Psychiatric and Behavioral Characteristics Among Male Adolescents With Sexually Acting Out Behaviors Admitted to a Residential Treatment Facility.

One quarter of sexual offenses in the criminal justice system are committed by children and adolescents. Mental health conditions, trauma history, and relationship to the victim may play a role in sexually acting out behaviors (SAB). A retroactive chart review was performed to discover commonalities among 109 adolescent males with SAB admitted to a residential treatment facility. Variables of interest included prior mental health diagnoses, trauma history, full scale intelligence quotient (IQ), relationship to the victim, sex of victim, history of multiple offenses, and history of sexually acting out on an individual aged ≤4 years. Results indicated that 70.6% of the sample had a diagnosis of attention-deficit/hyperactivity disorder, 24.7% had a full scale IQ <90, 41.3% had sexually acted out on more than one victim, and 22.9% sexually acted out solely on males. Pearson's chi-square analysis indicated a non-significant relationship between diagnostic groups and victim characteristics. [Journal of Psychosocial Nursing and Mental Health Services, 60(9), 29-36.].

Causes of Death Among Avalanche Fatalities in Colorado: A 21-Year Review.

INTRODUCTION: A better understanding of the nature of morbidity and mortality in avalanche accidents helps direct both rescue efforts as well as preventive strategies to reduce fatalities. METHODS: We reviewed all avalanche fatalities from the avalanche years beginning in 1994 to 2015 in the state of Colorado, United States, using the database maintained by the Colorado Avalanche Information Center. For each fatality, we obtained the coroner's official determination of cause of death, and autopsy records if one was performed. We used these records to determine cause of death. Injury severity scores (0-75 scale) were calculated for those victims who underwent autopsy. RESULTS: Mortality information was available for 110 fatalities occurring during the 21-year study period. Of these, 64 underwent autopsy. Asphyxia was the cause of death in 65% of fatalities (72/110). Trauma was the cause of death in 29% of the fatalities (32/110). Of these, the primary cause was multiple system trauma in 38% (12/32), head trauma in 31% (10/32), and spinal injuries in 19% (6/32). Of the victims who died of asphyxia and had autopsy, only 10% (4/42) also had significant trauma, defined as an injury severity score greater than 15. There were 6 fatalities from other causes, including hypothermia, drowning, and primary cardiac arrest. There was no correlation between trauma and mode of travel, avalanche type, or starting zone elevation. CONCLUSIONS: Asphyxia was the primary cause of death in avalanche fatalities in Colorado during our study period. The incidence of fatal trauma was 29% and did not correlate with user group demographics or avalanche characteristics.

Body Positioning of Buried Avalanche Victims.

OBJECTIVE: The immediate medical management of buried avalanche victims will to some extent be dictated by the victim's body positioning in the snow. Medical personnel are trained to assess and manage victims in a supine body position. Furthermore, avalanche first responders are trained to handle extricated avalanche victims carefully out of concerns for causing hemodynamic instability or for aggravating spinal injury. Thus, locating and extricating avalanche victims in positions other than supine has the potential to complicate immediate medical management. To our knowledge, the current medical literature does not detail the body positioning of buried victims. METHODS: In order to ascertain the most common body positioning of buried avalanche victims we reviewed the avalanche incident database of the Colorado Avalanche Information Center (CAIC). This comprehensive database strives to track over 160 fields of information for each avalanche victim, including the body and head positioning of buried victims. RESULTS: Head positioning was recorded for 159 buried victims. We found that 65% of buried avalanche victims were found with their heads in a downhill position, 23% with their heads uphill and 11% with their heads in the same level as the rest of their bodies. Body positioning was recorded in 253 victims. 45% of victims were found lying prone, 24% supine, 16% were sitting or standing and 15% were found lying on their sides. We identified 135 victims where both head and body position was registered. 40% of victims were found prone with their heads in a downhill position CONCLUSIONS: The majority of victims will be extricated with their heads in a downhill position. Moreover, almost half of victims will be found prone. We believe this will have significant impact on the immediate medical management. We believe current training in avalanche medical rescue should emphasize managing victims in non-supine positions. Finally, our findings may represent another benefit of modern extrication techniques.

The effectiveness of avalanche airbags.

AIM: Asphyxia is the primary cause of death among avalanche victims. Avalanche airbags can lower mortality by directly reducing grade of burial, the single most important factor for survival. This study aims to provide an updated perspective on the effectiveness of this safety device. METHODS: A retrospective analysis of avalanche accidents involving at least one airbag user between 1994 and 2012 in Austria, Canada, France, Norway, Slovakia, Switzerland and the United States. A multivariate analysis was used to calculate adjusted absolute risk reduction and estimate the effectiveness of airbags on grade of burial and mortality. A univariate analysis was used to examine causes of non-deployment. RESULTS: Binomial linear regression models showed main effects for airbag use, avalanche size and injuries on critical burial, and for grade of burial, injuries and avalanche size on mortality. The adjusted risk of critical burial is 47% with non-inflated airbags and 20% with inflated airbags. The adjusted mortality is 44% for critically buried victims and 3% for non-critically buried victims. The adjusted absolute mortality reduction for inflated airbags is -11 percentage points (22% to 11%; 95% confidence interval: -4 to -18 percentage points) and adjusted risk ratio is 0.51 (95% confidence interval: 0.29 to 0.72). Overall non-inflation rate is 20%, 60% of which is attributed to deployment failure by the user. CONCLUSION: Although the impact on survival is smaller than previously reported, these results confirm the effectiveness of airbags. Non-deployment remains the most considerable limitation to effectiveness. Development of standardized data collection protocols is encouraged to facilitate further research.