Jose Carlos Vera-Jimenez

Background/Objectives: Type 2 diabetes mellitus (T2DM) increases the risk of infection and sepsis while modifying host immune responses, clinical presentation, and biomarker performance. This review summarizes the mechanisms through which T2DM interferes with early sepsis recognition and evaluates conventional and emerging biomarkers in this population. Methods: A narrative literature review was conducted using PubMed/MEDLINE, Scopus, and Web of Science, complemented by Google Scholar. Original studies, systematic reviews, meta-analyses, and international guidelines addressing T2DM, sepsis, immune dysfunction, and sepsis biomarkers were critically analyzed. Results: Chronic hyperglycemia induces immune dysregulation, endothelial dysfunction, and low-grade inflammation, resulting in atypical infection presentations. However, evidence that T2DM reduces the diagnostic performance of clinical screening tools remains limited. Baseline elevations and altered kinetics of C-reactive protein, procalcitonin, interleukin-6, and other inflammatory biomarkers may reduce diagnostic specificity, although diabetes-specific accuracy data are scarce. Lactate retains prognostic value but requires cautious interpretation in diabetic ketoacidosis and metabolic disturbances, which may increase levels independently of sepsis. Emerging biomarkers, including presepsin, pro-adrenomedullin, soluble urokinase plasminogen activator receptor, cell-free DNA, and 16S rRNA, show potential, although evidence in diabetic populations remains limited. Conclusions: T2DM represents a context in sepsis that requires biomarker interpretation. Biomarkers should be interpreted alongside clinical and metabolic findings and according to their intended purpose, distinguishing infection assessment from organ dysfunction and prognostic evaluation. Multimarker strategies integrating clinical, metabolic, and laboratory data may improve early sepsis recognition; however, validation studies involving patients with T2DM are needed.

(1) Background: The use of force by public and private security forces is currently an issue of great relevance because of the potential injuries caused by any excessive use of force by either active or passive subjects or a deficit in the real mastery of appropriate physical intervention techniques (PITs). For this reason, certain traditionally used physical intervention techniques have been questioned by scientific research studies and punished by justice. On the other hand, certain media have dealt with this matter in a biased and unfair manner by broadcasting videos where the use of force by police officer is displayed out of context. As a consequence, this problem has been brought under the spotlight, causing general uneasiness of the communities and rapidly spreading over social networks while favoring all sorts of parallel judgments. (2) Research method: A suit was equipped with 19 inertial measurement units (IMUs) and a Biomechanics of Bodies software application for Marras analysis of the data collected on trajectory, trunk twisting velocity, sagittal angle, load, and nature and severity of the injuries associated with the different intervention techniques examined. (3) Results: According to the data registered, the implementation of operational tactical procedures (OTPs) reduces the probability of injuries and leads to a more satisfactory outcome. (4) Conclusions: The implementation of operational tactical procedures, together with an awareness of the risks associated with the excessive use of force by public and private security forces and bodies, could reduce the risk of injuries suffered by both officers and citizens.

(1) Background: A set of relevant police ergonomic parameters (PEP) have been used for the assessment and prevention of occupational risks involved in police physical interventions (PITs). Through this set of PEPs, a comparison has been made between two traditional PITs against two novel OTPs (operational tactical procedures). (2) Method: The data have been collected by means of a motion capture suit fitted with 19 inertial measurement units (IMUs). A specific and powerful software package specific for ergonomic analysis has been used to manage the large amount of data registered and to generate a series of three-dimensional plots. Traditional PITs and newer OTPs have been performed for their analysis. Specifically, the PEPs corresponding to the implementation of four PITs have been analyzed by collecting the measurements provided by a set of IMUs installed on a motion capture suit, and their occupational risk assessments have been compared against those corresponding to newer OTPs. (3) Results: For the four PITs, the PEPs have been analyzed with the measured values from the IMUs, throughout the duration of each technique. The two traditional intervention techniques have scored higher than the new OTPs in the REBA system, the asymmetry angle, L5-pelvis shear and joint contact forces, and the total muscle power measurements. (4) Conclusions: It has been confirmed that the new OTPs minimize the risk of injuries, since their PEPs reached lower values than those corresponding to the traditional PITs, which are still being taught at police academies.

(1) Background: A set of relevant Police Ergonomics Parameters (PEP) has been used for the assessment and prevention of occupational risks involved in Police Physical Interventions (PITs). Through this set of PEPs, a comparison has been made between 2 traditional PITs against 2 novel OTPs (Operational Tactical Procedures). (2) Method: The data have been collected by means of a motion capture suit fitted with 19 Inertial Measurement Units, IMUs. A specific and powerful software package specific for ergonomic analysis has been used to manage the large amount of data registered and to generate a series of 3-dimensional plots. Traditional PITs and newer OTPs have been performed for their analysis. Specifically, the PEPs corresponding to the implementation of 4 PITs have been analyzed by collecting the measurements provided by a set of IMUs installed on a motion capture suit and their occupational risk assessments have been compared against those corresponding to newer OTPs. (3) Results: For the 4 PITs, the PEPs have been analyzed with the measured values from the IMUs, throughout the duration of each technique. The two traditional intervention techniques have scored higher than the new OTPs in the REBA system, the Assymetry angle, L5-Pelvis Shear and Joint Contac Forces, and the Total Muscle Power measurements. (4) Conclusions: It has been confirmed that the new OPTs minimize the risk of injuries, since their PEPs reached lower values than those corresponding to the traditional PITs, which are still being taught at Police academies.

(1) Background: the use of force by Public and Private Security Forces is currently an issue of great relevance because of the potential injuries that any excessive use of force by either the active or passive subjects or a deficit in the real mastery of the appropriate Physical Intervention Techniques (PIT) may cause. For this reason, certain traditionally used Physical Intervention Techniques have been questioned by scientific research studies and punished by justice. On the other hand, certain media have dealt with this matter in a biased and unfair manner by broadcasting videos where the use of force by police officer is displayed out of context. As a consequence, this problem has been brought under the spotlight, causing general uneasiness of the communities and rapidly spreading over social networks while favoring all sorts of parallel judgments. (2) Research method: A suit equipped with 19 Inertial Measurement Units (IMU) and a Biomechanics of Bodies software application for the Marras’ analysis of the data collected on trajectory, trunk twisting velocity, its sagittal angle, load, nature and severity of the injuries associated to the different intervention techniques that have been examined. (3) Results: according to the data registered, the implementation of Operational Tactical Procedures (OTP) reduces the probability of injuries and leads to a more satisfactory outcome. (4) Conclusions: the implementation of Operational Tactical Procedures, to-gether with the awareness on the risks associated to the excessive use of force by Public and Private Security Forces and Bodies, could reduce the risk of injuries suffered by both officers and citizens.

(1) Background: a set of ergonomic parameters that are relevant for risk assessment methods for the prevention of occupational risks, such as REBA or NIOSH, have been measured by means of inertial sensors that allow capturing the movements of the human body. These methods base their assessment on a number of postural and dynamic parameters. In the case of police physical intervention techniques, trunk, legs, arms, forearms and wrists angles, joint contact force and sheer force at the L5-Pelvic junction, asymmetry (angle and factor), and muscle power are the more relevant parameters to be considered. (2) Method: The data have been collected by means of a motion capture suit equipped with 19 inertial sensors. The large amount of data and the 3-dimensional plots have been managed by a powerful software package specific for ergonomic analysis. The police physical intervention technique used was OTP. (3) Results: Five ergonomic parameters in a traditional police physical intervention technique have been analyzed. REBA scores and ergonomic metrics have been recorded and discussed with some prevention risk limits from the literature. (4) Conclusions: the usage of inertial sensors to capture the movements in OTPs provides a new and quite an efficient viewpoint for occupational risk research studies.

Background: The physical intervention techniques (PITs) typically used by the police in troublesome situations are examined in terms of injuring potential depending on whether they target a body zone of high, medium or low vulnerability. Based on legal and forensic considerations, and principles of congruence, opportunity and proportionality, a need exists to favor opponent locking and arrest techniques targeting non-vulnerable zones to minimize the risk of severe damage. Methods: A search of the training manuals for the different kind of law of enforcement officers was carried out. Revision of injuries was available from electronic databases of academic o medical journals. Results: Three different locking and arrest PITs based on operational tactical procedures (OTP) that avoid zones of high or medium vulnerability are proposed. The new techniques use blocking, diverting and grabbing of the upper and lower limbs, followed by dislocation and locking of the same targets. Conclusions: The damaging potential of such PITs was assessed in terms of anatomical region and most were found to have a high risk of severe damage. The alternative PITs proposed here, which rely on OTP, improve in legal and forensic medical terms on existing choices and dramatically reduce the risk of injuring arrestees.

This paper describes some operational tactical procedures (OTP) and discusses the results of a 14-year-long study, spanning the period 2003-2016, conducted by the Municipal Police of Cádiz, Spain, which comprised 3 time periods: 2003-2006, when the officers were trained in traditional policing procedures; 2007-2013, when the officers were taught an innovative set of OTP in the form of a basic set of self-defense and arrest mechanisms, different from the traditional policing procedures that rely on martial arts and combat sports; and finally 2014-2016, when the OTP training was discontinued. The aim of this study was to improve policing and reduce officer injuries resulting from interventions in controversial or violent situations, such as problematic arrests. The study involved 162 police officers and commanders of the Municipal Police of Cádiz, who were in street duty for their first time. There were 8 females and 154 males aged 24-55 years. Three OTP stages are shown as examples. Based on the analysis of "training hours" and "physical interventions in problematic arrests," the results were: 1) the number of sick leaves in the police was identical according to the number of arrests, and 2) data on sick leaves show remarkable differences among the 3 periods under analysis. The OTP-based training substantially reduced officer sick leaves. The overall reduction in sick leaves in the period 2007-2013 was observed that cannot be ascribed to a decrease in criminal acts, and hence in police physical interventions. Int J Occup Med Environ Health. 2020;33(1):35-43.

The rapid progress in information and communication technologies has promoted the development of smartphone applications (apps) for a wide variety of purposes including workplace safety. However, no specific apps for occupational risk prevention in the police domain seemingly exist as yet. In this work, an app running under the iOS and Android operating systems was developed to help police officers become acquainted with policing-related occupational risks and to prevent their damaging consequences. The proposed app, which uses an iterative user-centered design to avoid occupational risks in policing activities, was assessed for performance by a group of users and experts through a System Usability Scale (SUS) questionnaire. The mean overall score for the questionnaire was 82.3. The app has backend support to facilitate continual improvement through contributions from users and administrators. A field test revealed increased awareness of policing occupational risks after using the app in many users. A novel product that covers the needs of ORP requirements of police officers has been developed.