Poverty and Health Inequities in Children Investigated by Child Protective Services.

The objective of our study was to examine the association between poverty and child health outcomes in school-age children referred to child protective services. We conducted a secondary analysis of children aged 5 to 9 years in the Second National Survey of Child and Adolescent Well-Being, a nationally representative longitudinal observational data set of children referred to protective services for maltreatment (2008-2012). We analyzed the association of poverty, defined as family income below the federal poverty level (FPL), with caregiver report of the child's overall health, primary care, and emergency department visits using Pearson's chi-squared test. Children below FPL compared with children above it had poorer overall health (29.8% vs 18.0%, P = .03). We also conducted a longitudinal multivariable logistic regression analysis and found poverty was associated with the child's poorer overall health at 36 months (odds ratios 2.78, 95% confidence interval 1.55-5.01). Future studies and interventions to improve health in this at-risk population should target poverty.

Imaging patterns of thoracic injuries in survivors of intimate partner violence (IPV).

PURPOSE: To recognize the imaging patterns of thoracic injuries in survivors of intimate partner violence (IPV). MATERIALS AND METHODS: A retrospective radiological review of 688 patients self-reporting IPV to our institution's violence intervention and prevention program between January 2013 and June 2018 identified 30 patients with 89 thoracic injuries. Imaging and demographic data were collected. RESULTS: Thirty survivors with 89 injuries to the thorax were identified with a median age of 43.5 years (21-65 years). IPV was reported or disclosed as the direct cause of injury in 50% (15/30) of survivors, including all nine patients who sustained penetrating injuries. The most common injury type was fracture (72%, 64/89) with 52 rib, 3 sternal, 2 clavicular, and 7 vertebral fractures. There were 3 acromioclavicular dislocations. Among rib fractures, right lower anterior rib fractures (9-12 ribs) were the most common(30%, 16/52). There were 10 superficial soft tissue injuries. There were 12 deep tissue injuries which included 2 lung contusions, 2 pneumomediastinum, 7 pneumothoraces, 1 hemothorax. One third of patients had concomitant injuries of other organ systems, most commonly to the head and face, followed by extremities and one third of patients had metachronous injuries. CONCLUSION: Acute rib fractures with concomitant injuries to the head, neck, face, and extremities with an unclear mechanism of injury should prompt the radiologist to discuss the possibility of IPV with the ordering physician. ADVANCES IN KNOWLEDGE: Recognizing common injuries to the thorax will prompt the radiologists to suspect IPV and discuss it with the clinicians.

Facial injury patterns in victims of intimate partner violence.

PURPOSE: To evaluate the imaging findings of facial injuries in patients reporting intimate partner violence (IPV). METHODS: A retrospective review of radiology studies performed for 668 patients reporting IPV to our institution's violence prevention support program identified 96 patients with 152 facial injuries. Demographics, imaging findings, and clinical data obtained from a review of the electronic medical records (EMR) were analyzed to categorize injury patterns. RESULTS: The study cohort consisted of 93 women and 3 men with a mean age of 35 years (range 19-76; median 32). At the time of presentation, 57 (59.3%) patients reported IPV as the mechanism of injury. The most frequent site of injury was the midface, seen in 65 (67.7%) patients. The most common fracture sites were the nasal bones (45/152, 29.6%), followed by the mandible (17/152, 11.1%), and orbits (16/152, 10.5%). Left-sided injuries were more common (90/152; 59.2%). A vast majority of fractures (94.5%) showed minimal or no displacement. Over one-third of injuries (60/152, 39.4%) demonstrated only soft tissue swelling or hematoma without fracture. Associated injuries were seen most frequently in the upper extremity, occurring synchronously in 11 (11.4%) patients, and preceding the index facial injury in 20 (21%) patients. CONCLUSION: /advances in knowledge. The midface was the most frequent location of injury in victims of intimate partner violence, and the nasal bone was the most commonly fractured facial bone. Recognizing these injury patterns can help radiologists suspect IPV and prompt them to discuss the possibility of IPV with the clinical providers.

Systematic Review of Human Trafficking Educational Interventions for Health Care Providers.

Human trafficking is a global population health threat. Trafficking minors threatens the safety and well-being of youth. Limited studies measure health care providers' awareness and attitudes toward trafficking. This systematic review synthesized retrospective and current knowledge and identified gaps in educational interventions aimed at increasing providers' awareness and attitudes toward trafficking. A systematic search of four databases identified peer-reviewed published papers between January 1, 2000 and September 1, 2018. The Cochrane Collaboration's Preferred Reporting Items for Systematic Reviews was followed. Study quality was assessed using the Downs and Black checklist. The Psychometric Grading Framework was used to assess the validity of instruments. Findings across studies (N = 7) reveal providers (mostly social workers and physicians) have low awareness of trafficking and can have negative attitudes toward victims. Multiphase educational approaches and use of content experts, including survivors, in developing interventions enhanced sustainability of outcomes. Targeting multidisciplinary health care teams, including nurses, enhanced interventions.

Promoting Health Equity Through Trauma-Informed Care: Critical Role for Physicians in Policy and Program Development.

Trauma-informed care has emerged as an important model to address the pervasiveness of traumatic experiences across the life cycle and their association with significant adverse medical and psychiatric consequences. To achieve health equity, in which all people have the opportunity for health, it is crucial for physicians to become comfortable with a neurobiopsychosocial understanding of trauma and how to provide optimal trauma-informed care. Given the pervasiveness of trauma exposure, and its impact on individual and community health, this paradigm shift in adult health care delivery systems requires physician engagement at every stage of development and implementation.

Radiologic Findings in Intimate Partner Violence.

Purpose To assess the radiologic findings associated with intimate partner violence (IPV). Materials and Methods Electronic medical records of 185 patients referred to the IPV support program from the emergency department (ED) between January 2015 and October 2016 were retrospectively reviewed and compared with an age- and sex-matched control group of 555 subjects (1:3 ratio of IPV victims to control subjects) who presented to the ED. Reports of all imaging studies performed within 5 years prior to the index ED visit were reviewed. Results The majority of patients who experienced IPV (mean age, 34.2 years ± 12.2 [standard deviation]) were female (178 of 185 [96.2%]) and were largely African American (69 of 185 [37.3%]). Demographic and clinical variables independently associated with IPV were race (odds ratio [OR] range, 3.2-5.9; 95% confidence interval [CI]: 1.8, 12.7), psychiatric comorbidities (OR, 5.4; 95% CI: 3.4, 8.8), and homelessness (OR, 13.0; 95% CI: 5.4, 31.2). IPV victims underwent more imaging studies in the preceding 5 years (median, four studies) than did control subjects (median, one study). Obstetric-gynecologic findings (OR, 4.4; 95% CI: 2.1, 9.6) and acute fractures (OR, 2.4, 95% CI: 1.1, 5.3) seen on images were independently associated with IPV. The addition of imaging findings to demographic and clinical variables increased the area under the receiver operating characteristic curve (AUC) of the multivariate model to detect IPV (0.87 vs 0.86, P < .01), and the cross-validated multivariate model had an AUC of 0.85. Acute fractures involved the face or skull (range, P < .01 to P = .05), and chronic fractures affected the extremities and nasal bone (P < .01 and P = .05, respectively) more frequently in the IPV group than in the control group. Conclusion Intimate partner violence victims undergo more imaging studies and have a higher frequency of potential violence-related imaging findings when compared with age- and sex-matched control subjects. © RSNA, 2019 See also the editorial by Flores and Narayan in this issue.

Buriti oil (Mauritia flexuosa L.) negatively impacts somatic growth and reflex maturation and increases retinol deposition in young rats.

Buriti oil contains nutrients such as essential fatty acids and vitamins, which are directly involved with neonates' development. However, the refining process of this oil can change its nutrient profile. This study investigated the effects of maternal consumption of Buriti oil (crude or refined), on reflex and somatic development and retinol levels in neonatal rats. Thirty-six Wistar male neonate rats born from mothers who consumed diet with 7% lipids during gestation and lactation were used. Rats were randomized into three groups: rats receiving diet added of soybean oil (control-CG), crude Buriti oil (CB) and refined Buriti oil (RB). Offspring weight, tail length, reflex ontogeny and somatic maturation were assessed during lactation. At the end of the experiment, serum and liver retinol concentrations were measured. Animals from CB and RB groups showed delayed onset of palm grasp, righting reflex and cliff avoidance reflexes compared to the control group (CG). However, animals from RB group showed anticipation of auditory startle compared to those from BC group. Regarding somatic maturation indicators, animals from RB group showed delayed eye opening and eruption of superior and inferior incisors in relation to control and anticipation in the auditory conduit opening in relation to CB group. Rats from CB and RB groups showed higher serum and liver vitamin A contents. Buriti oil delays physical parameters and reflex maturation and increases serum and liver retinol deposition among neonatal rats.

[Precision of guidewire placement--can it be improved by applying the new, isocentric aiming principle?]. / Können Führungsdrähte durch ein neues isozentrisches Zielverfahren präziser platziert werden?

BACKGROUND: Exact placement of a guidewire is difficult for the less experienced surgeon as this complex 3D task usually is controlled by means of 2D fluoroscopic projections. The new isocentric aiming principle presented here splits up the 3D task into two planar, 2D steps. Movements of the guidewire to achieve correct placement are limited to one plane per step and can therefore be exactly controlled by fluoroscopy. The fluoroscopic projection needs to be changed only once in between the two steps. METHODS: The isocentric aiming principle became applicable to the proximal femur region by means of a mechanical aiming device. We have done an experimental study in order to compare the new isocentric aiming principle to the freehand aiming technique which is routinely applied. We documented the precision of guidewire placement achieved (angular deviation of the guidewire in two projections, linear deviation of the actual from the intended entry point), number of fluoroscopic controls, and procedure time when guidewire placement is done by an experienced and by an inexperienced surgeon. RESULTS: When applying the isocentric aiming principle the inexperienced surgeon succeeded in fixing the entry angle of the guidewire more precisely both in the AP [1.3 degrees (0.0-2.0 degrees ) versus 2.3 degrees (0.0-9.0 degrees ), p=0.034] as well as in the axial view [1.0 degrees (0.0-2.5 degrees ) versus 6.5 degrees (0.0-12.0 degrees ), p=0.036]. Linear displacement was not significantly different between the two methods: 4.4 (0.7-9.6) mm deviation with the isocentric aiming principle versus 3.9 (1.6-5.7) mm, p=0.406, when the freehand technique is applied. When applying the isocentric aiming principle for guidewire placement the experienced surgeon achieved less precise angulation in the AP view [2.5 degrees (0.0-4.0 degrees ) versus 1.8 degrees (0.0-3.5 degrees ), p=0.061], improved precision in the axial view [2.0 degrees (1.0-3.0 degrees ) versus 3.0 degrees (0.0-5.0 degrees ), p=0.074], and a slightly worsened linear displacement [2.5 (1.0-4.2) mm versus 2.0 (1.0-2.6) mm, p=0.131]. Both surgeons needed less fluoroscopic controls when using the isocentric aiming principle instead of the freehand aiming method: inexperienced surgeon: 8.0 controls (7.0-16.0) instead of 13.0 controls (7.0-16.0), p=0.043; experienced surgeon: 14.5 controls (8.0-26.0) instead of 16.5 controls (12.0-33.0), p=0.282. However due to the additional time needed to fix and align the aiming device to the bone both surgeons required increased procedure time when using the isocentric aiming principle: 4.3 (3.0-6.9) min instead of 2.6 (2.2-4.0) min, p=0.005, for the inexperienced surgeon and 3.3 (2.3-4.3) min instead of 1.9 (1.4-2.8) min, p=0.001, for the experienced surgeon. CONCLUSIONS: Based on the experimental results we would suggest clinical application of the isocentric aiming principle especially for the less experienced surgeon. Increased precision would outweigh the drawback of a slightly prolonged procedure time. X-ray exposure may also be reduced when using the isocentric aiming principle for guidewire placement. However our results have to be verified by a clinical study beforehand. The isocentric aiming principle can also be applied in other situations that allow for two orthogonal projections for guidewire placement.

Augmentation of implant purchase with bone cements: an in vitro study of injectability and dough distribution.

Vertebroplasty is widely used to treat (augment) osteoporotic fractures of the spine. This technique--with or without metallic implants--might have more widespread indications, if the mechanics of the injection and distribution of the cement dough through cannulated instruments and implants were better understood. This study was performed to investigate injectability of calcium phosphate and acrylic bone cements through implant prototypes, which featured different perforated sleeve designs. Using a custom-made capillary rheometer, the forces needed to inject 10 mL of the cement dough through standard cannulas were measured in the first series of experiments. In the second series, plastic sleeves were attached to the rheometer, simulating the implant. In both series, the dough was injected into ambient laboratory atmosphere, and in the second series, cement distribution was analyzed by means of an optical system. Injection of cement dough through the cannulas required forces between 50 and 400 N in the case of acrylic cements and between 40 and 500 N in case of the calcium phosphate cements. Using different sleeves did not have a significant influence on the distribution of the cement dough around the sleeve. The amount of cement dough injected was reduced when a perforated implant was attached to the cannula. More material was delivered through the proximal holes of the implant, leading to a V-shaped distribution of the cement dough. Among topics to be investigated in future studies is determination of the injectability of cement dough into trabecular bone or bone-like structures.

Nucleoside diphosphate kinase of Trypanosoma brucei.

Nucleoside diphosphate kinase (NDPK) is a highly conserved, multifunctional enzyme. Its originally described function is the phosphorylation of nucleoside diphosphates to the corresponding triphosphates, using ATP as the phosphate donor and a high-energy phosphorylated histidine residue as the reaction intermediate. More recently, a host of additional functions of NDPK have been discovered. Some of these correlate with the capacity of NDPK to transphosphorylate other proteins, in a manner reminiscent of bacterial two-component systems. Other functions may be mediated by direct DNA-binding of NDPK. This study describes the identification of NDPK from the parasitic protozoon Trypanosoma brucei. The genome of this major disease agent contains a single gene for NDPK. The predicted amino acid sequence of the trypanosomal enzyme is highly conserved with respect to all other species. The protein is constitutively expressed and is present in procyclic and in bloodstream forms. Immunofluorescence and immuno-electron microscopy demonstrate that trypanosomal NDPK (TbNDPK) is predominantly localized in the cell nucleus. Histidine phosphorylation of TbNDPK is essentially resistant to the experimental compound LY266500, a potent inhibitor of histidine phosphorylation of trypanosomal succinyl coenzyme A synthase.

Quantitation of atherosclerosis by magnetic resonance imaging and 3-D morphology operators.

The objective was to ascertain whether MRI and image processing can be used to quantify atherosclerosis by measuring wall thickness in rabbit aorta. The abdominal aortas of 2 healthy and 5 atherosclerotic rabbits were examined with a gradient-echo inflow angiography sequence (2DI) and a proton density weighted turbo-spin-echo sequence (PDW). Using thresholding by four observers and 3D morphology operators, segmentation of the artery and vein lumina was performed from the 2DI sequence, and of surrounding fat and muscle from the PDW sequence. Remaining voxels adjacent to the aortic lumen were classified as vessel wall. By measuring the vessel wall volume and the lumen volume, the wall percentage was calculated. The values were significantly higher for the diseased animals than for unaffected individuals (p < 0.01). It is concluded that aortic wall thickening in atherosclerotic rabbits can be measured quantitatively by using MRI combined with 3D morphology image processing operators.