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Pooja Raghavan,1 Charles M Katz21Department of Medicine, Mount Carmel Health, Columbus, OH, USA; 2Division of Endocrinology and Metabolism, Mount Carmel Health, Columbus, OH, USAAbstract: Pseudohypoparathyroidism is a rare disorder of calcium metabolism that involves target organ resistance to the action of the parathyroid hormone. As a result, calcium levels may become dangerously low, sometimes leading to seizures and other symptoms. We present a case of a 23-year-old Somalian female on antiepileptic therapy presenting with intractable epilepsy. She was subsequently found to have pseudohypoparathyroidism type Ia. She had multiple reasons accounting for loss of seizure control, including worsening hypocalcemia from resistance to the parathyroid hormone; vitamin D deficiency, which could have resulted from lack of exposure to direct sunlight and her antiepileptic medication; and extensive calcium deposition in the brain due to pseudohypoparathyroidism. The patient was stabilized with intravenous therapy and oral calcium, vitamin D, and calcitriol. Her antiepileptic therapy was changed to a medication that did not interfere with vitamin D metabolism or contribute to worsening hypocalcemia.Keywords: calcium, pseudohypoparathyroidism, epilepsy

Most episodes of recurrent hypoglycemia occur in patients with diabetes mellitus and can be prevented by changes in medication, diet, or activity. However, persistent, unexplained hypoglycemia can indicate a potentially grave, often treatable, underlying disorder, such as adrenal or pituitary insufficiency. Medication errors are another common cause of unexplained hypoglycemia. A focused laboratory workup is essential; obtain a plasma or serum glucose level and serum insulin and C-peptide levels. Insulin levels should be suppressed (less than 6 microIU/ml) when the glucose level is below 60 mg/dL. 'Normal' or high insulin and C-peptide levels suggest excessive endogenous insulin production. Another useful value is the serum beta-hydroxybutyrate level. Patients with insulin-mediated hypoglycemia typically have beta-hydroxybutyrate concentrations below 2.7 mg/dL. [ABSTRACT FROM AUTHOR]

With gun crime on the rise, efforts to curb this form of violence have captured the attention of government agencies and police departments alike. One form of such efforts is the proliferation of Crime Gun Intelligence Centers (CGICs) in police departments across the country. However, with only three non-peer-reviewed evaluations of these CGICs to date, our understanding of their effectiveness is limited. The present study aims to fill this gap by examining the impact of the Phoenix Police Department's (PPD) CGIC on clearance rates and prosecutorial outcomes for gun crimes. The data for this study come from PPD's Records Management System (RMS), computer-aided dispatch (CAD) system, impounded evidence, National Integrated Ballistics Information Network (NIBIN) lead data, and arrest data. Prosecutorial data were supplied by the Maricopa County Attorney's Office (MCAO). This study examined pretest and posttest differences that occurred over the study period. Difference-in-difference (DID) models were calculated to assess the impact of the CGIC on the outcome measures of interest. We found that from the year prior to the CGIC to 2 years post-CGIC, NIBIN inputs increased by 115%, NIBIN leads increased by 163%, timeliness of entry (of ballistics evidence) improved with 32% of processed items entered within 24-48 h in the second year of the CGIC compared with only 3% the year preceding the CGIC, and clearance rates for arrests increased significantly. These findings have implications for the continued adoption of CGIC, as well as the utility of NIBIN., (© 2021 American Academy of Forensic Sciences.)

Limited research attention has focused on homicides involving foreign-born victims. Using data from the National Violent Death Reporting System, we examined 9428 homicides that occurred in 2017 in the United States across 32 states and D.C. Approximately 8% of homicide victims were foreign-born. Homicide victimization rates were substantially lower for foreign-born persons, compared to U.S.-born persons. However, foreign-born persons from Honduras, El Salvador, and Jamaica had a substantially higher risk of homicide victimization. Notably, few homicides involving foreign-born victims were gang- or drug-trade-related. With the growing number of immigrants in the United States, policy and prevention efforts should be guided by research., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2022 The Author(s).)

This study explores advanced techniques in machine learning to develop a short tree-based adaptive classification test based on an existing lengthy instrument. A case study was carried out for an assessment of risk for juvenile delinquency. Two unique facts of this case are (a) the items in the original instrument measure a large number of distinctive constructs; (b) the target outcomes are of low prevalence, which renders imbalanced training data. Due to the high dimensionality of the items, traditional item response theory (IRT)-based adaptive testing approaches may not work well, whereas decision trees, which are developed in the machine learning discipline, present as a promising alternative solution for adaptive tests. A cross-validation study was carried out to compare eight tree-based adaptive test constructions with five benchmark methods using data from a sample of 3,975 subjects. The findings reveal that the best-performing tree-based adaptive tests yielded better classification accuracy than the benchmark method IRT scoring with optimal cutpoints, and yielded comparable or better classification accuracy than the best benchmark method, random forest with balanced sampling. The competitive classification accuracy of the tree-based adaptive tests also come with an over 30-fold reduction in the length of the instrument, only administering between 3 to 6 items to any individual. This study suggests that tree-based adaptive tests have an enormous potential when used to shorten instruments that measure a large variety of constructs., Competing Interests: Declaration of Conflicting Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (© The Author(s) 2020.)

The current study documents homicide trends in Honduras from 2008 to 2018. Specifically, this study describes demographics of homicide victims and incident profiles (ie, weapons) using homicide data from the Honduras National Police and census data from the National Institute of Statistics. A total of 58 543 homicide incidents were analysed. Results indicated that the homicide rate in Honduras increased from 2008 to 2011 and decreased substantially after 2011. In addition, the male homicide victimisation rate was significantly higher than the female homicide victimisation rate across the entire time period, with the highest rate for males aged 30-44 (233.4 per 100 000 population). Firearms were the weapons used most frequently in homicides (80.3%). Implications of the findings are discussed in light of public safety in Honduras., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2020. No commercial re-use. See rights and permissions. Published by BMJ.)

We explore the impact of information from ballistics imaging hit reports on the investigation into violent crimes. Ballistics imaging hits link two crimes involving the same firearm by forensically matching tool marks on the fired bullets or cartridge cases. Interview data collected from detectives who received a hit report were used to explore the relationship between the presence of a hit report and outcomes in 65 gun-related violent crime investigations in nine U.S. police agencies. Findings indicate hit reports rarely contribute to identification, arrest, charging, or sentencing of suspects, because of delays in producing hit reports. On average, hit reports were completed 181.4 days after the focal crime. This delay forces investigations to proceed without the benefit of information from ballistics analysis. Additionally, hit reports rarely contained detailed information that was immediately useful to investigators. Instead, hit reports required additional research by the investigator to unlock useful information., (© 2017 American Academy of Forensic Sciences.)

Objective: To estimate the effects on homicide rates of the gang truce that was brokered in El Salvador in 2012., Methods: Mathematical models based on municipal-level census, crime and gang-intelligence data were used to estimate the effect of the truce on homicide rates. One model estimated the overall effect after accounting for the linear trend and seasonality in the homicide rate. In a moderated-effect model, we investigated the relationship between the truce effect and the numbers of MS13 (Mara Salvatrucha 13) and Eighteenth-Street gang members imprisoned per 100 000 population. We then ran each of these two models with additional control variables. We compared values before the truce - 1 January 2010 to 29 February 2012 - with those after the truce - 1 March 2012 to 31 December 2013., Findings: The overall-effect models with and without additional control variables indicated a homicide rate after the truce that was significantly lower than the value before the truce, giving rate ratios of 0.55 (95% confidence interval, CI: 0.49-0.63) and 0.61 (95% CI: 0.54-0.69), respectively. For any given municipality, the effectiveness of the truce appeared to increase as the number of MS13 gang members imprisoned per 100 000 population increased. We did not observe the same significant relationship for imprisoned Eighteenth-Street gang members., Conclusion: In the 22 months following the establishment of a national gang truce, the homicide rate was about 40% lower than in the preceding 26 months. The truce's impact appeared particularly strong in municipalities with relatively high numbers of imprisoned MS13 gang members per 100 000 population.

Objectives: To describe the sources that active offenders in Trinidad and Tobago use to obtain firearms and report their motivations for obtaining them. To estimate relationships between gang involvement, drug selling, and firearm ownership (or possession)., Setting: Port of Spain (Republic of Trinidad and Tobago)., Methods: A cross-sectional research design was used to collect self-report data from 421 recently booked arrestees (within 72 h of their arrest) in the Port of Spain Police District Detention Center. A survey instrument was used to collect data on firearm acquisition, drug use, gang membership and other behaviours. The sample provides insights about guns in the lives of arrestees in Trinidad and Tobago., Results: 15% of respondents reported ever owning (or possessing) a firearm. Among the possessor group, 82% owned a gun primarily for defensive purposes, but approximately half reported using a gun in a crime. Nearly half of gun possessors stored their guns in outside locations. Firearm possession was greater among arrestees involved in gangs and those involved in drug selling., Conclusions: A comprehensive approach of prevention, intervention, and suppression strategies that are intended to prevent gun-related incidents should be focused on gangs, drugs, and guns. Searches for high-risk firearms should focus on public areas where gang members live and socialise. The study shows the value of collecting data from offender-based populations in the region for the purpose of directing violence-prevention strategies.

This study examined the interface between emergency departments and community general practice in terms of their delivery of primary care services. Through the collection of casemix and treatment data, and interviews with patients, information was gathered relating to the extent of primary care delivery in emergency departments, problems managed and treatments provided in the two settings and patients' characteristics and reasons for choosing to seek primary care in the emergency department. The results indicate a high proportion of primary care delivery is in emergency departments, and that there is a need for delivery in this setting to continue. The results are discussed in terms of such quality assurance issues as monitoring primary care in emergency departments and addressing patient needs.

Sliding-scale insulin therapy is seldom the best way to treat hospitalized diabetic patients. In the few clinical situations in which it is appropriate, close attention to details and solidly based scientific principles is absolutely necessary. Well-organized alternative approaches to insulin therapy usually offer greater efficiency and effectiveness.