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In this study, we used genomic sequencing to identify variants of severe acute respiratory coronavirus virus 2 (SARS-CoV-2) in healthcare workers with coronavirus disease 2019 (COVID-19) after receiving a booster vaccination. We compared symptoms, comorbidities, exposure risks, and vaccine history between the variants. Postbooster COVID-19 cases increased as the SARS-CoV-2 omicron variant predominated.
This chapter introduces the theme of mental illness in prison, situating it in the broader historiography of crime and punishment and the history of psychiatric care and institutional provision. It explains how our book redresses the neglect of prisons as a locus for the management of mental disorder, a major oversight given the number of mentally ill people confined in them during the nineteenth century. The introduction elucidates our particular methodology, with its emphasis on individual prison archives that provide a rich counter-balance to the sifted and mediated accounts of official inquiries and published annual reports. It outlines the potential of drawing on examples from England and Ireland, which, while sharing ideologies and with similar systems of prison administration, varied in interpretation and implementation. We summarise the expansion and remit of prisons in the nineteenth century, including the importance of the prison cell as a carefully curated space for reform and rehabilitation.
Chapter 4 further considers the ways in which prison medical officers provided evidence in court that might conflict with that of other medical witnesses and debated the applicability of the terms ‘criminal lunatic’, and ‘lunatic criminal’. The chapter discusses the establishment of institutional facilities for criminal lunatics, including Dundrum and Broadmoor, and legislative changes designed to establish whether individuals were ‘mad’ or ‘bad’. Prison medical officers now dealt with increasing numbers of cases of mental disorder among prisoners missed at the time of their trial or who became ill in prison. Though reluctant to relinquish prisoners and move them to asylums, many prisoners were transferred out of convict and local prisons and into criminal, district and county asylums, in a process often triggered by violence or disruptive behaviour rather than psychiatric diagnoses. The chapter explores how such transfers, and delays in making them, might trigger tensions between prison medical officers and asylum doctors and prison commissioners and lunacy commissioners and inspectors, evidenced in well-documented cases.
This chapter takes the particular example of feigning to explore claims of experience and expertise among prison medical officers. The feigning of insanity in prisons was believed to be prevalent and the sorting of prisoners between ‘genuine’ cases of insanity and those feigning or shamming insanity a key duty of prison medical officers. Particular concern was expressed about malingers’ ambitions to be removed to the better conditions offered by asylums, which then also presented opportunities for escape. The prison has been neglected in the broader historiography of feigning or malingering, yet has much to tell historians about the way it was seen as a particular problem among criminals; its detection, in the view of prison medical officers, both labour- and skill-intensive. Highlighting exchanges of medical expertise and knowledge among English and Irish alienists and prison medical officers, the chapter describes the often drawn-out processes of assessing whether a prisoner was feigning mental illness or was a genuine case of insanity, and reveals the tension between prison psychiatry and forensic experts and asylum doctors in claiming special knowledge in uncovering deception.
This chapter explores the introduction and rolling out of the separate system in England and Ireland, contextualising this in terms of earlier and rival systems of discipline, notably the silent system. It examines critiques of separate confinement, with vocal opponents often highly critical of the impact of the system on prisoner’s minds, and the extensive debates among prison administrators, governors, chaplains, and medical officers, as to whether separate confinement might provoke cases of mental disorder. Modifications were introduced to the purest form of separate confinement, yet, as we explain, the separate system continued to dominate penal policy and practice, despite persistent concerns about the damage it inflicted on prisoners’ minds. Drawing on examples from individual prisons, including Pentonville and Mountjoy, the chapter examines the management of mental illness among prisoners, and the ways in which power shifted from the chaplains, key advocates of separate confinement from the 1830s, to the medical officers in the 1850s, as the prison medical service became more coherent and regulated.
Chapter 6 outlines the growing momentum of prison reform, enacted by a broad range of prison reformers and within the prison administration itself, towards producing reforms of punitive penal regimes, including separate confinement. Critiques of late nineteenth-century prison regimes noted the continuing high incidence of mental breakdown in prisons and the detrimental effect of severe prison regimes. The chapter highlights how individual campaigners and campaign groups lobbied for the end of the separate system and for rehabilitative penal policies. However, while the Gladstone Committee inquiry of 1895 was hailed as a turning point, and the severity of prison discipline was eased earlier in Irish prisons, in practice change was ‘glacial’. The residue of the nineteenth-century prison system arguably remains with us today, in the physical structures of prison estates, in prison disciplines that still emphasise order and uniformity, in the retention of large numbers of mentally ill people and the imposition of solitary confinement, no longer a philosophy and method of reform, but a means of dealing with disruptive behaviour among prisoners and shortages of prison staff and resources.
Chapter 3 explores the prison as a place of incarceration of large numbers of mentally ill people in the late nineteenth century. It shows how the 1860s and 1870s was marked by the recalibration of separate confinement, as prison administration became increasingly centralised and uniform and discipline increasingly penal, its inspiration shifting from reformist imperatives to an emphasis on deterrence and punishment. By the 1860s transportation had mostly ended, the early optimism of the reformers was largely lost, and there was widespread concern about the retention of prisoners in the criminal justice system and high levels of recidivism, including in prisons with large female populations. The chapter addresses the constraints of ‘dual loyalty’ and its impact on the management of mental illness, with prison medical officers responsible for the health of their prisoner patients, but also required to implement and support the prison’s disciplinary practices. The chapter illuminates how prison medical officers produced their own distinct categories and labels to describe mental disorders, that was bolstered by an interest in discerning the relationship between criminality and mental illness.
Disorder Contained is the first historical account of the complex relationship between prison discipline and mental breakdown in England and Ireland. Between 1840 and 1900 the expansion of the modern prison system coincided with increased rates of mental disorder among prisoners, exacerbated by the introduction of regimes of isolation, deprivation and hard labour. Drawing on a range of archival and printed sources, the authors explore the links between different prison regimes and mental distress, examining the challenges faced by prison medical officers dealing with mental disorder within a system that stressed discipline and punishment and prisoners' own experiences of mental illness. The book investigates medical officers' approaches to the identification, definition, management and categorisation of mental disorder in prisons, and varied, often gendered, responses to mental breakdown among inmates. The authors also reflect on the persistence of systems of punishment that often aggravate rather than alleviate mental illness in the criminal justice system up to the current day. This title is also available as Open Access.
Cognitive impairment is common in individuals presenting to alcohol and other drug (AOD) settings and the presence of biopsychosocial complexity and health inequities can complicate the experience of symptoms and access to treatment services. A challenge for neuropsychologists in these settings is to evaluate the likely individual contribution of these factors to cognition when providing an opinion regarding diagnoses such as acquired brain injury (ABI). This study therefore aimed to identify predictors of cognitive functioning in AOD clients attending for neuropsychological assessment.
Clinical data from 200 clients with AOD histories who attended for assessment between 2014 and 2018 were analysed and a series of multiple regressions were conducted to explore predictors of cognitive impairment including demographic, diagnostic, substance use, medication, and mental health variables.
Regression modelling identified age, gender, years of education, age of first use, days of abstinence, sedative load, emotional distress and diagnoses of ABI and developmental disorders as contributing to aspects of neuropsychological functioning. Significant models were obtained for verbal intellectual functioning (Adj R2 = 0.19), nonverbal intellectual functioning (Adj R2 = 0.10), information processing speed (Adj R2 = 0.20), working memory (Adj R2 = 0.05), verbal recall (Adj R2 = 0.08), visual recall (Adj R2 = 0.22), divided attention (Adj R2 = 0.14), and cognitive inhibition (Adj R2 = 0.07).
These findings highlight the importance of careful provision of diagnoses in clients with AOD histories who have high levels of unmet clinical needs. They demonstrate the interaction of premorbid and potentially modifiable comorbid factors such as emotional distress and prescription medication on cognition. Ensuring that modifiable risk factors for cognitive impairment are managed may reduce experiences of cognitive impairment and improve diagnostic clarity.
To prioritise and refine a set of evidence-informed statements into advice messages to promote vegetable liking in early childhood, and to determine applicability for dissemination of advice to relevant audiences.
A nominal group technique (NGT) workshop and a Delphi survey were conducted to prioritise and achieve consensus (≥70 % agreement) on thirty evidence-informed maternal (perinatal and lactation stage), infant (complementary feeding stage) and early years (family diet stage) vegetable-related advice messages. Messages were validated via triangulation analysis against the strength of evidence from an Umbrella review of strategies to increase children’s vegetable liking, and gaps in advice from a Desktop review of vegetable feeding advice.
A purposeful sample of key stakeholders (NGT workshop, n 8 experts; Delphi survey, n 23 end users).
Participant consensus identified the most highly ranked priority messages associated with the strategies of: ‘in-utero exposure’ (perinatal and lactation, n 56 points) and ‘vegetable variety’ (complementary feeding, n 97 points; family diet, n 139 points). Triangulation revealed two strategies (‘repeated exposure’ and ‘variety’) and their associated advice messages suitable for policy and practice, twelve for research and four for food industry.
Supported by national and state feeding guideline documents and resources, the advice messages relating to ‘repeated exposure’ and ‘variety’ to increase vegetable liking can be communicated to families and caregivers by healthcare practitioners. The food industry provides a vehicle for advice promotion and product development. Further research, where stronger evidence is needed, could further inform strategies for policy and practice, and food industry application.
The aim of this study was to determine what clinically important events occur in ST-elevation myocardial infarction (STEMI) patients transported for primary percutaneous coronary intervention (PCI) via a primary care paramedic (PCP) crew, and what proportion of such events could only be treated by advanced care paramedic (ACP) protocols.
We conducted a health record review of STEMI transports by PCP-only crews and those transferred from PCP to ACP crews (ACP-intercept) from 2011 to 2015. A piloted data collection form was used to extract clinically important events, interventions during transport, and mortality.
We identified 214 STEMI bypass cases (118 PCP-only and 96 ACP-intercept). Characteristics were mean age 61.4 years; 44.4% inferior infarcts; mean response time 6 minutes, 19 seconds; total paramedic contact time 29 minutes, 40 seconds; and, in cases of ACP-intercept, 7 minutes, 46 seconds of PCP-only contact time. A clinically important event occurred in 127 (59.3%) of cases: SBP < 90 mm Hg (26.2%), HR < 60 (30.4%), HR > 100 (20.6%), arrhythmias 7.5%, altered mental status 6.5%, airway intervention 2.3%. Two patients (0.9%) arrested, both survived. Of the events identified, 42.5% could be addressed differently by ACP protocols. The majority related to fluid boluses for hypotension (34.6%). In the ACP-intercept group, ACPs acted on 51.6% of events. There were six (2.8%) in-hospital deaths.
Although clinically important events are common in STEMI bypass patients, a smaller proportion of events would be addressed differently by ACP compared with PCP protocols. The majority of clinically important events were transient and of limited clinical significance. PCP-only crews can safely transport STEMI patients directly to primary PCI.
The purpose of this study was to describe Canadian contextual trends in pediatric firearm injuries and death from powder and non-powder firearms.
This is a registry study of firearm-related injuries captured by the Canadian Hospitals Injury and Reporting Prevention Program (CHIRPP) for children ages 0 to 18 years presenting to participating CHIRPP emergency departments (EDs) from 2006 to 2013. Data included age, sex, year, setting, circumstance, and disposition for each case.
The CHIRPP dataset included 325 non-powder firearm injuries and 80 powder gun injuries. The rate of firearm injuries remained stable from 2006 to 2013 (44 per 100,000 ED visits). Forty-five patients required hospital admission and 2 died in the ED; 8 of 9 intentional self-harm injuries were inflicted with a powder gun. Most injuries occurred unintentionally from non-powder firearms (n=298, 71%) in the context of recreation (n=179) and sport (n=48). Eyes were the most commonly injured body part (n=150), 98% of which resulted from a non-powder firearm. Forty-three percent (n=141) of non-powder firearm injuries required treatment or admission.
Eye injuries inflicted by non-powder firearms are a prevalent category of firearm-related injury. Most occurred through recreation and sport, highlighting a potential focus for primary prevention.