Incorporation of internal iliac arteries as target vessels during physician-modified fenestrated branched endovascular repair of pararenal abdominal aortic aneurysm with concomitant bilateral short common iliac artery aneurysms.

This report describes an alternative endovascular approach to iliac branch devices for treatment of an abdominal aortic aneurysm with concomitant bilateral short common iliac aneurysms. The short distance between the renal arteries and internal iliac artery origins made the addition of distal iliac branch devices to the proximal fenestrated stent graft challenging. We elected to perform physician-modified fenestrated branched endovascular repair, using four fenestrations for the visceral and renal arteries and an additional two directional branches for the bilateral internal iliac arteries. The patient recovered uneventfully, and the 24-month follow-up imaging shows successful aneurysm exclusion with patent internal iliac artery branches.

Positive Engagement with Pets Buffers the Impact of Intimate Partner Violence on Callous-Unemotional Traits in Children.

Childhood exposure to intimate partner violence (IPV) is associated with serious psychological outcomes including increased odds of developing callous-unemotional (CU) traits and behaviors. Recent studies suggest that concomitant exposure to animal cruelty (AC) may increase this risk. However, even under these circumstances, bonds with companion animals may still be a protective factor that buffers the deleterious impact of IPV on child adjustment. This cross-sectional study evaluates whether, and to what extent, the association between exposure to IPV and children's CU and empathic-prosocial (EP) traits vary as a function of children's positive engagement with pets and exposure to AC. Participants included 204 children (aged 7-12 years; 57% Latinx) and their maternal caregiver who were recruited from domestic violence agencies in a western US state. We conducted multiple moderation analyses to evaluate each outcome individually (i.e., CU traits, EP traits), adjusting for the effects of child age, gender, and Hispanic ethnicity. Positive engagement with pets significantly moderated the relationship between IPV and CU traits, ∇R = 0.03, F (1, 195) = 7.43, ß = -0.17, t(195) = -2.73, p = .007. Specifically, when high levels of positive engagement with pets is present, IPV is negatively associated with CU traits, whereas the reverse was true at low levels of positive engagement with pets. Evidence of moderation by AC was not supported. Our findings suggest that children who form close relationships with their pets in the context of IPV appear to derive important support from these animals; safeguarding the well-being of these animals may be critical to their long-term emotional health.

Antegrade Superficial Femoral Artery Access for Lower Extremity Arterial Disease Is Safe and Effective in the Outpatient Setting.

BACKGROUND: Antegrade superficial femoral artery (SFA) access for peripheral artery disease reduces the time, radiation, and contrast required with contralateral common femoral access (CFA). Yet, this technique remains underutilized in the treatment of SFA, popliteal and tibial disease, and there remains limited data on the safety and effectiveness of antegrade SFA access in the outpatient setting. METHODS: A retrospective review of lower extremity peripheral arterial interventions in our office-based endovascular suite was conducted from 2013 to 2018. Interventions necessitating CFA access such as iliac, common femoral, or deep femoral artery revascularization were excluded (n = 206). In addition, interventions potentially requiring large sheaths not amenable to SFA access (e.g., popliteal aneurysm) were excluded. Relevant demographic and treatment variables including postoperative complications were abstracted. RESULTS: We identified 718 patients, who underwent revascularization of the SFA, popliteal and tibial arteries. Antegrade SFA access was chosen in 448 patients (62.4%) with the remaining 270 patients having retrograde CFA access. Antegrade SFA access was achieved primarily with a 4-French sheath, while a majority of retrograde CFA interventions utilized a 6-French sheath for access (87.7% vs 69.5%, P < 0.001). Significantly less fluoroscopy (9.5 vs 16.4 min, P < 0.001) and contrast (25.4 vs 38.5 mL, P < 0.001) were used during SFA access compared with retrograde access. Technical success was achieved in 93.2% with antegrade SFA vs 94.8% retrograde CFA access (P = 0.42). The overall rate of complications was low for both cohorts (2.7% vs 3.7%, P = 0.78) and there were no statistical differences in access site complications (1.1% vs 1.5%, P = 0.94), hematoma (0.7% vs 1.1%, P = 0.84), and pseudoaneurysm (0.4% vs 0%, P = 0.98) between techniques. CONCLUSIONS: Percutaneous antegrade SFA access can be performed safely in the outpatient setting and remains an effective alternative to retrograde CFA access with significantly less utilization of fluoroscopy and contrast.

Exposure to intimate partner violence and internalizing symptoms: The moderating effects of positive relationships with pets and animal cruelty exposure.

BACKGROUND: It is estimated that more than half of children living in households where intimate partner violence (IPV) occurs are also exposed to animal cruelty (AC). Although prior research links bonds with pets with higher levels of socioemotional competence among school-age children, exposure to AC may negate the protective effects of pet ownership and/or exacerbate the potentially deleterious effect of IPV on children's mental health. OBJECTIVE: The current study evaluates whether and to what extent the associations between exposure to IPV and several indicators of children's mental health vary as a function of children's positive engagement with pets and exposure to AC. PARTICIPANTS AND SETTING: Participants included 204 children (aged 7-12 years; 47% female; 57% Latinx) and their maternal caregiver who were recruited from domestic violence agencies in a western U.S. state. METHOD: Multiple moderation analysis evaluated whether the association between children's exposure to IPV and internalizing and posttraumatic stress symptoms vary as a function of children's positive engagement with pets and exposure to AC. RESULTS: Analyses revealed several moderation effects for positive engagement with pets (e.g., internalizing problems: [b = -.15, t(195) = -2.66, p = .008]; posttraumatic stress symptoms: [b = -.13, t(195) = -2.24, p = .026]), whereas exposure to AC only moderated the association between IPV and anxious/depressed symptoms (b = .32, t(195) = -2.41, p = .017). CONCLUSIONS: These findings highlight the potential protective effects of positive engagement with pets and importance of screening for exposure to AC when engaging in trauma-informed work with children exposed to IPV.

Intimate Partner Violence Survivors' Reports of Their Children's Exposure to Companion Animal Maltreatment: A Qualitative Study.

Children living in households where intimate partner violence (IPV) is present are at increased risk of being exposed to concomitant maltreatment of companion animals. Recent research suggests that childhood exposure to maltreatment of companion animals is associated with compromised socioemotional well-being in childhood and adulthood. To date, there is a dearth of qualitative research examining how children experience animal maltreatment in the context of IPV. The current qualitative study explored the following research question in an ethnically diverse sample of IPV survivors: How do maternal caregivers convey the ways in which their children experience animal maltreatment in IPV-affected households? Sixty-five women with at least one child (age 7-12 years) were recruited from domestic violence agencies and described their child(ren)'s experiences of animal maltreatment in the home. Template analysis was used to analyze interview data (KALPHA = .90). Three themes emerged related to children's experiences of animal maltreatment: (a) direct exposure to animal maltreatment and related threats, (b) emotional and behavioral responses to animal maltreatment exposure, and (c) animal maltreatment as coercive control of the child. Results suggest that children's exposure to animal maltreatment is multifaceted and may exacerbate children's risk of negative psychosocial outcomes in the context of co-occurring IPV. Intervention programs designed to assist children exposed to IPV should consider the extent of children's awareness of the abuse of their pets and their strong and deleterious reactions to it.

Exploring Empathy and Callous-Unemotional Traits as Predictors of Animal Abuse Perpetrated by Children Exposed to Intimate Partner Violence.

We explored the relation between empathy, callous-unemotional (CU) traits, and animal abuse in a sample of 290 seven- to twelve-year-old children whose mothers were exposed to intimate partner violence (IPV). The sample comprises mostly Latino and White participants, and 55% of the children's mothers were born outside the United States (primarily Mexico). To our knowledge, among studies examining child-perpetrated animal abuse, this study is the first to examine empathy levels and one of only a few to examine CU traits. When comparing Griffith Empathy Measure (empathy) and Inventory of Callous-Unemotional Traits (callous-unemotional [CU] traits) scores with those from studies of White schoolchildren, our sample scored lower on affective empathy, higher on cognitive empathy, and lower for overall CU scores as well as Callous and Unemotional subscales. Of 290 children, 47 (16.2%) harmed an animal at least once according to either mother or child report. There were no significant sex or age differences between Abuse and No Abuse groups. The Abuse group scored significantly higher on affective empathy, CU, and Callousness/Unemotional subscales, and significantly lower on cognitive empathy. However, in regression analyses that controlled for income, only lower cognitive empathy and higher CU significantly predicted having abused an animal. In summary, low cognitive empathy (but not affective empathy) and CU traits may serve as reliable predictors of child animal abuse. However, replication of these results is necessary. A larger sample with a high percentage of Latino children whose mothers were exposed to IPV, along with a non-exposed comparison group, would be ideal.

The relations among animal abuse, psychological disorders, and crime: Implications for forensic assessment.

The confluence of developments in the assessment of animal abuse, the evolution of psychiatric nosology for the diagnosis of conduct disorder, legislative changes involving crimes against non-human animals, and the recent inclusion of crimes against animals in the FBI's National Incident-Based Reporting System, highlights the critical need for examining the forensic dimensions of animal abuse cases. We provide an overview of the research literature on these topics in the hope that forensic evaluators will have an evidence-based framework for assessing cases they encounter that include perpetration of violence against animals.

Discontinuation of Postoperative Prophylactic Antibiotics After Noninstrumented Spinal Surgery: Results of a Quality Improvement Project.

BACKGROUND: Numerous medical society guidelines recommend discontinuation of antibiotics at a maximum of 24 hours after noninstrumented spinal surgery, even when a drain is left in place. As a result of these recommendations, our institution's Neurosurgery Quality Improvement Committee decided to stop administering prolonged prophylactic systemic antibiotics (PPSAs) to patients with drains after noninstrumented spinal surgery. METHODS: We retrospectively reviewed data for patients who had noninstrumented spinal surgery performed by a neurosurgeon at our institution between December 2012 and July 2014 (PPSA period) and December 2014 and July 2016 (non-PPSA period) and had a drain left in place postoperatively. In the PPSA period, patients received antibiotics until drain removal. In the non-PPSA period, patients received antibiotics for a maximum of 24 hours. RESULTS: We identified 58 patients in the PPSA period and 55 in the non-PPSA period. Discontinuation of PPSAs resulted in a nonsignificant increase in the frequency of surgical site infections (SSIs; 0% in the PPSA period vs 4% in the non-PPSA period; P = .24). CONCLUSION: After discontinuing PPSAs for patients with noninstrumented spinal procedures, as is recommended for quality improvement, we saw a nonsignificant increase in our rate of SSIs. Further monitoring of this population is warranted.

A Template Analysis of Intimate Partner Violence Survivors' Experiences of Animal Maltreatment: Implications for Safety Planning and Intervention.

This study explores the intersection of intimate partner violence (IPV) and animal cruelty in an ethnically diverse sample of 103 pet-owning IPV survivors recruited from community-based domestic violence programs. Template analysis revealed five themes: (a) Animal Maltreatment by Partner as a Tactic of Coercive Power and Control, (b) Animal Maltreatment by Partner as Discipline or Punishment of Pet, (c) Animal Maltreatment by Children, (d) Emotional and Psychological Impact of Animal Maltreatment Exposure, and (e) Pets as an Obstacle to Effective Safety Planning. Results demonstrate the potential impact of animal maltreatment exposure on women and child IPV survivors' health and safety.

Intimate Partner Violence and Animal Abuse in an Immigrant-Rich Sample of Mother-Child Dyads Recruited From Domestic Violence Programs.

We examined rates of animal abuse in pet-owning families experiencing intimate partner violence (IPV). We also examined whether higher levels of IPV (as measured by subscales from the Conflict Tactics Scales) predicted increased risk for partner-perpetrated animal abuse. Our sample included 291 mother-child dyads, where the mothers sought services from domestic violence agencies. Nearly half the sample is comprised of Mexican immigrants. Mothers reported that 11.7% of partners threatened to harm a pet and 26.1% actually harmed a pet, the latter of which represents a lower rate than in similar studies. When examining animal abuse by "Hispanic status," follow-up analyses revealed significant omnibus differences between groups, in that non-Hispanic U.S.-born partners (mostly White) displayed higher rates of harming pets (41%) than either U.S.-born or Mexican-born Hispanic groups (27% and 12.5%, respectively). Differences in rates for only threatening (but not harming) pets were not significant, possibly due to a small number of partners ( n = 32) in this group. When examining whether partners' IPV predicted only threatening to harm pets, no IPV subscale variables (Physical Assault, Psychological Aggression, Injury, or Sexual Coercion) were significant after controlling for income, education, and Hispanic status. When examining actual harm to pets, more Psychological Aggression and less Physical Assault significantly predicted slightly higher risk of harm. However, Mexican-born partners had nearly 4 times lower risk of harming a pet. Overall, these results suggest that Hispanic men who are perpetrators of IPV are less likely to harm pets than non-Hispanic perpetrators of IPV, particularly if Mexican-born. Considering that the United States has a significant proportion of Mexican immigrants, it may be worthwhile to explore the topics of IPV and animal abuse within this group.

Concomitant Exposure to Animal Maltreatment and Socioemotional Adjustment among Children Exposed to Intimate Partner Violence: a Mixed Methods Study.

This study uses a mixed-methods approach to examine how patterns of exposure to animal maltreatment (AM) are related to socioemotional adjustment among children (N = 291) recruited from intimate partner violence (IPV) services. First, latent profile analysis (LPA) was used to identify subgroups of children with similar patterns of socioemotional functioning. Next, qualitative data from mothers and children were analyzed to identify thematic patterns in AM exposure among two subgroups of children identified through the LPA: Asymptomatic children and children with Emotional and Behavioral Difficulties (EBD). Seven themes were identified. Overall, EBD children, when compared to Asymptomatic children, were more likely to: a) have been exposed to severe forms of violence against animals, b) have experienced direct victimization by an IPV perpetrator following an effort to protect a pet, and c) express justification and normalization of violence against pets. Implications of our findings for research and clinical practice are discussed.

A single-center intervention to discontinue postoperative antibiotics after spinal fusion.

INTRODUCTION: Postoperative antibiotics (PA) are often administered to patients after instrumented spinal surgery until all drains are removed to prevent surgical site infections (SSI). This practice is discouraged by numerous medical society guidelines, so our institutional Neurosurgery Quality Improvement Committee decided to discontinue use of PA for this population. METHODS: We retrospectively reviewed data for patients who had instrumented spinal surgery at our institution for seven months before and after this policy change and compared the frequency of SSI and development of antibiotic related complications in patients who received PA to those who did not (non-PA). RESULTS: We identified 188 PA patients and 158 non-PA patients. Discontinuation of PA did not result in an increase in frequency of SSI (2% of PA patients vs. 0.6% of non-PA patients, p = .4). Growth of resistant bacteria was not significantly reduced in the non-PA period in comparison to the PA period (2% in the PA period and 1% in the non-PA period). The cost of antibiotics for PA patients was $5,499.62, whereas the cost of antibiotics for the non-PA patients was $0. On a per patient basis, the cost associated with antibiotics and resistant infections was significantly greater for patients who received PA than for those who did not (median of $26.32 with IQR $9.87-$46.06 vs. median of $0 with IQR $0-$0; p < .0001). CONCLUSION: After discontinuing PA for patients who had instrumented spinal procedures, we did not observe an increase in the frequency of SSI. We did, however, note that there was a non-significant decrease in the frequency of growth of resistant organisms. These findings suggest that patients in this population do not need PA, and complications can be reduced if PA are withheld.

Evaluation of the Parent-Report Inventory of Callous-Unemotional Traits in a Sample of Children Recruited from Intimate Partner Violence Services: A Multidimensional Rasch Analysis.

OBJECTIVE: Our study applied multidimensional item response theory (MIRT) to compare structural models of the parent-report version of the Inventory of Callous and Unemotional Traits (ICU; English and North American Spanish translations). METHOD: A total of 291 maternal caregivers were recruited from community-based domestic violence services and reported on their children (77.9% ethnic minority; 47% female), who ranged in age from 7 to 12 years (mean = 9.07, standard deviation = 1.64). We compared 9 models that were based on prior psychometric evaluations of the ICU. RESULTS: MIRT analyses indicated that a revised 18-item version comprising 2 factors (callous-unemotional and empathic-prosocial) was more suitable for our sample. Differential item functioning was found for several items across ethnic and language groups, but not for child gender or age. Evidence of construct validity was found. CONCLUSION: We recommend continued research and revisions to the ICU to better assess the presence of callous-unemotional traits in community samples of school-age children.

The role of callous/unemotional traits in mediating the association between animal abuse exposure and behavior problems among children exposed to intimate partner violence.

Children exposed to intimate partner violence are at increased risk for concomitant exposure to maltreatment of companion animals. There is emerging evidence that childhood exposure to maltreatment of companion animals is associated with psychopathology in childhood and adulthood. However, few studies have explored developmental factors that might help to explain pathways from animal maltreatment exposure to children's maladjustment. The present study addresses this gap in the literature by examining relations between children's exposure to animal maltreatment, callous/unemotional traits (i.e., callousness, uncaring traits, and unemotional traits), and externalizing and internalizing behavior problems. A sample of 291 ethnically diverse children (55% Latino or Hispanic) between the ages of 7 and 12 was recruited from community-based domestic violence services. A meditational path model indicated that child exposure to animal maltreatment was associated with callousness (ß=0.14), which in turn was associated with greater internalizing (ß=0.32) and externalizing problems (ß=0.47). The effect of animal maltreatment exposure on externalizing problems was mediated through callousness. Results suggest that callous/unemotional traits are a potential mechanism through which childhood exposure to animal maltreatment influences subsequent behavior problems. Future research is needed to evaluate the extent to which exposure to animal maltreatment affects children's adjustment over time in the context of other co-occurring adverse childhood experiences.

Antibiotic prophylaxis for subdural and subgaleal drains.

OBJECTIVE The authors sought to determine the effects of eliminating the use of prolonged prophylactic systemic antibiotics (PPSAs) in patients with subdural and subgaleal drains. METHODS Using a retrospective database, the authors collected data for patients over the age of 17 years who had undergone cranial surgery at their institution between December 2013 and July 2014 (PPSAs period) or between December 2014 and July 2015 (non-PPSAs period) and had subdural or subgaleal drains left in place postoperatively. RESULTS One hundred five patients in the PPSAs period and 80 in the non-PPSAs period were identified. The discontinuation of PPSAs did not result in an increase in the frequency of surgical site infection (SSI). The frequency of Clostridium difficile (CDI) and the growth of resistant bacteria were reduced in the non-PPSAs period in comparison with the PPSAs period. In the 8 months after the drain prophylaxis protocol was changed, $93,194.63 were saved in the costs of antibiotics and complications related to antibiotics. CONCLUSIONS After discontinuing PPSAs for patients with subdural or subgaleal drains at their institution, the authors did not observe an increase in the frequency of SSI. They did, however, note a decrease in the frequency of CDI and the growth of resistant organisms. It appears that not only can patients in this population do without PPSAs, but also that complications are avoided when antibiotic use is limited to 24 hours after surgery.

Children's experiences of companion animal maltreatment in households characterized by intimate partner violence.

Cruelty toward companion animals is a well-documented, coercive tactic used by abusive partners to intimidate and control their intimate partners. Experiences of co-occurring violence are common for children living in families with intimate partner violence (IPV) and surveys show that more than half are also exposed to abuse of their pets. Given children's relationships with their pets, witnessing such abuse may be traumatic for them. Yet little is known about the prevalence and significance of this issue for children. The present study examines the experiences of children in families with co-occurring pet abuse and IPV. Using qualitative methods, 58 children ages 7-12 who were exposed to IPV were asked to describe their experiences of threats to and harm of their companion animals. Following the interviews, template analysis was employed to systematically develop codes and themes. Coding reliability was assessed using Randolph's free-marginal multirater kappa (kfree=.90). Five themes emerged from the qualitative data, the most common being children's exposure to pet abuse as a power and control tactic against their mother in the context of IPV. Other themes were animal maltreatment to discipline or punish the pet, animal cruelty by a sibling, children intervening to prevent pet abuse, and children intervening to protect the pet during a violent episode. Results indicate that children's experiences of pet abuse are multifaceted, potentially traumatic, and may involve multiple family members with diverse motives.

Efficiency and factors influencing efficiency of Community Health Strategy in providing Maternal and Child Health services in Mwingi District, Kenya: an expert opinion perspective.

INTRODUCTION: Community Health Strategy (CHS) is a new Primary Health Care (PHC) model in Kenya, designed to provide PHC services in Kenya. In 2011, CHS was initiated in Mwingi district as one of the components of APHIA plus kamili program. The objectives of this study was to evaluate the efficiency of the CHS in providing MCH services in Mwingi district and to establish the factors influencing efficiency of the CHS in providing MCH services in the district. METHODS: This was a qualitative study. Fifteen Key informants were sampled from key stakeholders. Sampling was done using purposive and maximum variation sampling methods. Semi-structured in-depth interviews were used for data collection. Data was managed and analyzed using NVIVO. Framework analysis and quasi statistics were used in data analysis. RESULTS: Expert opinion data indicated that the CHS was efficient in providing MCH services. Factors influencing efficiency of the CHS in provision of MCH services were: challenges facing Community Health Workers (CHWs), Social cultural and economic factors influencing MCH in the district, and motivation among CHWs. CONCLUSION: Though CHS was found to be efficient in providing MCH services, this was an expert opinion perspective, a quantitative Cost Effectiveness Analysis (CEA) to confirm these findings is recommended. To improve efficiency of the CHS in the district, challenges facing CHWs and Social cultural and economic factors that influence efficiency of the CHS in the district need to be addressed.

A Life Course Approach to Understanding Poverty Among Older American Adults.

A relatively new strategy for studying the prevalence of poverty in America is to analyze it as a potential life course event. We use such an approach in order to examine the likelihood of both income and asset poverty for individuals between the ages of 60 and 90. Nearly half of all elderly Americans will encounter at least one year of poverty or near poverty across these ages. In addition, 58 percent of those between the ages of 60 and 84 will at some point fail to have enough liquid assets to allow them to weather an unanticipated expense or downturn in income. The policy and practice implications of these findings are discussed.

Descriptive analysis of individual and community factors among African American youths in urban public housing.

African American adolescents are disproportionately represented in urban public housing developments. These neighborhoods are generally characterized by high rates of poverty, crime, violence, and disorganization. Although evidence is emerging on youths in these communities, little is known about their depressive symptoms, perceived efficacy, or frequency of substance use and sex-risk behavior. Further, even less is known about their exposure to community and household violence, their parents' behavior, or their sense of connection to their communities. Using a sample of 782 African American adolescents living in public housing neighborhoods located in four large U.S. cities, this article attempts to rectify the observed gap in knowledge by presenting a descriptive overview of their self-reported depressive symptoms; self-efficacy; frequencies of delinquent and sexual-risk behavior; and alcohol, tobacco, and other drug use. The self-reported ratings of their parents' behavior as well as their exposure to community and household violence are presented. Analytic procedures include descriptive statistics and mean comparisons between genders and across research cities. Results suggest several differences between genders and across research sites. However, results are not very different from national data. Implications for social work practice are discussed.