Haiti's unprecedented sociopolitical upheavals have severely impacted health care services. Limited research exists on HIV clinic operations under such strain. We examined the potential interruptions to antiretroviral treatment (ART) provision through discrete time periods using Haiti's national HIV surveillance system. We analyzed weekly count data from HIV clinics (January 2018-December 2024). Time segments were bounded by the COVID-19 emergency period (April 2020-September 2020), hospital strikes (November 2020), the presidential assassination (July 2021), protests over increases in fuel prices (September 2022), and intensifying gang violence (March 2024). We accounted for autocorrelation in weekly time series and measured immediate, level, and trend changes in new ART enrollment. We triangulated this series with Google's weekly cell phone mobility reports to cross-validate our event selection. In Haiti, ART enrollment declined 25% from 13,304 (CY2018) to 11,773 (CY2024) people per year (mean = 222 people/week in 2024). Only the fuel protests had an immediate impact on ART enrollment (β = -111.1 [95% CI: -179.3, -42.9]) and this was isolated to the largest clinical electronic medical record. Mean weekly ART enrollment in most periods was lower. Trend visualization suggests that historical patterns of disruption followed by numerical rebound may have changed after the gang violence in 2024. ART enrollment declined substantially in Haiti from 2018 to 2024. Future work should discern whether the epidemiology of HIV transmission is changing after accounting for these health systems disruptions.
Drug-induced homicide laws, which hold people criminally responsible for overdose deaths linked to drugs they distribute, are a prominent feature of modern United States drug policy. Some are concerned that support for these laws is bolstered by racialized assumptions about people who sell drugs. The current study examines whether and how the perceived race-ethnicity of a suspected "drug dealer" affects support for drug induced homicide laws. Participants (n = 2940) recruited from Cint Theorem were randomized to one of four vignettes which varied the race-ethnicity of a suspect who distributed drugs connected to an overdose death (Latine, Black, white, or unidentified race). Participants answered questions about their general support for a drug-induced homicide law as well as several determinants of support: beliefs about deterrence, moral justification, preference for the "homicide" charge name, and desire for additional incarceration. Compared to those shown a non-Latine suspect, respondents shown a Latine suspect had significantly greater odds of supporting drug-induced homicide laws, believing they are morally justified, and desiring additional incarceration, but were statistically indistinguishable for beliefs about deterrence and preference for the "homicide" charge name. Results were driven by non-Hispanic respondents. This is the first study of its kind to consider the Latine community as a target of punitive drug policy bias. These results suggest that race- and ethnicity-based assumptions continue to influence public opinion about drug policy, echoing the punitive racialization patterns of past "wars" on drugs.
This study describes 16 deaths from Alberta, Canada, caused by ligature strangulation using self-locking zip tie(s), also known as cable ties. All decedents were male, and all ligatures were horizontally oriented. The manner of death was classified as suicide in 15 cases and undetermined in one. Notably, one quarter of cases lacked petechiae, explained by the highly constrictive nature of zip ties and their ratchet locking mechanism. In half of the cases, neck compression resulted from a single ligature formed by one heavy-duty zip tie (6 cases) or several smaller zip ties interconnected to create one ligature (2 cases). The remaining half of the cases involved multiple zip tie ligatures. Most cases (14/16) demonstrated congestion of the head and neck above the ligature mark, occasionally accompanied by ear or nose bleeding. Review of previously published cases revealed similar findings, except for one reported double homicide involving an adult female and her child, a vulnerable population as further corroborated by several news stories. This study emphasizes the importance of recognizing the unique properties of zip ties, particularly their ratchet mechanism, when evaluating ligature strangulation. Without such awareness, the absence of petechiae or congestion may lead to diagnostic uncertainty and the mistaken assumption that neck compression did not contribute to death. One case involving an elderly male showed neither congestion nor petechiae, raising the possibility of reflex cardiac arrest triggered by carotid sinus stimulation.
This paper presents the first conceptual framework for understanding 'honour'-based abuse (HBA), violence and killing: the Three Phase Model of Perpetration. Positioned within priorities of prevention and intervention, the model situates HBA within a public health framework, distinguishing it from other forms of child abuse, family violence and domestic homicide. Narrative review and conceptual analysis. A synthesis of academic and grey literature, statutory reviews, victim case studies, and survivor and perpetrator accounts identified recurring patterns in perpetrator behaviour and systemic responses. The Three Phase Model maps HBA perpetrator behaviour across the lifespan through three interconnected phases - Control, Punish and Protect - showing how honour codes are socialised, enforced and justified within families and communities through collective coercive control and victim-shaming by multiple perpetrators. HBA is a public health crisis requiring a targeted response. Its persistent framing through cultural identity rather than biopsychosocial processes has created a public health blind spot, limiting effective prevention. The Three Phase Model offers a framework to strengthen practitioner insight, enhance cultural competence, and inform training and policy reform for multi-agency safeguarding.
Violence is a social determinant of health, and hospitals are well-positioned to promote patient well-being by addressing its root causes. Understanding factors associated with hospital engagement in community violence prevention can guide intervention development and capacity building. To examine hospital and county-level factors associated with the presence of community violence prevention programs (CVPPs) in U.S. hospitals. This cross-sectional study linked data from the 2022 American Hospital Association Annual Survey with county-level socioeconomic and demographic data from the US Census Bureau and all-cause homicide rates from the US Centers for Disease Control and Prevention. The sample included general medical and surgical hospitals with Medicare identification numbers. Survey-adjusted logistic regression assessed associations between hospital CVPP presence and all-cause homicide. Our response variable was whether or not the hospital had a CVPP, and our explanatory variable was county-level all-cause homicide rates. We adjusted for hospital characteristics and county-level socio-demographics. Of 4,374 hospitals, 990 (22.6%) reported having CVPPs. Compared to those without CVPPs, hospitals with CVPPs were more likely to be nonprofit (85.0% vs. 62.9%), large (> 500 beds; 16.9% vs. 4.7%), have more annual ED visits (51,873.9 vs. 26,224.5), and be urban (81.1% vs. 51.8%) (all p < 0.001). They also more frequently offered outpatient psychiatric (86.1% vs. 46.9%), substance use (74.4% vs. 23.2%), and pain management (93.1% vs. 65.2%) services. In adjusted models, homicide rates were not associated with CVPP presence (aOR = 1.01, 95% CI [0.99, 1.04]). CVPP presence was independently associated with nonprofit ownership, larger size, trauma designation, and lower social deprivation in urban counties. Hospital and community characteristics, rather than homicide rates, predict CVPP presence. CVPPs are concentrated in larger, urban, well-resourced hospitals rather than in areas with the highest homicide rates, highlighting potential misalignment between program placement and community need.
Planned complex suicides that combine multiple mechanisms pose substantial challenges for medicolegal reconstruction. We report a rare case of a 27-year-old man who simultaneously employed four methods: plastic-bag asphyxia with a continuous natural-gas supply (stove hose taped to bag tubing), environmental sealing of door seams with adhesive tape, rodenticide ingestion, and superficial incised injuries to the neck and wrist. Scene reconstruction, full autopsy, and comprehensive toxicology established asphyxia from natural-gas inhalation via the plastic-bag apparatus as the cause of death; anticoagulant rodenticides and superficial sharp-force injuries were contributory but not independently lethal. The high level of technical preparation supported classification as a planned complex suicide and underscores the need for integrated, multidisciplinary assessment to avoid misclassification as homicide and to weigh contributory mechanisms appropriately.
Drug intoxication deaths increasingly fall under medicolegal jurisdiction, yet national trends in death-certificate-recorded autopsy utilization for community intoxication deaths are not well characterized. Using CDC WONDER MCOD tabulations (2003-2023), we performed a retrospective cross-sectional analysis. Primary analyses were restricted to a community/emergency department (Community/ED) subset (home; dead on arrival; outpatient/ER; other; or unknown). The outcome was intoxication autopsy utilization among deaths with known autopsy status (Yes/[Yes+No]), modeled with Joinpoint regression. We also described Community/ED autopsy workload proxy and intoxication share, estimated a national historical-baseline gap in intoxication autopsies under a 2006-2011 baseline utilization rate, and compared state changes between 2018-2019 and 2022-2023. Total all-place intoxication deaths increased from 348,082 (2003-2012) to 411,446 (2020-2023). In the Community/ED subset, autopsy utilization declined from 84.74% (2003) to 69.78% (2023), with a joinpoint in 2018 and a steeper decline during 2018-2023 (annual percent change, -3.09%/year); the largest year-to-year decrease was 2019-2020 (-5.01 percentage points). The homicide autopsy benchmark (all places) remained 98.06%-98.82%. All-cause Community/ED autopsies increased from 128,494 (2003) to 216,842 (2023), and the intoxication deaths share rose from 12.56% to 30.15%. The historical-baseline gap reached 13,867 fewer intoxication autopsies than expected in 2023. From 2018-2019 to 2022-2023, age-adjusted intoxication mortality increased in 49 states while Community/ED autopsy utilization declined in 33. Death-certificate-recorded community intoxication autopsy utilization declined amid rising intoxication burden, with substantial state heterogeneity and widening historical-baseline gaps, highlighting implications for medicolegal capacity and death-certificate autopsy documentation.
To investigate the relationship between the legacy of slavery and contemporary racial disparities in homicide rates at the county level in the United States. Cross-sectional, multilevel, spatial dependence regression analysis. County-level crude homicide rates and racial homicide disparities during the period 2000-2020 were obtained for the overall, non-Hispanic Black, and non-Hispanic White populations. We explored the relationship between the percentage of enslaved persons in each county in 1860 and contemporary racial disparities in homicide using a multilevel, spatial dependence model. Controlling for a range of county- and state-level factors, counties in the South had a White homicide rate that was 16.3% higher than in the non-South, a Black homicide rate that was 21.3% lower, and a Black-White homicide rate ratio that was 32.4% lower. Higher White homicide rates and lower Black homicide rates in the South were only observed for firearm-related homicide. Within the South, the percentage of enslaved persons in 1860 was not associated with homicide rates in adjusted analyses. Even after controlling for a range of homicide-related factors, counties in the South had higher White firearm homicide rates, lower Black firearm homicide rates, and lower Black-White racial disparities in homicide. These results suggest that while the White population in the South gained socioeconomic advantage due to slavery, this came at the expense of increased levels of violence resulting in higher White homicide rates.
Territorial conflicts in animals can inform aspects of human warfare, but civil war, with its shifting group identities, has not been previously observed. We report a rare, permanent fission in the largest-known group of wild chimpanzees (Pan troglodytes). Using 30 years of behavioral observations and network analyses, we describe a transition from cohesion to polarization in 2015 and the emergence of two distinct groups by 2018. Over the next 7 years, members of one group made 24 attacks, killing at least seven mature males and 17 infants in the other group. These findings indicate that group identities can shift and escalate into lethal hostility in one of our closest living relatives in the absence of the cultural markers often thought necessary for human warfare.
Different disciplinary and socio-geographical approaches to counting, reporting, and categorizing death can yield divergent and often contradictory values of risk, harm, and mortality. This article examines historical and contemporary ways of recording and narrating the incidence of female homicide in South Africa (one of the countries with the highest femicide rates in the world), from state and police statistics to medical studies and media reports, and explores how each of these uses both common and discrete necrodata to construct specific narratives that reveal the [dead] body as a site of conflicting assertions of power.
Mothers and fathers kill their children at similar rates, making filicides (child murders by parents) unique among homicides. In this article, the authors focus on maternal mental illness, child maltreatment, and homicide. Nearly all neonaticides (murder in the first day of life) are committed by young women acting alone. Most filicides in the general population are due to fatal child maltreatment; however, among perpetrators who are found legally insane, altruistic motives predominate. Mental illness intersects with the phenomena of neonaticide and filicide. Personality disorders, untreated mental illness, poor attachment, and substance use disorders may elevate risk. Filicide and child maltreatment are relevant to psychiatrists because they may coexist with mental illnesses. Psychiatrists, both in reproductive psychiatry and general psychiatry, should carefully consider risks and resources for their patients who are parents.
Homicide is the third leading cause of death for US adolescents and the leading cause among Black youth. Youth violence also contributes to significant mental health burden and educational disruption, with the highest impact in neighborhoods with limited resources. Programs that address intersecting determinants, including social factors and limited economic opportunities, may reduce violence experiences and perpetration. This protocol paper describes a community-partnered, 2-arm cluster-randomized trial across 16 neighborhoods (12 in Pittsburgh, Pennsylvania, and 4 in the Washington, DC, region) evaluating the Forging Hopeful Futures (FHF) intervention, enrolling approximately 720 youth aged 13 to 19 years. FHF comprises 12 sessions delivered over 6 to 12 weeks by trusted community facilitators and addresses conflict resolution, peer and intimate partner relationships, youth leadership, and job readiness with connections to employment and mentorship. Comparison clusters receive enhanced usual care (individual wellness check-ins). Assessments occur at baseline, the end of the program, 3 months, and 6 months post-program. Primary outcomes are violence involvement (experience and perpetration); secondary outcomes include experiences of multiple types of violence (eg, relationship abuse, sexual violence, bullying, and weapon carrying). Implementation data are collected using RE-AIM (reach, effectiveness, adoption, implementation, and maintenance)-informed tools and qualitative interviews. The study was funded in October 2022, and recruitment began in July 2023. As of December 1, 2025, the study had enrolled 542 participants, with follow-up expected to continue through July 30, 2026. Data analysis for primary end points is expected on January 1, 2027. Primary analyses will estimate intervention effects on recent violence perpetration using generalized linear mixed models with random effects for neighborhood and participant, adjusting for baseline values and city. Exploratory analyses will examine mediation (eg, shifts in attitudes) and moderation (eg, baseline risk profiles). This trial is designed to provide rigorous effectiveness and implementation evidence to inform policy and practice in youth violence prevention. If demonstrated to be effective, FHF could serve as an integrated, scalable model that addresses the social and economic drivers of youth violence and leverages community partnerships for sustainability.
In this article, we explore survivor strategies for safety and the development of resilience in the context of domestic and intimate partner violence (D/IPV) experienced in rural Canada. Through the thematic analysis of 24 qualitative interviews, this paper identifies several ways that survivors sought safety on individual, relational, and community levels. Engaging a social ecological understanding of resilience, we highlight how the close-knit nature of rural cultures presents opportunities and challenges when seeking safety for survivors of D/IPV. The findings of this study inform broader academic and policy discourses on rural D/IPV as well as D/IPV service provision in rural communities by deepening an understanding of the unique strategies for safety of rural survivors and the role of informal support in their resilience as they navigate extreme forms of D/IPV in rural Canada. Dans cet article, nous examinons les stratégies mises en œuvre par les survivantes pour assurer leur sécurité et développer leur résilience dans le contexte de la violence domestique et conjugale (D/IPV) subie dans les zones rurales du Canada. À travers l'analyse thématique de 24 entretiens qualitatifs, cet article identifie plusieurs moyens par lesquels les survivantes ont cherché à se mettre en sécurité aux niveaux individuel, relationnel et communautaire. En nous appuyant sur une conception socio‐écologique de la résilience, nous mettons en évidence comment la nature très soudée des cultures rurales présente à la fois des opportunités et des défis pour la recherche de sécurité des survivantes de D/IPV. Les résultats de cette étude alimentent les discours académiques et politiques plus larges sur la D/IPV en milieu rural ainsi que sur la prestation de services liés à la D/IPV dans les communautés rurales, en approfondissant la compréhension des stratégies de sécurité propres aux survivantes rurales et du rôle du soutien informel dans leur résilience alors qu'elles font face à des formes extrêmes de D/IPV dans les régions rurales du Canada.
The Brazilian legislative debate on end-of-life practices involves ethical-axiological tensions related to euthanasia, assisted suicide, palliative care, and advance directives, in which divergent conceptions of these practices and of the value of life confront one another, influencing the normative formulation of the dying process. This study analyzes how such tensions are constructed and justified in the discourses of the Federal Legislative Branch, examining the normative meanings and the hierarchy of values attributed to the palliative care framework and to advance directives, as well as their ethical and moral implications. A qualitative documentary study was conducted, guided by a hermeneutic-dialectical approach and grounded in contemporary frameworks of the bioethics of responsibility and everyday bioethics. A total of 193 federal legislative documents (1981-2020) were examined. The analysis yielded two thematic categories: (1) the palliative care framework: meanings and attributions, which reveals the legislative tendency to limit the right to therapeutic refusal; and (2) instruments and mechanisms for the reversal of advance directives, which exposes restrictions on instruments intended to protect autonomy. The findings indicate the predominance of arguments grounded in vital values treated as absolute, to the detriment of personal values such as human dignity, autonomy, and self-determination, which may restrict the right to die with dignity in Brazil. El debate legislativo brasileño sobre prácticas de fin de vida involucra tensiones ético-axiológicas relacionadas con la eutanasia, el suicidio asistido, los cuidados paliativos y las directivas anticipadas de voluntad, en el que se confrontan concepciones divergentes de estas prácticas y el valor de la vida, influyendo en la formulación normativa del proceso de morir. Este estudio analiza cómo tales tensiones son construidas y justificadas en los discursos del Poder Legislativo Federal, comprendiendo los sentidos normativos y la jerarquía de valores atribuidos a los cuidados paliativos y a las directivas anticipadas de voluntad, así como sus implicaciones ético-morales. Se realizó una investigación documental cualitativa, orientada por la hermenéutica-dialéctica y fundamentada en referentes contemporáneos de la bioética de la responsabilidad y de la bioética cotidiana. Se examinaron 193 documentos legislativos federales (1981–2020). Del análisis emergieron dos categorías temáticas: 1) conjunto paliativo: sentidos y atribuciones, que evidencia la tendencia legislativa a limitar el derecho a la negativa terapéutica; y 2) instrumentos y mecanismos de acción para la inversión de las directivas anticipadas de voluntad, que revela la restricción de instrumentos destinados a la protección de la autonomía. Los resultados señalan la prevalencia de argumentos basados en valores vitales, tratados como absolutos, en detrimento de valores personales como la dignidad humana, la autonomía y la autodeterminación, lo que puede restringir el derecho a morir con dignidad en Brasil.
Firearms are a leading cause of violent injury and death. Most crime-related shootings and fatalities within the United States involve low-velocity, medium-caliber or large-caliber firearms, such as .380 Automatic Colt Pistol (ACP), 9 mm, 0.40 Smith & Wesson, or 0.45 ACP handguns, or high-velocity firearms, such as Assault Rifle-15 self-loading rifles. Low-velocity, small-caliber rounds, such as the ubiquitous 0.22 long-rifle cartridge, are occasionally encountered in crime-related shootings, but are less common than incidents involving center-fired cartridges. A lesser-known small-caliber cartridge is the 0.17 Hornady Magnum Rimfire (HMR). Like the 0.22 cartridge, the 0.17 cartridge is rim-fired, being contained in a casing that is of similar diameter as a normal 0.22; however, the neck of the casing is tapered down to contain the 0.17 diameter projectile. In contrast to the 0.22, the 0.17 HMR is considered a high-velocity round and is touted as an excellent choice for hunting small game and eliminating varmints. There is limited literature documenting deaths and wounds from these high-velocity, rim-fired, small-caliber bullets. Herein, we describe 2 homicide cases where 0.17 HMR caliber bullets were involved in lethal outcomes.
This study examines casefiles of children in England who were fatally stabbed between 2019 and 2024, focusing on their prior experiences of violence and adversity, aiming to identify missed opportunities for earlier intervention. We conducted a quantitative analysis using descriptive statistics and qualitative casefile analysis of 58 casefiles from the National Childhood Mortality Database, encompassing child fatalities by stabbing in England between 2019 and 2024, which had files available. Casefiles were examined for indicators of prior victimisation and perpetration. Patterns of polyvictimisation and polyperpetration were identified to understand concurrent and cumulative experiences of violence. Casefile analysis revealed that, prior to this point, a significant number (58%) of children had experienced childhood domestic violence and abuse and were seldom supported by specialist services. 59% had experienced a victim/perpetrator overlap. Casefile narratives indicated a range of barriers to effective support related to identification, assessment, and classification of early experiences of violence. Findings show that children are seldom treated as primary victims of childhood domestic violence and specialist support is often missed. Current intervention pathways fail to recognise the holistic, long-term, overlapping and cumulative experiences of violence in children's lives.
Firearm violence remains a public health crisis in the United States, disproportionately affecting racially marginalized and historically disinvested neighborhoods. The relationship between neighborhood-level disability prevalence and healthcare access with firearm violence risk remains poorly understood. This ecological, spatiotemporal analysis of 77 community areas in Chicago from 2011 to 2023 used Bayesian negative binomial models to estimate associations between community-level disability prevalence and healthcare underservice-defined as proportion of land designated as a Medically Underserved Area (MUA)-with annual rates of nonfatal firearm victimizations and firearm homicides. Stratified models by neighborhood racial/ethnic plurality were also explored. Analyses were conducted from April 2025 to March 2026. A 5-percentage point increase in disability prevalence was associated with a 10% higher rate of firearm victimization (95% credible interval [CrI], 2%-18%) and an 19% higher rate of firearm homicide (95% CrI, 8%-31%). A 5-percentage point increase in MUA coverage was associated with a 10% increase in firearm victimization (95% CrI, 6%-15%) and 9% increase in firearm homicide (95% CrI, 5%-13%). In stratified models, disability was most strongly associated with firearm violence in plurality non-Hispanic Black neighborhoods. Associations between MUA coverage and firearm violence were largest in plurality non-Hispanic white and Hispanic neighborhoods. Neighborhood-level disability and healthcare underservice are significantly associated with firearm violence in Chicago, with differences by racial/ethnic composition. Findings underscore the need to integrate disability and healthcare access into public health violence prevention frameworks.
Violence associated with schizophrenia is typically restricted to a small proportion of patients experiencing acute psychosis, impaired insight, or abrupt discontinuation of antipsychotic medication. Longitudinal forensic cases demonstrating recurrent severe violence across multiple decades are rarely documented. This report describes a 48-year-old man with chronic schizophrenia who committed two major violent acts-spousal homicide and attempted parricide-each following abrupt cessation of antipsychotic medication. Despite long-term legal supervision under Article 57 of the Turkish Penal Code and continuous follow-up via a Community Mental Health Center, medication nonadherence triggered rapid psychotic relapse and targeted interpersonal violence. This multi-decade trajectory offers rare insight into the chronic and fluctuating nature of violence risk in schizophrenia. The case highlights system-level challenges in community-based adherence monitoring and emphasizes the essential role of long-acting injectable antipsychotics, dynamic risk assessment, and structured relapse-prevention strategies in forensic psychiatric populations. It contributes new understanding to an underrepresented area of forensic science by identifying a predictable but underrecognized mechanism of recurrent violence, demonstrating that long-term remission does not eliminate risk among high-liability individuals.
The Surpass Elite (Stryker Neurovascular) is a third-generation flow diverter featuring modified braid architecture with increased braid angle and novel surface charge neutralization treatment. This study presents the first clinical experience with the Surpass Elite globally. A retrospective analysis of 81 consecutive cases (78 unique patients) treated with the Surpass Elite across four centers by two operators from January to July 2025 was performed. Data collected included patient demographics, aneurysm characteristics, procedural details, technical success, complications, and angiographic/clinical outcomes. Primary endpoints were technical success rate, perioperative safety profile, and aneurysm occlusion rates at approximately 6-month follow-up. The cohort comprised 78 unique patients (76.9% female, mean age 59.2 ± 14.5 years) with 81 aneurysms treated using 112 total devices (mean 1.38 devices per case). Aneurysms were predominantly located in the internal carotid artery (75.3%). Technical success was achieved in 100% of cases regardless of access site. Balloon angioplasty was required in only 13.6% of cases. Among 61 aneurysms with complete angiographic follow-up at a mean of 6 months, complete occlusion (RROC Class I or OKM Grade D) was achieved in 78.7%. In-stent stenosis (< 50%) was observed in only 3.3% of cases with follow-up imaging, suggesting favorable vessel remodeling with minimal intimal hyperplasia. The immediate intraprocedural complication rate was 2.5% (2/81), including one device-related microperforation (complete recovery) and one intraoperative thrombosis (managed successfully intraprocedurally; delayed stroke from subsequent medication noncompliance). Delayed complications within 30 days included one stroke from antiplatelet noncompliance (fatal) and one access-site hematoma (recovered). One delayed adverse event beyond 30 days (delayed right temporal intraparenchymal hemorrhage at 10 months) was observed in a patient on dual antiplatelet therapy plus apixaban and was attributed to cerebral amyloid angiopathy; this event was not considered device- or procedure-related. Overall mortality was 7.4% (6/81): one death (1.2%) was procedure-related (stroke from medication noncompliance), one death occurred within 30 days from post-SAH vasospasm in a ruptured aneurysm case, and four deaths occurred after 30 days (recurrent ICH at 3 weeks, acute respiratory failure with acute on chronic heart failure at 5 months, homicide at approximately 6 months, and one of unknown cause), none of which were device- or procedure-related. This first published clinical experience with Surpass Elite flow diverter demonstrates reliable technical deliverability, favorable early occlusion rates comparable to established flow diverters, and a satisfactory safety profile. The low rates of required balloon angioplasty support the clinical benefit of the modified braid architecture. These preliminary findings support the continued clinical evaluation of the Surpass Elite in larger prospective cohorts.
Background: Siblings bereaved by homicide or accidents are often referred to as the forgotten bereaved because they face difficulties in accessing adequate support. Globally, research focusing directly on siblings' perspectives remains scarce, and studies specifically addressing siblings' resilience are almost absent in Japan. A deeper understanding of siblings' experiences is required to develop support systems that acknowledge their emotions and strengthen their resilience.Objective: This study aimed to clarify the psychological transformation processes of bereaved siblings in Japan, focusing on interactions between individual and environmental factors of resilience.Method: Semi-structured interviews were conducted with 10 siblings who had lost their brother or sister to homicide or accidents. The data were analysed using a modified grounded theory approach that emphasizes context and social interaction in qualitative research.Results: The analysis generated six categories. The siblings experienced the process of grieving and adapting simultaneously during their adjustment. They engaged in practical coping strategies while struggling with the latent conflicts in their families and social relationships. Importantly, positive interactions from others, such as friends of the deceased greeting them at the family altar or spending time together as before, helped the siblings to construct continuing bonds and supported their resilience.Conclusion: These findings highlight distinctive features of grief and adaptation among Japanese siblings. By highlighting siblings' perspectives, this study underscores the importance of culturally sensitive community-based support that validates hidden grief and promotes resilience. This study explored resilience in siblings bereaved by homicide and traffic accidents in Japan.Siblings grieved and adapted simultaneously, influenced by individual and environmental resilience factors.Deceased siblings’ friends recognizing the deceased helped surviving siblings to foster resilience through a continuing bond with their deceased sibling. Antecedentes: Los hermanos que han perdido a un ser querido por homicidio o accidentes suelen ser considerados con frecuencia los dolientes olvidados porque enfrentan dificultades para acceder al apoyo adecuado. A nivel mundial, la investigación que se focaliza directamente en las perspectivas de los hermanos sigue siendo escasa y los estudios que abordan específicamente la resiliencia de los hermanos son casi nulos en Japón. Se requiere una comprensión mas profunda de las experiencias de los hermanos para desarrollar sistemas de apoyo que reconozcan sus emociones y fortalezcan su resiliencia. Objetivo: Este estudio tuvo como objetivo esclarecer el proceso de transformación psicológica de los hermanos en duelo en Japón, centrándose en las interacciones entre factores individuales y ambientales de resiliencia. Método: Se condujeron entrevistas semiestructuradas con diez hermanos que habían perdido a su hermano o hermana por homicidio o accidente. Los datos se analizaron utilizando un enfoque de la teoría fundamentada modificado que enfatiza el contexto y la interacción social en la investigación cualitativa. Resultados: El análisis genero seis categorías. Los hermanos experimentaron simultáneamente el proceso de duelo y adaptación durante su proceso de ajuste. Ellos emplearon estrategias prácticas de afrontamiento mientras lidiaban con los conflictos latentes en sus familias y relaciones sociales. Es importante destacar, que las interacciones positivas de otras personas, tales como el saludo de los amigos del difunto en el altar familiar o el tiempo que pasaban juntos como antes, ayudaron a los hermanos a construir lazos continuos y apoyaron su resiliencia. Conclusión: Estos hallazgos resaltan las características distintivas del duelo y adaptación entre los hermanos japoneses. Al destacar las perspectivas de los hermanos, este estudio subraya la importancia del apoyo basado en la comunidad culturalmente sensible que valida el duelo oculto y promueve la resiliencia.