Camden County College

Agencies across the country have begun the practice of having police and public safety officers attend annual wellness visits with a mental health professional. While wellness visits are increasing in frequency, with some states enacting legal mandates, little is known about how these visits are conducted. Eighty-seven clinicians responded to a survey about their practices related to this service. Summaries of the content covered in wellness visits, the procedures for carrying out visits, the outcome of the visits, and issues related to the laws and regulations governing visits are provided. Practitioners also offered opinions on what to call this service, about the primary purposes of the visits, and on what other psychological services they believe can be provided by the same clinician within a department offering the visits. While many consistent practices were revealed, some variation and disagreement were apparent. Important issues that require clarification and guidance for clinicians who conduct wellness visits include the use of testing, the amount of information reported back to the agency, and the requirements for recording keeping. The data herein provides a first look at the practice of conducting wellness visits and initial recommendations are offered for a path forward to effectively use this service to protect and enhance the mental health and well-being of officers.

In 2022, the Camden Coalition Medical-Legal Partnership began providing civil and criminal legal services to substance use disorder patients at Cooper University Health Care’s Center for Healing. This paper discusses early findings from the program’s first year on the efficacy of the provision of criminal-legal representation, which is uncommon among MLPs and critical for this patient population. The paper concludes with takeaways for other programs providing legal services in an addiction medicine setting.

Introduction: Previous studies have demonstrated racial disparities in the treatment of atrial fibrillation (AF). Potential explanations for disparities in care include cost and insurance coverage issues. This has not been examined in relation to anticoagulation (AC) therapy for thromboembolic prophylaxis of AF in a more contemporary practice using an inpatient cohort. Hypothesis: For hospitalized patients with AF, is there disparity in the rate of prescription of direct oral anticoagulant (DOAC) therapy at discharge for Black compared to White patients? Methods: A single-center retrospective query of all patients hospitalized at a University Hospital with a primary or secondary diagnosis of “AF” in 2022 and a prescription for AC at time of discharge was performed using EPIC. Baseline characteristics and AC prescription were compared between Black and White patients using the χ2 test for categorical variables and t test for continuous variables. Results: There were 275 patients that met the inclusion criteria. Demographics were 38.2% female, 66.5% White, and 14.9% Black (Table). DOAC was prescribed at discharge for 66.1% of White and in 55.0% of Black patients (p=0.01). The distribution of type of AC prescribed at discharge is shown (Figure). Conclusions: There is an ongoing racial disparity in the rate of DOAC prescription in hospitalized patients with AF, despite similar insurance status. Further investigation into underlying reasons for these differences and ways to eliminate disparities is warranted.

Background People with intellectual disability often experience aggressive challenging behaviour and mental health issues. It can be difficult to identify those who are at higher risk of adverse clinical outcomes when in clinical care. Aims To characterise potential subgroups in adults with intellectual disability referred to mental health services in those presenting with aggressive behaviour or common mental disorders (CMDs). Method There were 836 adults (≥18 years) with intellectual disability and a record of aggressive challenging behaviour, and 205 patients with intellectual disability and CMDs, who were seen in specialist mental health services over a 5-year period. Cluster analysis was used to define patient characteristics associated with clinical outcome. Results Distinct patient groups with differentiated profiles were observed in people with intellectual disability displaying aggressive challenging behaviour, and in those presenting with CMDs. Characteristics of the aggressive behaviour group who experienced adverse outcomes included being <30 years old, being male, more mentions of aggression and agitation in their clinical record, a diagnosis of pervasive developmental disorder and prescription of psychotropic medication. Characteristics of the CMD cluster that experienced adverse clinical outcomes were being older, being a White male, having a mild intellectual disability and physical health concerns. Conclusions People with intellectual disability who experience adverse clinical outcomes can be identified with a cluster analysis approach of common features, but differ by clinical presentation. This could be used not only to stratify this clinically heterogeneous population in terms of response to interventions, but also improve precision in the development of tailored interventions.

Introduction: Alteplase is the only FDA approved thrombolytic agent for acute ischemic stroke, tenecteplase is rapidly emerging as an alternative. While both agents are readily available worldwide, low to middle income countries have limited access to acute treatment. To our knowledge, there is no validated tool available to objectively measure access to thrombolytic agents or barriers to routine clinical use. Methods: We develop the 17-item tPA Spot Check tool to assess utilization of acute stroke thrombolysis in multiple languages. This tool was used to evaluate the current state of clinical practices in the MT2020+ Caribbean Region. Data was analyzed via SPSS. Results: The survey was validated by three international experts with an Average Content Validity Index of 1 and a Universal Agreement index of 1 across three domains: local experience, financial constraints, and barriers to utilization.Survey response rate was 64% (73/114 responses) 46 in English, 14 in Spanish and 13 in French. Fifteen out of 44 MT2020+ Caribbean countries (34%) participated: Haiti, Dominican Republic, Jamaica, Puerto Rico, St. Lucia, Bermuda, Bahamas, Cayman Islands, Trinidad and Tobago, Barbados, Dominica, Venezuela, Nicaragua, Honduras, and Guadalupe. There was limited or no access to thrombolytic agents in 40% of countries surveyed, with 13% resorting to the use of streptokinase. Among cases treated with thrombolytics, 43% of patients had to pay out of pocket before treatment provided, 36% of treatment was paid by insurance plus patients and less than 10% were covered by insurance or governmental support respectively. Among 51% of countries survey, no acute thrombolytic treatment was provided for acute stroke in 2021 calendar year. Only 1 center treated more than 100 cases per year. Majority of respondents (88%) agreed there were barriers to acute stroke thrombolysis in the region. Absence of Stroke protocol (p<0.001), upfront cost of alteplase (p= 0.003) and access to CT scan (p=0.03) were independent predictors of fewer patients treated per year. Conclusion: This this survey brings light to an enormous disparity in care of stroke patients around the world, specifically in the MT2020+ Caribbean region. We create a valid tool can be used to assess local access to thrombolytic.

This chapter provides suggestions as to what could be included in a crisis communication and management plan. It is strongly encouraged that a professional review the plan and customize it for the specific needs of a school district or business. This chapter will briefly focus on three main topics of crisis communication and management: 1) pre-crisis/preparedness, planning ahead in the event of a crisis with the main goal of preventing loss of life, injury, or damage to property; 2) active crisis/response, what to expect and what will take place after authorities are on the scene; and 3) post-crisis/recovery, debriefing after the crisis to document what occurred and discuss what could have been done differently.

For efficient processing, spatiotemporal spike patterns representing similar input must be able to transform into a less similar output. A new computational model with physiologically plausible parameters shows how the neuronal process referred to as “pattern separation” can be very well achieved by single neurons if the temporal qualities of the output patterns are considered. Spike patterns generated by a varying number of neurons firing with fixed different frequencies within a gamma range are used as input. The temporal and spatial summation of dendritic input combined with theta-oscillating excitability in the output neuron by subthreshold membrane potential oscillations (SMOs) lead to high temporal separation by different delays of output spikes of similar input patterns. A Winner Takes All (WTA) mechanism with backward inhibition suffices to transform the spatial overlap of input patterns to much less temporal overlap of the output patterns. The conversion of spatial patterns input into an output with differently delayed spikes enables high separation effects. Incomplete random connectivity spreads the times up to the first spike across a spatially expanded ensemble of output neurons. With the expansion, random connectivity becomes the spatial distribution mechanism of temporal features. Additionally, a “synfire chain” circuit is proposed to reconvert temporal differences into spatial ones.

In a time of unprecedented and interlinked challenges–mitigating climate change, building resiliency to its impacts, protecting biodiversity, and ensuring human well-being, the Intergovernmental Panel on Climate Change reports that climate change has led to widespread shrinking of the cryosphere. The dangers of climate change have been known since the 1980s, but a lack of societal awareness and political and economic investment has inhibited the necessary vigorous change. We are now at a crucial moment where, with every degree, a cascade of tipping points and a “hothouse Earth'' will become more probable. At the same time, the COVID-19 pandemic has disrupted socio-economic systems and threatens the development gains of the past decades. Thus, it is imperative to undertake dynamic initiatives to promote effective partnerships and address interdependencies around climate mitigation, systems adaptation, healthy ecosystems, and community well-being, including sustainable water-energy-food (WEF) management. Sustainable development and human well-being require us to protect WEF resources. The WEF Nexus can help build mutually-beneficial partnerships, reduce trade-offs between sectors, and allow better coordination and informed decision-making. A pilot project in Morocco's Youssoufia Province demonstrates the benefits of decentralized renewable energy initiatives in developing nations

The goal of every contemporary recognition approach is to learn robust and unambiguous object representations in feature space. These learned powerful disentangled representations make it possible to build effective classifiers and are an active research topic in many fields such as face analytics.

Multiple myeloma (MM) is a plasma cells neoplasm. The overexpression of Bcl-2 family proteins, particularly myeloid cell leukemia 1 (Mcl-1), plays a critical role in the pathogenesis of MM. The overexpression of Mcl-1 is associated with drug resistance and overall poor prognosis of MM. Thus, inhibition of the Mcl-1 protein considered as a therapeutic strategy to kill the myeloma cells. Over the last decade, the development of selective Mcl-1 inhibitors has seen remarkable advancement. This review presents the critical role of Mcl-1 in the progression of MM, the most prominent BH3 mimetic and semi-BH3 mimetic that selectively inhibit Mcl-1, and could be used as single agent or combined with existing therapies.

Spanish-speaking families in the United States must often overcome multiple challenges to support their young children’s early language development (e.g., language and cultural barriers, financial stress, limited learning resources, etc.). These challenges highlight the need for early language interventions tailored to the needs of Spanish-speaking families and developed in collaboration with them. For diverse populations, early language interventions which are both translated into the relevant language and culturally responsive are the most effective for improving child outcomes. However, few interventions meet both criteria, demonstrating a need for materials that are accessible across both language and culture. The current study describes the five-phase process of creating a linguistically and culturally relevant Spanish adaptation of Duet, an early language intervention. The adaptation of the Duet intervention modules involved multiple language experts, including Spanish-speaking developmental psychologists, a translation company, and Spanish-speaking caregivers of infants and toddlers. Fourteen caregivers were recruited to participate in two, 3-h focus groups. Input from caregivers was a particularly important step in the adaptation process, as caregivers hold knowledge about everyday experiences with their children. Through this process, the authors aim to shed light onto the importance of collaborating with the community and present a possible framework for others who are adapting interventions.

The voluntary movement demands integration between cognitive and motor functions. During the initial stages of motor learning until mastery of a new motor task, and during a demanding task that is not automatic, cognitive and motor functions can be perceived as independent from each other. Areas used for actually performing motor tasks are essentially the same used by Motor Imagery (MI). The main objective of this study was to investigate inhibition effects on cognitive functions of motor skills induced by low-frequency (1 Hz) Repetitive Transcranial Magnetic Stimulation (rTMS) at the sensory-motor integration site (Cz). In particular, the goal was to examine absolute alpha and beta power changes on frontal regions during Execution, Action observation, and Motor Imagery of finger movement tasks. Eleven healthy, right-handed volunteers of both sexes (5 males, 6 females; mean age 28 ± 5 years), with no history of psychiatric or neurological disorders, participated in the experiment. The execution task consisted of the subject flexing and extending the index finger. The action observation task involved watching a video of the same movement. The motor imagery task was imagining the flexion and extension of the index finger movement. After performing the tasks randomly, subjects were submitted to 15 minutes of low-frequency rTMS and performed the tasks again. All tasks were executed simultaneously with EEG signals recording. Our results demonstrated a significant interaction between rTMS and the three tasks in almost all analyzed regions showing that rTMS can affect the frontal region regarding Execution, Action observation, and Motor Imagery tasks.

Introduction: To evaluate overall ischemic stroke rates, specific subtypes, and clinical presentation during the COVID-19 pandemic in a multicenter observational study from eight states across US. Methods: We compared all ischemic strokes admitted between January 2019 and May 2020, grouped as; March-May 2020 (COVID-19 period), March-May 2019 (seasonal pre-COVID period) and November 2019-January 2020 (immediate pre-COVID-19 period). Primary outcome was stroke severity at admission measured by NIHSS stratified as mild (0-7), moderate (8-14), and severe (>14) symptoms. Secondary outcomes were number of large vessel occlusions (LVOs), stroke etiology, IV-tPA rates, and disposition. Results: Of the 7,969 patients diagnosed with acute stroke during the study period, 933 (12%) presented in the COVID-19 period, 1319 (17%), and 1254 (16%) presented in the seasonal pre-COVID-19 and immediate pre-COVID-19 periods, respectively. Significant decline was observed in the weekly mean volume of newly diagnosed strokes (98±7.3 vs 50±20, p<0.01 and 95±10.5 vs 50±20, p<0.01), LVOs (16.5±3.8 vs 8.3±5.9, p<0.01 and 14.3± 4.5 vs 8.3±5.9, p<0.01), and IV-tPA (5.3±2.9 vs 10.9±3.4 and 12.7±4.1, p<0.01). Mean weekly proportion of LVOs remained the same, when compared with seasonal pre-COVID-19 period (18%±5 vs 16%±7, p=0.24) and immediate pre-COVID-19 period (17.4%±4 vs. 16%±7, p=0.32). Additionally, these patients presented with less severe disease (NIHSS<14; aOR: 0.63, 95%CI: 0.41-0.97, p=0.035) during the COVID-19 period as compared to immediate pre-COVID-19 period. Conclusions: We observed a decrease in newly diagnosed stroke cases and rates of IV-tPA administration, while the LVO frequency remained unchanged during the COVID-19 pandemic. Additionally, these stroke patients had more severe presentations.

Aim The study investigated the cortical activity changes and time production task performance induced by changes in motion speed of a non-immersive 3D virtual stimulus. Material and methods Twenty-one individuals were participated in the crossover study with the visual-time reproduction task under three-speed conditions: original, slow and fast virtual stimulus. In addition, the electroencephalographic analysis of the theta band power in the dorsolateral prefrontal cortex was done simultaneously with time production task execution. Results The results demonstrated that in the slow speed condition, there is an increase in the error in the time production task after virtual reality (p < 0.05). There is also increased EEG theta power in the right dorsolateral prefrontal cortex in all speed conditions (p < 0.05). Conclusions We propose that the modulations of speed of virtual stimulus may underlie the accumulation of temporal pulses, which could be responsible for changes in the performance of the production task of the time intervals and a substantial increase in right dorsolateral prefrontal cortex activity related to attention and memory, acting in cognitive domains of supraseconds.

Temporal structure of cognitive and sensory processing holds the key to understanding complex neural mechanisms involved in higher order brain functions like perception of time. A hypothesis of embodied cognition posits that cognitive processes are deeply rooted in the interactions with the external world (Wilson et al., 2002; Anderson et al., 2012). These interactions of the brain with the external world depend on the accurate representation of the time-dimension in neural circuits (Gupta, 2014). For example, one cannot catch a flying ball unless the timing of the movements matches the speed of the ball. Many real world situations depend on the mapping between the neural and physical representation of time, which is maintained at different hierarchical levels. Hierarchical processing, consistent with multiple time scales, is manifested during goal-driven tasks, such as interval timing, duration judgement, and movement coordination. Contributions to this Research Topic elucidate how key aspects of the time-dimension such as the temporal binding of neural events play important roles in various cognitive processes, which include perception, mental time travel, and speech production. Additionally, the multi-scale representation of such processes from the micro to meso scales—from single neurons to a population of neurons to field potentials and macroscopic scales of EEG - is, discussed.

The storage of temporally precise spike patterns can be realized by a single neuron. A spiking neural network (SNN) model is utilized to demonstrate the ability to precisely recall a spike pattern after presenting a single input. We show by using a simulation study that the temporal properties of input patterns can be transformed into spatial patterns of local dendritic spikes. The localization of time-points of spikes is facilitated by phase-shift of the subthreshold membrane potential oscillations (SMO) in the dendritic branches, which modifies their excitability. In reference to the points in time of the arriving input, the dendritic spikes are triggered in different branches. To store spatially distributed patterns, two unsupervised learning mechanisms are utilized. Either synaptic weights to the branches, spatial representation of the temporal input pattern, are enhanced by spike-timing-dependent plasticity (STDP) or the oscillation power of SMOs in spiking branches is increased by dendritic spikes. For retrieval, spike bursts activate stored spatiotemporal patterns in dendritic branches, which reactivate the original somatic spike patterns. The simulation of the prototypical model demonstrates the principle, how linking time to space enables the storage of temporal features of an input. Plausibility, advantages, and some variations of the proposed model are also discussed.