Associations between adolescents watching pornography and poor mental health in three Swedish surveys.

The aim of this study was to examine the association between watching pornography and poor mental health in three repeated cross-sectional surveys in Sweden (2004, 2009, 2014) among high school seniors (13,277 students) with an average age of 18 years. The same index questions concerning ever having watched pornography and the frequency of watching pornography during the last year were combined with three different measures of psychological health and background control variables in multiple logistic regression and forward stepwise logistic regression models. The repeated cross-sectional surveys did not find any consistent associations across years between poor mental health and ever having watched pornography or the frequency of watching pornography. Having watched deviant pornography (containing violence, children and/or animals) was associated with poor mental health among boys in two surveys but only in one survey among girls. Other characteristics, such as mother's unemployment (especially boys), parenting style (especially high controlling parents among boys) and experiences of sexual abuse (especially penetrating abuse among girls), were more consistently and strongly associated to poor mental health across the three surveys. This study stresses the importance of controlling for multiple background variables when studying the association between watching pornography and mental health, since the association might primarily be explained by underlying confounding variables.

Sexual harassment among employees and students at a large Swedish university: who are exposed, to what, by whom and where - a cross-sectional prevalence study.

BACKGROUND: Sexual harassment (SH) in the workplace is prevalent and associated with poor health. Universities are large workplaces with complex formal and informal power relations, which may influence the prevalence of SH. Although employees and students share the university context, few studies on SH have included both groups. The overall aim of the study was to investigate SH among employees and students at a large Swedish public university regarding types of harassment, prevalence in different groups, characteristics of the perpetrators, and the circumstances in which it occurs. METHODS: A cross-sectional analysis was performed, based on a web-based survey with 120 items that was sent out to all staff, including PhD students (N = 8,238) and students (N = 30,244) in November 2019. The response rate was 33% for staff and 32% for students. Exposure to SH was defined as having experienced at least one of ten defined SH behaviors during their work or studies. RESULTS: Among women, 24.5% of staff and 26.8% of students reported having been exposed to SH. The corresponding figures were 7.0% and 11.3% for male staff and students and 33.3% and 29.4% for non-binary individuals among staff and students. Unwelcome comments, suggestive looks or gestures, and 'inadvertent' brushing or touching were the three most common forms of reported harassment, both among staff and students. Attempted or completed rape had been experienced by 2.1% of female and 0.6% of male students. Male and female perpetrators were reported by about 80% and 15%, respectively, of exposed participants. Among staff most reported events occurred during the everyday operation of the university, while among students the majority of the events took place during social events linked to student life. When exposed to a perpetrator from the same group (staff or students), women reported more often being in a subordinate power position in relation to the perpetrator. CONCLUSIONS: The results indicate that sexual harassment is common in the university context, and interventions and case management routines of events should consider power relations between victim and perpetrator, as well as the various contexts within which sexual harassment takes place.

Child Sexual Abuse-Challenging Conditions for Adult Oral Health: A Qualitative Study.

The aim was to analyze perceptions of oral health in adults who have been exposed to child sexual abuse. Eleven participants (10 women), 19 to 56 y of age, who had experienced sexual abuse as children were purposively selected and interviewed in-depth. The participants were encouraged to describe how they perceived the effect of the sexual abuse on their oral health as adults. The interviews were recorded digitally and transcribed verbatim. The collected material was analyzed according to qualitative content analysis. The theme "challenging conditions for maintaining oral health" was identified, comprising 2 categories: first, "the emotional significance," with the subcategories 1) emotional barriers and 2) powerful relief, and second, "the obstacles to oral health," with the subcategories 1) daily self-care with complications and 2) dental appointments with difficulties. The findings indicate that the experience of sexual abuse during childhood can have a negative impact on oral care in adulthood. The informants stated that oral health was of utmost importance but also associated with strong emotions. There were obstacles to maintenance of oral health that were difficult to surmount.Knowledge Transfer Statement:The study provides access to the attitudes of survivors of child sexual abuse regarding oral health and the needs and obstacles that they experience. This is important knowledge for dental professionals to optimize dental care.

Assessing work capacity - reviewing the what and how of physicians' clinical practice.

BACKGROUND: Although a main task in the sickness certification process, physicians' clinical practice when assessing work capacity has not been thoroughly described. Increased knowledge on the matter is needed to better understand and support the certification process. In this review, we aimed to synthesise existing qualitative evidence to provide a clearer description of the assessment of work capacity as practiced by physicians. METHOD: Seven electronic databases were searched systematically for qualitative studies examining what and how physicians do when they assess work capacity. Data was analysed and integrated using thematic synthesis. RESULTS: Twelve articles were included. Results show that physicians seek to form a knowledge base including understanding the condition, the patient and the patient's workplace. They consider both medical and non-medical aspects to affect work capacity. To acquire and process the information they use various skills, methods and resources. Medical competence is an important basis, but not enough. Time, trust, intuition and reasoning are also used to assess the patient's claims and to translate the findings into a final assessment. The depth and focus of the information seeking and processing vary depending on several factors. CONCLUSION: The assessment of work capacity is a complex task where physicians rely on their non-medical skills to a higher degree than in ordinary clinical work. These skills are highly relevant but need to be complemented with access to appropriate resources such as understanding of the associations between health, work and social security, enough time in daily work for the assessment and ways to better understand the patient's work place. Also, the notion of an "objective" evaluation is questioned, calling for a greater appreciation of the complexity of the assessment and the role of professional judgement.

Versatile optical laser system for experiments at the European X-ray free-electron laser facility.

We present the main features of the final prototype of a pulsed optical laser, developed for pump-probe and other experiments in conjunction with the femtosecond x-ray beams at the European X-ray free-electron laser facility. Adapted to the temporal x-ray emission pattern of the facility, the laser provides 10 Hz bursts of up to 600 µs duration with intra-burst pulse frequencies as high as 4.5 MHz. In this mode, we have generated pulses as short as 12 fs at 350 W average power during the burst and with beam qualities close to the diffraction limit. This is, to the best of our knowledge, the highest power to date of a few-cycle laser operating at a center wavelength of 800 nm. Important for experimental flexibility, the laser can be configured in various unique ways, enabling, e.g., energy scaling to >3 mJ per pulse through a frequency change down to 100 kHz and the generation of nearly transform limited pulses between 12 fs and 300 fs. In addition to the 800 nm femtosecond beam line, a synchronized long pulse (0.8 ps or 400 ps) 1030 nm beam can be utilized, offering up to 4 kW burst average power, i.e. up to 40 mJ per pulse at 100 kHz. Efficient nonlinear wavelength conversion and tuning through intrinsic and external means further enhance the capabilities of the laser.

Thomson spectrometer-microchannel plate assembly calibration for MeV-range positive and negative ions, and neutral atoms.

We report on the absolute calibration of a microchannel plate (MCP) detector, used in conjunction with a Thomson parabola spectrometer. The calibration delivers the relation between a registered count numbers in the CCD camera (on which the MCP phosphor screen is imaged) and the number of ions incident on MCP. The particle response of the MCP is evaluated for positive, negative, and neutral particles at energies below 1 MeV. As the response of MCP depends on the energy and the species of the ions, the calibration is fundamental for the correct interpretation of the experimental results. The calibration method and arrangement exploits the unique emission symmetry of a specific source of fast ions and atoms driven by a high power laser.

Enhanced proton acceleration by an ultrashort laser interaction with structured dynamic plasma targets.

We experimentally demonstrate a notably enhanced acceleration of protons to high energy by relatively modest ultrashort laser pulses and structured dynamical plasma targets. Realized by special deposition of snow targets on sapphire substrates and using carefully planned prepulses, high proton yields emitted in a narrow solid angle with energy above 21 MeV were detected from a 5 TW laser. Our simulations predict that using the proposed scheme protons can be accelerated to energies above 150 MeV by 100 TW laser systems.

Complementary ion and extreme ultra-violet spectrometer for laser-plasma diagnosis.

Simultaneous detection of extreme ultra-violet (XUV) and ion emission along the same line of sight provides comprehensive insight into the evolution of plasmas. This type of combined spectroscopy is applied to diagnose laser interaction with a spray target. The use of a micro-channel-plate detector assures reliable detection of both XUV and ion signals in a single laser shot. The qualitative analysis of the ion emission and XUV spectra allows to gain detailed information about the plasma conditions, and a correlation between the energetic proton emission and the XUV plasma emission can be suggested. The measured XUV emission spectrum from water spray shows efficient deceleration of laser accelerated electrons with energies up to keV in the initially cold background plasma and the collisional heating of the plasma.

The Thomson deflectometer: a novel use of the Thomson spectrometer as a transient field and plasma diagnostic.

Laser accelerated proton beams have been used for field characterization in expanding plasmas. The Thomson parabola spectrometer, as a charged particles analyzer, also allows precise measurement of the charged particles' trajectories. The proton's deflections by fast changing plasma fields can be measured with the new design of the Thomson parabola spectrometer and, therefore, it can be applied for proton deflectometry. It is shown that from resulting spectrograms the plasma field dynamics can be reconstructed with high temporal resolution. In a proof-of-principle experiment, a weakly relativistic plasma expansion is studied as an example.

10-Hz grazing--incidence pumped Ni-like Mo x-ray laser.

The operation of a Ni-like Mo x-ray laser at 18.9 nm with a repetition rate of 10 Hz has been demonstrated. The laser has been pumped applying the grazing incidence pump arrangement, where a short (picoseconds) pulse irradiates a Mo plasma column generated by a long (a few hundred picoseconds) pulse. The delayed short pulse is incident at a grazing angle on the plasma to heat it efficiently. We used a total energy of less than 450 mJ ( 150 mJ in the long and 250-300 mJ in the short pulse) in a line focus of 7 mm by 50 microm .

Transverse spatial coherence of a transient nickellike silver soft-x-ray laser pumped by a single picosecond laser pulse.

The degree of spatial coherence in the direction perpendicular to the target surface is reported for a transient nickellike silver x-ray laser at 13.9 nm. An x-ray laser plasma column was produced by irradiating a slab silver target with a single shaped picosecond laser pulse with energy less than 3 J. Young's double-slit method was applied to measure the fringe visibility as a function of the slit separation for different target lengths. The diameter of the equivalent incoherent source and the coherence radius of the output radiation were determined as well.

High-frequency oscillatory ventilation in pediatric patients.

HFOV is a mode of ventilation that can achieve oxygenation and ventilation while maintaining maximal lung recruitment on the deflation limb of its pressure-volume curve. The primary theoretical advantages of HFOV over CMV in the management of acute lung injury are that HFOV allows adequate alveolar ventilation with minimal peak-trough pressure changes, provides lung recruitment, and avoids end-inspiratory overdistension of the relatively compliant nondependent lung. Taken together, the results of studies in animals, preterm and term neonates, and older pediatric patients reveal that an "open-lung" strategy, with the goal of a high end-expiratory lung volume, is safe and superior to CMV in both the short-term (rapidly improved oxygenation and/or ventilation) and longer-term (lower incidence of chronic lung disease). The improved longer-term clinical outcomes on HFOV are presumably because of less ventilator-induced lung injury. As experience with HFOV in older patients grows, ventilator technology matures, and understanding of the pathophysiology of acute respiratory distress syndrome (RDS) deepens, it is likely that HFOV will find widespread use for the management of respiratory failure caused by acute lung injury in patients from preterm neonates to adults.

Bacterial subretinal abscess: a case report and review of the literature.

PURPOSE: To report a case of Klebsiella subretinal abscess with a successful visual outcome with treatment and to review the literature pertaining to focal intraocular infection in bacterial endophthalmitis. METHODS: Clinical data including medical history, findings on physical examination, blood cultures, and an abdominal computed tomographic scan were collected in a 32-year-old man with Klebsiella sepsis, liver abscesses, and a focal subretinal abscess. Ocular data including visual acuity, fundus photographs, fluorescein angiography, and ultrasound were evaluated, as were results of culture and histopathologic studies. RESULTS: Despite immediate intervention, including vitreous tap and intravitreal antibiotics, the eye deteriorated, with enlargement of the abscess. A pars plana vitrectomy was performed in which the subretinal abscess material was removed after an extensive retinectomy of the involved area in association with an endophotocoagulative barrier and intravitreal amikacin without gas or oil tamponade. Culture confirmed Klebsiella subretinal infection. A retinal detachment occurred 1 month postoperatively and was successfully repaired. Visual acuity was 20/30 and has remained stable for 14 months. CONCLUSION: Klebsiella endophthalmitis with subretinal abscess formation is a rare but devastating ocular condition. In the present case, prompt intervention with extensive retinectomy, complete abscess excision, and intravitreal antibiotic therapy resulted in unprecedented visual recovery.

Acquisition of expression of the Pseudomonas aeruginosa ExoU cytotoxin leads to increased bacterial virulence in a murine model of acute pneumonia and systemic spread.

Pseudomonas aeruginosa is the nosocomial bacterial pathogen most commonly isolated from the respiratory tract. Animal models of this infection are extremely valuable for studies of virulence and immunity. We thus evaluated the utility of a simple model of acute pneumonia for analyzing P. aeruginosa virulence by characterizing the course of bacterial infection in BALB/c mice following application of bacteria to the nares of anesthetized animals. Bacterial aspiration into the lungs was rapid, and 67 to 100% of the inoculum could be recovered within minutes from the lungs, with 0.1 to 1% of the inoculum found intracellularly shortly after infection. At later time points up to 10% of the bacteria were intracellular, as revealed by gentamicin exclusion assays on single-cell suspensions of infected lungs. Expression of exoenzyme U (ExoU) by P. aeruginosa is associated with a cytotoxic effect on epithelial cells in vitro and virulence in animal models. Insertional mutations in the exoU gene confer a noncytotoxic phenotype on mutant strains and decrease virulence for animals. We used the model of acute pneumonia to determine whether introduction of the exoU gene into noncytotoxic strains of P. aeruginosa lacking this gene affected virulence. Seven phenotypically noncytotoxic P. aeruginosa strains were transformed with pUCP19exoUspcU which carries the exoU gene and its associated chaperone. Three of these strains became cytotoxic to cultured epithelial cells in vitro. These strains all secreted ExoU, as confirmed by detection of the ExoU protein with specific antisera. The 50% lethal dose of exoU-expressing strains was significantly lower for all three P. aeruginosa isolates carrying plasmid pUCP19exoUspcU than for the isogenic exoU-negative strains. mRNA specific for ExoU was readily detected in the lungs of animals infected with the transformed P. aeruginosa strains. Introduction of the exoU gene confers a cytotoxic phenotype on some, but not all, otherwise-noncytotoxic P. aeruginosa strains and, for recombinant strains that could express ExoU, there was markedly increased virulence in a murine model of acute pneumonia and systemic spread.

Continuous improvement learning for residents.

Physicians must be ready to assume an active role in the design, implementation, and improvement of emerging models of health care delivery. Knowledge and skill in continuous improvement prepare them to engage seriously in the processes of change, on the basis of the same scientific principles they always have relied on in the use of evidence to improve outcomes. This includes include the ability to 1) identify the health needs of the individuals and communities for which they provide health services; 2) assess the impact of current practice with appropriate outcome measures; 3) discover what in the process of health care may be contributing to less than desired outcomes; 4) design and test interventions to change the process of care to improve outcomes; 5) act as an effective member of the interdisciplinary team required to complete these tasks; and 6) consider ethical principles and professional values when making decisions about change in health services delivery. Graduate medical education presents special opportunities and challenges for learning about continuous improvement. Early experiences at Rainbow Babies and Children's Hospital in Cleveland and Children's Hospital in Boston suggest how we might prepare pediatricians and other physicians to create positive change and continually improve health care.