Improving the quality of care for people detained in police custody requires careful measurement and monitoring. However, a standardized and endorsed set of quality indicators for healthcare in police custody settings is lacking. This study aimed to develop a core set of quality indicators to monitor and evaluate police custody healthcare in the Netherlands. A four-phase modified Delphi process was conducted between February 2024 and September 2025: (1) identification of candidate quality indicators ethrough expert brainstorming; (2) rating of indicators on relevance and measurability in a self-administered questionnaire; (3) an in-person group consultation meeting to refine and prioritize the indicators; and (4) content validation of the core set by an advisory committee. A multidisciplinary pool of professionals from healthcare, police, justice, and adjacent sectors participated throughout. Brainstorming sessions with 14 experts yielded 185 candidate indicators, which were rated by 19 experts in the questionnaire. The group consultation meeting with 15 participants refined the list, and feedback from 8 advisory committee members informed the final selection. The resulting core set comprised 15 structure, 9-12 process (7 fixed and 2-5 variable), and 17 outcome indicators, covering all key domains of police custody healthcare quality. The first evidence-based set of indicators provides a foundation for the systematic assessment and continuous learning in police custody healthcare. Routine healthcare data may serve as a valuable measurement source, though their usefulness depends on data quality, accessibility, and system readiness.
To reduce injury burden among police recruits we must identify who is responsible for implementing prevention strategies. Using a novel methodology, we aimed to examine the perspectives of police force recruits and staff to determine who they perceived to be responsible to implement important injury prevention strategies. We performed a cross-sectional study co-designed by our broader consumer, industry and research advisory groups. Five data collection sessions were conducted, involving a total of nine separate groups; analyses were performed by group rather than at the individual level. Groups were clustered by organisational role: management (n=2 groups), training delivery (n=3 groups) and recruits (n=4 groups). Participants allocated 57 previously identified important injury prevention strategies to the group(s) ((1) recruits, (2) training delivery, (3) management) responsible for implementing each strategy. Participants identified almost three-quarters of prevention strategies required shared responsibility among recruits, training delivery staff and/or management. No strategies were considered the sole responsibility of recruits. Our research demonstrated that while recruits must take ownership and responsibility for some aspects of their training no prevention priority areas are the sole responsibility of recruits. Thus, recruit injury prevention must be implemented by recruits, training delivery staff and management.
Royal Canadian Mounted Police (RCMP) frequently encounter potentially psychologically traumatic events (PPTEs) which include direct (e.g., happened to me) or indirect (e.g., part of my job) exposure to actual or threatened death, serious injury, or sexual violence, and subsequently demonstrate an increased risk of developing posttraumatic stress injuries (PTSIs). Although PTSIs include mental health disorders, physical impairments such as the development of chronic pain and cardiovascular conditions are also implicated. The current study was designed to assess for changes in cardiac function among RCMP within their first three years of field service. Participants (n=96) were mostly male (71.6%), men (71.6%), White (85.6%), with a mean age of 30.22±6.22 years. The current results evidenced deteriorations in cardiac function; diastolic cardiac function began to deteriorate as early as the second year of field service, with changes in systolic function occurring concurrently, or within the following year, suggesting that deteriorating cardiac function may constitute a PTSI. Incorporating bestpractice cardiac rehabilitation exercise prescription guidelines tailored to the maintenance or improvement of diastolic function into existing occupational health and wellness programs may support a mechanistic role in reducing the risk of major adverse cardiac events among RCMP officers and other high-risk occupational populations.
Cytotoxic chemotherapy is intended to eliminate transformed cells but can also provoke therapy-induced senescence, a persistent and pro-inflammatory cell state that can promote tumor progression. The molecular mechanisms that govern the apoptosis-senescence fate decision remain incompletely understood. Here, we show that the mitochondrial pore-forming proteins BAX and BAK function as a critical checkpoint that restricts entry to therapy-induced senescence. Genetic ablation of BAX and BAK markedly enhanced entry to senescence in response to multiple DNA-damaging agents, whereas loss of the BAX/BAK antagonists Bcl-xL or Mcl-1 suppressed entry to senescence and promoted cell death. Mechanistically, genotoxic stress induced BH3-only proteins, including Noxa, Bid, and Puma, creating a dependence on Bcl-xL and Mcl-1 to restrain BAX/BAK activation and maintain survival. These findings identify the Bcl-2 family network as a central regulator of entry to therapy-induced senescence, a pro-inflammatory cell state that goes beyond the mere avoidance of apoptosis.
Electric tricycles are widely used for short-distance passenger and freight transport in China, particularly in urban-fringe and rural areas. Their rapid growth has raised safety concerns because these vehicles provide limited occupant protection and frequently operate in mixed-traffic environments. This study examined age-related heterogeneity in injury severity among electric tricycle drivers and identified factors associated with severe/fatal injury outcomes across different age groups. Police-reported electric tricycle crashes from 2020 to 2024 were analyzed. After data screening, 1,425 crashes were retained. Drivers were classified into three age groups: under 45 years, 45-59 years, and 60 years and above. Injury severity was categorized into three levels: property-damage-only, slight injury, and severe/fatal injury. Age-stratified random-parameters logit models were estimated to account for unobserved heterogeneity, and marginal effects were calculated to compare injury-severity patterns across age groups. In addition, a pooled model with age-by-risk-factor interaction terms and COVID-19 period sensitivity analyses were conducted to further examine age-related differences and the temporal robustness of the findings. The results showed clear age-related heterogeneity in injury-severity determinants among electric tricycle drivers. Drivers aged 60 years and above accounted for the largest share of crashes and showed a more pronounced severe/fatal injury pattern than younger and middle-aged drivers. Among older drivers, helmet nonuse, unlicensed driving, pedestrian or rollover crashes, rear-end collisions, turning maneuvers, and signal-controlled intersections were more strongly associated with severe/fatal injury. By contrast, severe/fatal injury among drivers under 45 years was more closely associated with nighttime conditions and specific time-of-day factors, while injury severity among drivers aged 45-59 years was mainly related to selected maneuver and crash-configuration factors. The pooled interaction model further showed that, compared with younger unlicensed drivers, older unlicensed drivers had higher severe/fatal injury probabilities. Middle-aged and older drivers also showed higher severe/fatal injury probabilities in no-responsibility crashes. COVID-19 period analyses indicated that the main age-related findings were generally stable. Older electric tricycle drivers bear a disproportionate burden of fatal and serious injury in police-reported crashes. Prevention strategies should therefore prioritize older adults through improved helmet use, strengthened licensing and safety management, age-friendly roadway and intersection design, and safer operating environments for electric tricycles. At the same time, interventions should also reflect the distinct risk profiles of younger and middle-aged drivers. Age-stratified safety policies may be more effective than one-size-fits-all approaches in reducing injury severity among electric tricycle users.
Conservation communication often uses the celebrity endorsement strategy. However, robust evidence regarding its effectiveness is still limited. More importantly, practitioners do not have guidelines for selecting an ideal endorser because there is no clear consensus on what endorser attributes are most critical. We explored these issues by examining advocacy for the ivory trade ban in China through the use of two public service announcements (PSAs). The contents of the two PSAs were similar, except that one was endorsed by a sports celebrity (Yao Ming) and the other by a noncelebrity (a police officer). Based on a real-world, randomized, controlled trial intervention experiment (N = 550), we found that although the celebrity was rated as more attractive, the PSAs did not differ significantly in perceived attractiveness. The police officer produced a statistically significant but small improvement in attitude toward the ban (Cliff's delta = -0.11), with no significant differences in behavioral intentions, indicating limited practical superiority. According to the structural equation model (SEM), endorser attractiveness was positively associated with PSA attractiveness, which in turn was associated with communication behavioral intention, whereas endorser credibility was more strongly associated with conservation behavioral intention. These findings suggested that the selection of endorsers should be contextualized. In particular, if the aim is to promote widespread communication, then celebrities may be the recommended endorsers, as they have the potential to attract people's attention. If the aim is to promote attitude or behavioral change, then endorsers with high credibility levels may be more appropriate. Future studies should conduct empirical research on multiple types of celebrities and explore how endorser attributes interact with different message framings and various conservation contexts to better inform strategic communication efforts. Influencia de los atributos de los patrocinadores en la comunicación sobre la conservación Resumen La comunicación sobre conservación suele recurrir a la estrategia del patrocinio de celebridades. Sin embargo, aún hay pocas pruebas sólidas sobre su eficacia. Y lo que es más importante, los profesionales no disponen de directrices para seleccionar al patrocinador ideal, ya que no existe un consenso claro sobre qué atributos de los promotores son los más importantes. Hemos analizado estas cuestiones estudiando la campaña a favor de la prohibición del comercio de marfil en China mediante el uso de dos anuncios de servicio público (ASP). El contenido de los dos anuncios de servicio público era similar, salvo que uno contaba con el respaldo de una celebridad del mundo del deporte (Yao Ming) y el otro, de una persona no famosa (un agente de policía). A partir de un experimento de intervención en el mundo real, aleatorio y controlado (N = 550), observamos que, aunque la celebridad fue valorada como más atractiva, los anuncios de servicio público no presentaban diferencias significativas en cuanto al atractivo percibido. El agente de policía generó una mejora estadísticamente significativa, aunque pequeña, en la actitud hacia la prohibición (delta de Cliff = ‐0.11), sin diferencias significativas en las intenciones de comportamiento, lo que indica una superioridad práctica limitada. Según el modelo de ecuaciones estructurales (MEE), el atractivo del patrocinador se asoció positivamente con el atractivo del anuncio de servicio público, que a su vez se asoció con la intención de comportamiento comunicativo, mientras que la credibilidad del patrocinador se asoció más fuertemente con la intención de comportamiento conservacionista. Estos resultados sugieren que la selección de los patrocinadores debe contextualizarse. En concreto, si el objetivo es promover una comunicación generalizada, las celebridades podrían ser los patrocinadores recomendados, ya que tienen el potencial de atraer la atención de la gente. Si el objetivo es promover un cambio de actitud o de comportamiento, los patrocinadores con altos niveles de credibilidad podrían ser más adecuados. Los estudios futuros deberían llevar a cabo investigaciones empíricas sobre múltiples tipos de celebridades y explorar cómo los atributos de los patrocinadores interactúan con diferentes marcos de mensaje y diversos contextos de conservación para orientar mejor los esfuerzos de comunicación estratégica. 代言人特性如何影响保护传播效果 名人代言在保护传播中应用广泛, 但关于其有效性的有力证据仍然有限。更重要的是, 传播实践者缺乏如何选择理想代言人的明确指导, 因为目前尚不清楚代言人的特性如何影响传播效果。为此, 本研究以两则宣传中国象牙贸易禁令的公益广告为例, 探讨上述问题。这两则广告内容高度相似, 唯一区别在于一则由体育名人(姚明)代言, 另一则由非名人(警察)代言。 基于一项随机对照试验(N = 550), 研究发现, 尽管名人更具吸引力, 但不同代言人类型所代言广告的吸引力并无显著差异。与名人代言的广告相比, 观看警察代言广告的受访者对象牙贸易禁令的态度显著更为积极, 但差异幅度较小(Cliff's delta = −0.11), 且在行为意愿上未表现出显著差异, 表明代言人警察具有一定但有限的有效性。结构方程模型的结果显示, 代言人的吸引力与广告吸引力呈正相关, 而广告吸引力又与积极的传播行为意愿相关;与此同时, 代言人的可信度与保护行为意愿之间的关联更为紧密。 因此, 代言人的选择应根据具体情境而定。具体而言, 若目标是促进广泛传播, 名人因其具备吸引公众注意力的潜力, 是较为合适的代言人;若目标是促进态度或行为转变, 则具有较高可信度的代言人更为适宜。未来研究应涵盖更多类型的名人, 并探讨代言人属性如何与不同的信息框架及各类保护情境相互作用, 从而为战略传播实践提供指导。.
Lighting conditions are a critical factor influencing crash risk and injury outcomes for large truck drivers, particularly in lane departure crashes. This study examines how reported lighting conditions influence driver injury severity in single-vehicle lane departure crashes involving large trucks. Specifically, it evaluates whether the effects of key contributing factors remain stable across daylight and dark conditions or vary systematically. Police-reported crash data from Washington State (2018-2022) were analyzed. A mixed logit model with heterogeneity in means and variances was estimated to account for unobserved heterogeneity. A partially constrained modeling approach was applied to evaluate whether the effects of contributing factors differ between daylight and dark conditions. Likelihood ratio tests were conducted to assess parameter transferability across lighting environments. An out-of-sample prediction analysis was also performed to examine aggregate predictive implications. Likelihood ratio tests indicated statistically significant differences in injury severity determinants across lighting conditions. Only three variables such as driver age (56-65 years), overturn, and guardrail face impacts, exhibited consistent effects across both conditions. Several factors, including seatbelt use, speeding, fatigue-related driving, and alcohol impairment, showed varying effects. Speeding was associated with a higher likelihood of minor injury during daylight but with an increased likelihood of severe injury under dark conditions. Out-of-sample prediction indicated only small differences in predicted injury-severity probabilities when daylight-condition parameters were applied to dark-condition crashes, with Krinsky-Robb uncertainty intervals including zero for all outcomes. The results indicate that reported lighting conditions are associated with different factor-severity relationships in large-truck lane-departure crashes and that selected parameter estimates are not fully transferable across lighting environments. Safety strategies for large-truck lane departure crashes should consider lighting-condition-specific associations while recognizing the observational nature of the crash data.
Road traffic crashes cause substantial global mortality and disability. Conventional injury severity scores may not fully capture the complex interactions among demographic, clinical, crash and environmental factors. Artificial intelligence and machine learning may improve mortality prediction by modelling non-linear patterns in traffic crash data. This systematic review followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidance. PubMed/MEDLINE, Web of Science, Scopus and IEEE Xplore were searched on 7 August 2025 for English-language peer-reviewed studies published from 2014 to 2025 that applied artificial intelligence or machine learning to predict mortality after road traffic crashes. Two reviewers screened records and extracted data on study characteristics, data sources, algorithms, predictors, validation, imbalance handling and performance. Methodological quality was assessed using the Qiao quality assessment tool. Because of substantial heterogeneity, findings were synthesised narratively. 18 studies met the inclusion criteria. Most were retrospective studies using structured tabular data. Common objectives were binary mortality prediction, multiclass injury severity prediction including death and death risk assessment. National or regional databases were the most frequent data sources, followed by hospital records and police or insurance datasets. Regression-based models and decision trees remained common, while ensemble methods including random forest and gradient boosting increased in recent years. Frequently reported predictors included age, Injury Severity Scores, body region injured, crash mechanism, temporal factors and geographical characteristics. Only two studies reported external validation. Artificial intelligence and machine learning show promise for traffic crash mortality prediction, but clinical translation remains limited by insufficient external validation, inconsistent handling of class imbalance, incomplete reporting of tuning and missing data strategies and limited use of explainability methods. Future work should prioritise prospective, externally validated, interpretable models developed using standardised reporting frameworks.
Youth suicide and depression rates increased during the COVID-19 pandemic. In Philadelphia, firearm violence surged and has since declined to pre-pandemic levels. We examined whether youth depression and suicide risk also declined and whether community firearm violence moderated these trajectories, given its documented associations with trauma and stress in youth. This cross-sectional study examined 71 663 well visits among youth aged 12 to 18 years in a pediatric primary care network in Philadelphia, 2017 to 2024. Youth were screened for depression and suicidality using the Patient Health Questionnaire, modified for teens. Three pandemic eras were defined by stay-at-home orders and the World Health Organization's declaration ending the global emergency. Neighborhoods were classified as firearm violence hot, neutral, and cold spots based on cumulative police-reported shootings. Period differences in mental health outcomes were evaluated using models accounting for patient clustering and interaction terms testing moderation by community violence. Among 35 137 patients (50% female, 67% non-Hispanic Black), community firearm violence moderated changes in youth suicide risk from the pre- to post-pandemic period: risk declined in cold spots (-2.2 percentage points [pp] [95 % CI -3.9 to -0.4]) but increased in neutral (+0.9 pp [0.1-1.6]) and hot spots (+2.0 pp [0.3-3.7]). Overall, suicide risk remained elevated post-pandemic (10.8% vs 9.6%, +1.1 pp [1.1-1.2]), particularly among non-Hispanic Black and Medicaid-insured youth, whereas depression returned to pre-pandemic levels (7.6% vs 7.3%). After the pandemic, suicide risk remained elevated among youth in areas with high community firearm violence. Beyond universal screening, addressing persistent pandemic-related stressors within the context of community firearm violence is critical for improving youth mental health.
In Malaysia, pervasive institutional discrimination harms lesbian, gay, bisexual, transgender and queer (LGBTQ+) people and complicates how they may build and sustain trust with different public institutions. Employing a mixed-methods approach, this study examined the prevalence of institutional (dis)trust among a sample (n = 647) of LGBTQ+ adults in Malaysia, and the factors that influenced their institutional (dis)trust. Using descriptive analyses and generalised linear regression to explore demographic differences in the prevalence of institutional (dis)trust across police, political, law, and media institutions, we found that cisgender women, trans men, and non-binary participants (compared to cisgender men), as well as Malay and Indian participants (compared to Chinese), reported higher distrust towards different public institutions. Participants' open-ended responses (n = 228) were analysed using reflexive thematic analysis to identify three interrelated themes that described the factors influencing LGBTQ+ people's institutional (dis)trust: 1) being the target of scapegoating, 2) fear of dehumanisation, and 3) waning hope for the future. The findings highlight the need to strategically address institutional discrimination towards LGBTQ+ people in Malaysia, as a means for bolstering their institutional trust and improving their long-term health and well-being.
This study examines 20-year trends in child sexual abuse (CSA) investigations within Canada's child welfare system, using data from the Canadian Incidence Study of Reported Child Abuse and Neglect (CIS) between 1998 and 2019. Data in the current study represent all Canadian provinces/territories except for Quebec. Findings indicate a substantial decline in both investigated and substantiated CSA cases, particularly among children aged 0-7 and cases involving non-parental perpetrators. Substantiated investigations among the youngest children fell by more than 80%, highlighting a marked shift in the age profile of cases coming to the attention of authorities. The overall reduction in CSA investigations may reflect genuine decreases in abuse for certain subgroups, but may also signal changing thresholds for reporting, professional hesitancy, and structural constraints within child welfare and law enforcement agencies. Notably, fewer substantiated cases in 2019 involved police intervention or ongoing services compared with 1998, raising concerns about unmet needs, diminished access to justice, and potential erosion of public confidence.
To characterise the associations of heat and bushfire smoke with health services utilisation and medication use at a national scale to support Australia's first National Climate Risk Assessment. Cross-sectional, population study, covering health conditions with the highest burden of disease. People in Australia accessing public health services between 2014 and 2020 for care related to cardiovascular, respiratory and mental health conditions. Relative risks of heat and bushfire smoke (particulate matter ≤ 2.5 μm in diameter [PM2.5]) on health system utilisation and medication use, measured as emergency department (ED) presentations, hospital inpatient admissions, Medicare Benefits Schedule service claims in primary care and Pharmaceutical Benefits Scheme prescriptions dispensed. Relative risks (RRs) and 95% confidence intervals were estimated for short-term lags between exposure periods and health system usage. Heat was most strongly associated with ED presentations, with a RR of 1.033 (95% CI, 1.023-1.043; p < 0.001) per degree temperature change for respiratory conditions and 1.023 (95% CI, 1.016-1.031; p < 0.001) for mental health conditions. PM2.5 at a 1-day lag had the highest association with hospital admissions, with a RR of 1.014 per 1 μg/m3 change in particulate density for both cardiovascular (p = 0.001) and respiratory (p = 0.002) conditions. Primary care visits for mental health conditions were strongly associated with levels of PM2.5 (RR, 1.049 [95% CI, 1.040-1.058]; p < 0.001) and with temperature (RR, 1.027 [95% CI, 1.014-1.039]; p < 0.001), while medication use increased across respiratory, cardiovascular and mental health categories in response to both exposures, with particulate matter showing stronger effects for cardiovascular, respiratory and mental health prescriptions. Mental health outcomes consistently showed vulnerability across all domains. Heat was strongly associated with acute ED presentations, while particulate matter was strongly associated with hospital admissions and medication use. Mental health services are broadly sensitive to both exposures. These findings emphasise the need for integrated air quality management and heat-health polices to reduce system-wide health burdens. The Known: Heat and air pollution are major environmental health risks. The New: To our knowledge, this is the first study to examine national‐scale associations of heat and bushfire smoke with health system utilisation and medication use. It utilised national data repositories from Australian Government initiatives to support evidence‐based climate change policy. To our knowledge, this is the first time that the Australian Institute of Health and Welfare bushfire dataset has been used to estimate nationally focussed relative risks consistent with published recommendations. The Implications: The findings underscore the urgent need for targeted public health interventions to reduce environmental exposures. Further research should explore the combined effects of multiple risk factor exposure and pollutant interactions.
The incidence of anterior knee pain (AKP) in female military personnel is twice that of their male counterparts. However, whether AKP affects functional outcomes differently in females remains unclear. The objective of this study was to identify differences in AKP-associated functional outcomes between male and female combatants. This was a cross-sectional secondary analysis by biological sex (male/female) of active combat soldiers of the Israel Defense Forces and Israel Border Police personnel with AKP due to overuse, using screening data originally collected for a registered interventional study. Outcome measures included Kujala AKP scores by functional domain, anatomical mapping of pain location (by tenderness on palpation) and pain level measured using a Visual Analogue Scale (VAS). The cohort comprised 27 females, 45 males and 112 knees. Females were younger (20.1 ± 1.3 vs 22.9 ± 6.3 years, p< 0.001), had lower body mass index (23.0 ± 3.2 vs 24.6 ± 3.2 kg/m², p=0.006) and reported less premilitary physical activity (67% vs 89%, p=0.021). In female combatants, tenderness on palpation was more frequent over the patellar ligament (PL) versus the patella (P) itself (PL vs P: females, 59% vs 32%, p=0.016; males, 51% vs 48%, p=0.74). Females reported significantly higher pain levels than males (VAS: 54±23 vs 45±23 mm on scale, p=0.046) and significantly lower overall functionality and symptoms (Kujala: 67±12 vs 73±11, p=0.030). The frequencies of affected performance from AKP were significantly greater in females for running and ascending/descending stairs (running: 30% vs 9%, p=0.022 and stairs: 82% vs 56%, p=0.025, respectively). Female combatants suffer more from AKP, report higher pain levels and have greater functional disability compared with their male counterparts. This study points to the important need for a sex-specific approach for evaluation of AKP-related functional disabilities in order to optimise treatment protocols and reduce the time to return to active service or performance in physically demanding settings. NCT02845869.
This study aimed to describe the phenomenon of losing human life by suicide, based on the lived experiences of suicide survivors and professionals. Phenomenological participatory action research was conducted, comprising 50 group sessions with 51 participants including suicide survivors, registered nurses, response police officers, and general practitioners. The essence of losing human life through suicide is characterized by profound emotional vulnerability when confronted with an existential tragedy. This means a powerlessness and an abrupt shift in existence, awakening the instinct to escape and the responsibility to act. Being the messenger of death is a heavy burden, and a sense of abandonment arises when survivors are left alone. Simply being together as human beings awakens a sense of vulnerability and a strong impulse to uphold human dignity. These findings underscore that everyone involved is vulnerable to existential challenges following suicide and provide insight into the fragility of humanity. Professionals need awareness of their own vulnerability and moral courage to encounter survivors as fellow human beings. Support for survivors should acknowledge that grief and existential suffering do not follow fixed timelines. The methodological combination of phenomenology and participatory action research proved fruitful, generating rich insights and offering a promising approach for future studies.
The growing emergence of new psychoactive substances (NPS) challenges traditional approaches to drug monitoring, highlighting a need for innovative surveillance strategies. We explored the potential to better understand the NPS market in Australia by combining wastewater analysis with toxicosurveillance programs. Focussing on a time of year of likely higher NPS and drug use, influent wastewater samples were collected from four Australian states (South Australia, Victoria, Queensland and New South Wales) over the New Year period from 2019-20 to 2024-25. Clinical samples presenting between 15 December and 15 January each period from the toxicosurveillance systems Emerging Drugs Network of Australia (including Western Australia, South Australia and Queensland), Emerging Drugs Network of Australia Victoria (Victoria) and Prescription, Recreational and Illicit Substance Evaluation - PRISE (New South Wales) were extracted. In total, 294 wastewater and 117 clinical samples were included in this work. A total of 47 individual NPS were found in both datasets. This included: 21 only in wastewater, 37 only in clinical, and 12 in both. Overall, 743 instances of NPS were found in all wastewater samples and 172 in clinical data. In wastewater samples, N,N-dimethylpentylone (54%), mitragynine (52%) and bromazolam (45%) were the most frequently detected. In the clinical samples, the most common were bromazolam (44%) and clonazolam (21%). Overall, synthetic cathinones and plant-based compounds were more prevalent in wastewater, and synthetic opioids and benzodiazepines in clinical samples. Differences in detected NPS classes illustrate the complementary nature of these surveillance systems. Higher wastewater concentrations may indicate broader use and lower acute harm than drugs identified clinically. Integrating these datasets with additional sources such as surveys, coronial records, police seizures, and drug-checking services can strengthen NPS monitoring.
Illicit psychostimulant use during pregnancy represents a major public health issue due to its detrimental effects on offspring neurodevelopment. Prenatal exposure to smokable cocaine derivatives such as crack cocaine and coca paste (CP) is particularly concerning, as it has been associated with an increased risk of impairments in learning, memory, and social behavior from birth through early childhood. CP's low cost, wide availability, high toxicity, and strong addictive potential heighten its danger. While CP use during pregnancy is well documented, its specific neurodevelopmental consequences remain poorly understood compared to those of crack. Here, we used a rat model to examine the effects of chronic prenatal exposure to a street-grade CP sample obtained from police seizures on hippocampal neuronal morphogenesis, synaptogenesis, and function, as well as hippocampus-dependent recognition memory. Primary hippocampal neurons from neonates prenatally exposed to CP once daily from gestational day (GD) 8 until GD21 showed reduced neuronal survival, impaired neurite outgrowth, and decreased dendritic complexity, together with reduced synaptic vGlut1 abundance. These structural alterations were accompanied by significant deficits in recognition memory in the novel object recognition task in juvenile offspring. Our findings suggest that prenatal CP exposure disrupts hippocampal development and function, leading to cognitive deficits. This study supports the severe neurodevelopmental risks associated with prenatal CP exposure and underscores the importance of preventive strategies addressing drug use during pregnancy.
This study presents a comparative evaluation of conventional traffic accident black spot analyses based on historical crash records and driving simulator-based black spot analyses within a proactive road safety framework. The primary objective is to investigate whether driving simulator data can identify hazardous road segments beyond those detected through conventional crash-based approaches. In the first stage, traffic accident black spots were identified using Kernel Density Estimation (KDE) based on official police-reported fatal and injury crash records from the 2017-2020 period; property-damage-only crashes were excluded from the analysis. In the second stage, the examined road segment was replicated in a high-fidelity driving simulator environment, and controlled experimental driving sessions were conducted with licensed drivers. Driver behavior and vehicle control performance were assessed through critical risk events observed during the simulations, including run-off-road events, collisions with roadside safety elements, severe loss-of-control situations, and crash events preventing route completion. The spatial locations of these simulator-derived events were recorded and analyzed using KDE to identify clustered risk sections along the road. The results demonstrated strong spatial consistency between several simulator-based risk locations and conventionally identified accident black spots. In addition, the simulator analyses revealed several hazardous road segments that were not identified through official crash records. These locations were associated with vehicle instability, control difficulties, and increased run-off-road tendencies, indicating the presence of latent safety risks before their manifestation in conventional accident statistics. The findings indicate that driving simulator-based black spot analyses complement and extend traditional crash-based approaches by enabling the early detection of potentially hazardous road segments. The proposed methodology offers a driver-oriented, proactive, and preventive framework that can support road safety planning, risk assessment, and infrastructure improvement studies.
Veterans and first responders like firefighters, police officers, paramedics, and military personnel face higher rates of mental health issues and suicide compared to the general population. Implementing and evaluating mental health projects for Veterans and first responders is crucial for enhancing their ability to serve society effectively. Economic evidence is increasingly used to improve the effectiveness and accountability of health and social programs. However, current methods are insufficient for comparing resource efficiency and value for money across different sectors and countries. This study introduces a novel methodology to accommodate heterogeneity across multiple projects within a grant program, enable standardization, and facilitate comparison in real-world implementation research. The choice of perspective in economic evaluation depends on context, stakeholder viewpoints, resource availability, and intended use. We used a flexible approach, combining various methods to standardize resource utilization, valuation, and outcome assessment. This allowed us to estimate an overall return on investment at the program level by pooling diverse projects together. We evaluated costs from the funder's perspective, using general population valuation for healthcare interventions. We estimated overall and individual project Return on Investment ratios for the funder's investment in the Mental Health Program, considering both total and in-kind costs. Results show that for every $1 invested in the Veterans and first responders Mental Health Program, the program returns $1.14 in overall health value, slightly exceeding the financial resources invested. Standard economic evaluation methodologies do not accommodate real-world complexities and the heterogeneity across projects inherent in grant programs. Yet the development of pragmatic economic methods to assess value and return on investment of grant programs is essential given current funding pressures. Our study demonstrates the feasibility of addressing economic evaluations across heterogenous, international projects. Although not strictly adhering to established methods, our pragmatic approach focuses on funder return on investment. This methodology provides a pathway for economic analysis of grant programs.
Mass-fatality incidents involving severe thermal injury pose major challenges for disaster victim identification, particularly when access to the oral cavity is limited and conventional dental radiography cannot be performed. This study reports the first large-scale, real-world deployment of a portable cone-beam computed tomography (CBCT) system during the forensic identification of civilian victims following the October 7, 2023 attack in Israel and evaluates its contribution to odontological identification. We conducted an observational analysis of cases examined by the Israel Police forensic odontology teams, documenting body condition, availability of antemortem dental records, imaging modality used, and final identification outcomes. Portable CBCT was used primarily in victims with severe burns or restricted oral access. All scans were diagnostically interpretable, and repeat acquisition was required in only five cases. CBCT contributed directly to positive identification in 40 of 170 scanned victims (23%), all of which were later confirmed by DNA testing. Most identifications were based on dental treatment patterns, followed by dental morphology and jaw morphology. Brief hands-on training enabled rapid proficiency among forensic odontologists, allowing continuous use under field conditions. These findings demonstrate that portable CBCT is a practical, non-invasive imaging solution in mass-fatality settings, providing diagnostically useful data when conventional methods are not feasible and supporting timely forensic identification.
Firearm violence remains a leading cause of death in the US, yet the neighborhood consequences of large-scale public school closures are poorly understood. We evaluated whether Chicago's 2013 closure of 49 public elementary schools was associated with subsequent firearm violence in surrounding communities. Chicago Police Department shooting data (2010-2024) were geocoded using ArcGIS and linked with Census-derived neighborhood covariates. Census tracts with centroids within 0.5 miles of a closed school were classified as exposed. Shooting trends were compared within and outside the exposure radius, and difference-in-differences Poisson regression evaluated post-closure changes for all-age and youth victims, stratified by schools that reopened (n=32) versus those remaining vacant (n=17). Among 47,112 shootings, neighborhoods outside the exposure radius experienced stable shooting rates (1.7 to 1.5 per 1,000 population, 2010-2024). Rates increased from 2.5 to 3.1 per 1,000 near schools that reopened and from 3.0 to 4.7 per 1,000 near schools that remained vacant. Post-closure increases were greater within exposed neighborhoods (reopened schools: IRR 1.17, p=0.009; persistently vacant schools: IRR 1.51, p<0.001). Among youth, associations were strongest near persistently vacant schools (IRR 2.00, p<0.001), whereas increases near reopened schools were not statistically significant (IRR 1.18, p=0.122). The 2013 mass closure of Chicago public elementary schools was associated with increased neighborhood firearm violence, particularly where school buildings remained vacant. These findings suggest that long-term school vacancy may contribute to community firearm violence and should be considered in education and urban policy decisions.