP and relaxed CVP (7.3 ± 3.0 vs. 1.1 ± 0.7 mmHg, p < 0.001). CONCLUSION: Patients with large respiratory excursions in CVP often have significant expiratory muscle activity that will cause their CVP to overestimate transmural right atrial pressure. The magnitude of expiratory muscle activity can be assessed by measuring ΔIAP. Subtracting ΔIAP from the end-expiratory CVP usually provides a reasonable estimate of the CVP that would be obtained if exhalation were passive.

Police officer perceptions of intimate partner violence: an analysis of observational data.

This article explores police officer perceptions of intimate partner violence (IPV) using observational data from police ride-alongs. We performed a qualitative analysis of narrative data from the Project on Policing Neighborhoods (POPN) to examine officers' views of IPV as well as whether policing philosophy is related to officers' attitudes toward IPV. Results indicate that POPN officers expressed problematic views of IPV (including simplification of IPV, victim blaming, patriarchal attitudes toward women, and presumption of victim noncooperation) as well as progressive views of IPV (including recognition of the complexity of IPV, awareness of barriers to leaving, and consideration of IPV as serious and worthy of police intervention). Additionally, our analysis offers tentative support for a relationship between policing philosophy and officers' attitudes toward IPV. While this study is largely exploratory, we address the implications of our findings both for police practice and training and for future research.

A summary of personal protection order statutes in the United States.

A systematic analysis of statutes regarding personal protection orders (PPOs) was completed for all 50 states plus the District of Columbia to determine which states are most "victim friendly" in protecting women against domestic violence. Indicators used include compliance with the Violence Against Women Act (VAWA), the relationship between petitioner and respondent, ease of the PPO administrative process, and severity of punishment for violations. Results indicate that most states have PPO legislation that is consistent with VAWA; however, states differ dramatically in accessibility of orders for victims of violence.