Anthony R. Mawson

Understanding Mass Panic and Other Collective Responses to Threat and Disaster

Abstract While mass panic (and/or violence) and self-preservation are often assumed to be the natural response to physical danger and perceived entrapment, the literature indicates that expressions of mutual aid are common and often predominate, and collective flight may be so delayed that survival is threatened. In fact, the typical response to a variety of threats and disasters is not to flee but to seek the proximity of familiar persons and places; moreover, separation from attachment figures is a greater stressor than physical danger. Such observations can be explained by an alternative “social attachment” model that recognizes the fundamentally gregarious nature of human beings and the primacy of attachments. In the relatively rare instances where flight occurs, the latter can be understood as one aspect of a more general affiliative response that involves escaping from certain situations and moving toward other situations that are perceived as familiar but which may not necessarily be objectively safe. The occurrence of flight-and-affiliation depends mainly on the social context and especially the whereabouts of familiar persons (i.e., attachment figures); their physical presence has a calming effect and reduces the probability of flight-and-affiliation, while their absence has the opposite effect. Combining the factors of perceived physical danger and the location of attachment figures results in a four-fold typology that encompasses a wide spectrum of collective responses to threat and disaster. Implications of the model for predicting community responses to terrorist attacks and/or use of weapons of mass destruction are briefly discussed.

Risk factors for early occurring pressure ulcers following spinal cord injury.

We carried out a prospective study to determine the association between immobilization in the immediate postinjury period and the development of pressure ulcers in spinal cord-injured patients following their admission to Charity Hospital, New Orleans. Of 39 patients consecutively admitted to the hospital, 23 (59%) developed a grade one ulcer within 30 days, mostly in the sacral region (57%), the peak time of onset being day 4 postinjury (6/23 cases). In partial support of an earlier retrospective study (Linares HA, Mawson AR, Suarez E, Biundo JJ Jr: Association between pressure sores and immobilization in the immediate post-injury period. Orthopedics 1987;10:571-573), duration of unrelieved pressure prior to ward admission was significantly associated with ulcers developing within the first eight days of injury (P=0.04), but not with ulcers developing during the entire 30-day observation period (P=0.09). Time on the spinal board was also significantly associated with ulcers developing within 8 days (P=0.01), but not with ulcers developing within 30 days (P=0.09). An unexpected finding was the significant inverse association between systolic blood pressure and the development of ulcers both within 8 days (P=0.03) and within 30 days (P=0.02), suggesting that reduced tissue perfusion increases the spinal cord-injured patients susceptibility to pressure ulcers.

Association between pressure sores and immobilization in the immediate post-injury period

Pressure sores are a frequent complication of spinal cord injury (SCI) and are assumed to result from insufficient rotation following admission to the acute care unit. The likelihood of pressure sores occurring before admission to the nursing unit is not usually recognized. This study attempts to determine whether pressure sores are associated with prolonged immobilization in the early post-injury period, before admission to the acute care ward, and to identify other etiological factors relating to evacuation, transportation, and emergency room treatment. Thirty-two SCI patients were studied, 16 of whom developed sores in the hospital, and 16 who did not. Excluding five patients who failed to recall their immediate post-injury care, none of the remaining 14 patients with sores recalled being turned within two hours of injury; all 13 patients without sores said that they were rotated within two hours. Almost all patients said they were first turned on the hospital ward by a nurse. Whereas most of those without sores took less than two hours to reach the ward, most of those who later developed sores took three hours or longer.

Sacral transcutaneous oxygen tension levels in the spinal cord injured: risk factors for pressure ulcers?

Evidence is mounting that susceptibility to pressure ulcers in the spinal cord injured is due to the interactive effects of prolonged immobilization and injury-related autonomic dysfunction associated with reduced tissue perfusion. To determine whether tissue oxygenation at the sacrum is reduced in spinal cord injury, we compared transcutaneous oxygen tension (PtcO2) levels in 21 subjects with spinal cord injury and 11 able-bodied controls lying prone and supine on egg-crate mattresses. Spinal cord injured subjects above and below the median supine PtcO2 value were also compared in terms of the presence or absence of pressure ulcers. The PtcO2 level of the spinal cord injured (mean +/- SD) was lower than that of the controls in the prone position (65.3 +/- 16mmHg vs 76.4 +/- 13mmHg; F = 3.9, df = 1, p = .053), and markedly lower in the supine position (49.1 +/- 26mmHg versus 74.2 +/- 10mmHg; F = 9.7, df = 1, p = .004). Examination of mean PtcO2 levels over time showed that those of the controls fell slightly following supination but returned to the previous level within 15 minutes. In contrast, those of the spinal cord injured fell rapidly by 18mmHg and stabilized after 15 minutes at a level 27mmHg below that of the controls. Five of the 10 (50%) spinal cord injured subjects with PtcO2 levels below the median supine PtcO2 level had a pressure ulcer compared to one among the 11 (9%) spinal cord injured subjects with PtcO2 levels above the median (p = .055, by Fishers exact test). These results suggest the need for further studies on the role of reduced tissue oxygenation in the etiology of pressure ulcers.

Disaster Mythology and Fact: Hurricane Katrina and Social Attachment:

Misconceptions about disasters and their social and health consequences remain prevalent despite considerable research evidence to the contrary. Eight such myths and their factual counterparts were reviewed in a classic report on the public health impact of disasters by Claude de Ville de Goyet entitled, The Role of WHO in Disaster Management: Relief, Rehabilitation, and Reconstruction (Geneva, World Health Organization, 1991), and two additional myths and facts were added by Pan American Health Organization. In this article, we reconsider these myths and facts in relation to Hurricane Katrina, with particular emphasis on psychosocial needs and behaviors, based on data gleaned from scientific sources as well as printed and electronic media reports. The review suggests that preparedness plans for disasters involving forced mass evacuation and resettlement should place a high priority on keeping families together—and even entire neighborhoods, where possible—so as to preserve the familiar and thereby minimize the adverse effects of separation and major dislocation on mental and physical health.

Effect of high voltage pulsed galvanic stimulation on sacral transcutaneous oxygen tension levels in the spinal cord injured

Evidence is mounting that spinal cord injured (SCI) persons may be at increased risk of pressure ulcers due to prolonged immobilization together with the injury-induced loss of sympathetic tone and decreased vascular resistance. With a view to developing a new method of preventing pressure ulcers, the objective of this study was to determine whether high voltage pulsed galvanic stimulation (HVPGS) could increase sacral transcutaneous oxygen tension (PtcO2) in SCI persons lying prone and supine. In experiment 1, HVPGS applied to the back at spinal level T6 led to a sustained, dose-related increase in sacral PtcO2 in 3 subjects lying prone. In experiment 2, carried out on 29 subjects lying supine on egg-crate mattresses, HVPGS (75 volts, 10 Hz) produced a 35% increase in sacral PtcO2, from a baseline level (Mean ± SD) of 49 ± 21 mmHg to 66 ± 18 mmHg after 30 minutes of stimulation (F = 39.4, p < .00001). In experiment 3, simulated HVPGS was found to have no effect on sacral PtcO2 in 5 subjects lying supine. In experiment 4, HVPGS was repeated on 10 subjects and its effects found to be highly reproducible. It is hypothesized that HVPGS restores sympathetic tone and vascular resistance below the level of the spinal cord lesion, thereby increasing the perfusion pressure gradient in the capillary beds. Randomized controlled trials are now indicated to determine the efficacy of HVPGS for preventing pressure ulcers.

Preventing lethal violence in schools: the case for entry-based weapons screening

Violence-related behavior in schools has declined in recent years, but the perception of risk remains high. Disturbingly high percentages of students and teachers report staying home out of fear, and many students bring weapons to school for protection. Current proposals for preventing school violence include punishing the violence-prone, expulsion for weapon carriers, and creating a culture of nonviolence through various behavioral methods like conflict resolution. None of these proposals address the issue of lethal violence and hence personal safety. The risk of lethal violence in schools (related mainly to firearms) could be substantially reduced by creating an effective barrier between firearms and people. This could be achieved by using entry-based weapons detection systems similar to those now used in airports and courts. Decreasing the risk and fear of violence by converting schools into weapons-free zones would also be expected to increase attendance and improve scholastic performance. Randomized, controlled studies should be undertaken to evaluate the efficacy and cost-effectiveness of entry-based weapons detection systems for achieving these outcomes.

Effects of antiretroviral therapy on occurrence of pre-eclampsia.

I propose that highly active antiretroviral therapy (HAART) causes pre-eclampsia by a direct toxic effect on the liver in which the synthesis and secretion of retinol-binding proteins are impaired leading to the reduced serum retinol concentrations typically found in pre-eclampsia. Vitamin A would thus be expected to accumulate in the liver due to defective mobilisation. Retinyl esters retinoic acid and other biologically active biliary metabolites of vitamin A that would normally be excreted harmlessly via the intestine are instead regurgitated or leaked from damaged hepatocytes into the maternal circulation. Low serum retinol concentrations would thus be paradoxically associated with increased concentrations of active retinoids. These retinoids have not been previously assessed in pre-eclampsia or in HIV-1- positive patients treated with HAART. (excerpt)

Stimulation-induced behavioral inhibition: a new model for understanding physical violence.

Physical violence is widely considered to result from action carried out with the intention of causing injury; that is, from aggression. However, the “hypothesis” of aggression is inapplicable in all but a few instances as well as inappropriate for many destructive rage-associated responses directed at inanimate objects. This paper outlines a new perspective on physical violence, reinterpreting many behaviors hitherto labeled aggressive as stimulation-seeking behaviors (SSBs) above an arbitrary level of intensity. It is further proposed that: 1) physical violence is a by-product of SSB, driven, in part by brain catecholaminergic (CA) systems, and the direct result of exchanges of energy that exceed the bodys tolerance threshold; 2) allegedly discrete categories of motor-motivational behavior represent overlapping bands of intensity on a continuous spectrum of SSB; and 3) the sensory input derived from SSB is fed back into the central nervous system where it activates, brain serotonergic and/or cholinergic systems, which in turn inhibit CA systems, resulting in a general state of behavioral quiescence. In addition to accounting for a number of previously unexplained observations, the model suggests that physical violence could be prevented by providing groups at high risk with extensive opportunities for therapeutic sensory stimulation to substitute for that derived from excessive SSB. For people at especially high risk, portable devices could be developed that would allow the user to self-administer desired levels of sensory stimulation at moments of intense anger, thereby preventing potentially dangerous outbursts of SSB prior to the onset of the behavior.

Gout and vitamin A intoxication : is there a connection ?

Several lines of indirect evidence implicate vitamin A intoxication, associated mainly with impaired renal function, in the etiopathogenesis of gouty arthritis. The enzyme xanthine oxidase is involved not only in the conversion of xanthine to uric acid but also in that of retinol to its more toxic metabolite, retinoic acid. Retinoic acid should therefore be present in high concentration in hyperuricemic states.