Testing evolutionary conflict theories for sexual and physical intimate partner violence in Sub-Saharan Africa.

Intimate partner violence (IPV) refers to physical, sexual and psychological violence. Here an evolutionary approach is used to compare risk factors for male-to-female IPV perpetration, analysing physical and sexual IPV separately. Two hypotheses based on sexual conflict theory have been applied to IPV perpetration, but they remain largely untested using empirical data: (a) men perpetrate IPV in response to a perceived threat to their paternity certainty; and (b) IPV is caused by men pursuing a higher fertility optima than their partners, either within marriage (reproductive coercion) or outside marriage (paternal disinvestment). Demographic Health Survey data from couples in 12 sub-Saharan African countries (n = 25,577) were used to test these evolutionary hypotheses, using multilevel models and controlling for potential social and environmental confounds. The results show that evolutionary theory provides important insight into different risk factors by IPV type. Indicators of paternity concern are associated with an increased risk of both physical and sexual IPV, indicators of paternal disinvestment are associated with an increased risk of physical IPV only, while reproductive coercion is not associated with either IPV type. The risk factors identified here correspond with proximate-level explanations for IPV perpetration, but an evolutionary interpretation explains why these particular factors may motivate IPV in certain contexts.

No relationship found between female genital cutting and intimate partner violence across six sub-Saharan African countries.

Female genital cutting (FGC) and intimate partner violence (IPV) are highly prevalent forms of violence against women, and the UN has encouraged strengthening policy linkages between FGC and IPV programme work (UN Women, Female genital mutilation/cutting and violence against women and girls. Strengthening the policy linkages between different forms of violence. UN Women, 2017a). However few studies have examined the relationship between these behaviours. This study addresses two research gaps identified by the UN; (a) whether women with FGC are more likely to experience physical or sexual IPV, and (b) whether women's IPV experiences are associated with their support for FGC. Multilevel multivariate logistic regression models were run using Demographic and Health Survey data from 6 sub-Saharan African countries (Burkina Faso, Ethiopia, The Gambia, Ivory Coast, Kenya and Nigeria, n33,170). Our results show no association between FGC and IPV. Women with FGC are not at greater risk of experiencing IPV, and women who experienced IPV in the preceding year are not more likely to support FGC. Further, the importance of individual and community factors differ; IPV experience is influenced by individual factors, whereas FGC support is more influenced by ethnic group characteristics. Although the proposition that FGC and IPV could be tackled collaboratively is attractive for policy makers, these results are important because they indicate that eradication programmes will be more effective when targeted at specific behaviours.

Frequency-dependent female genital cutting behaviour confers evolutionary fitness benefits.

Female genital cutting (FGC) has immediate and long-term negative health consequences that are well-documented, and its elimination is a priority for policymakers. The persistence of this widespread practice also presents a puzzle for evolutionary anthropologists due to its potentially detrimental impact on survival and reproductive fitness. Using multilevel modelling on demographic health survey datasets from five West African countries, here we show that FGC behaviour is frequency-dependent; the probability that girls are cut varies in proportion to the FGC frequency found in their ethnic group. We also show that this frequency-dependent behaviour is adaptive in evolutionary fitness terms; in ethnic groups with high FGC frequency, women with FGC have significantly more surviving offspring than their uncut peers, and the reverse is found in ethnic groups with low FGC frequency. Our results demonstrate how evolutionary and cultural forces can drive the persistence of harmful behaviours.

Platelet dysfunction is an early marker for traumatic brain injury-induced coagulopathy.

BACKGROUND: The goal of this study is to determine the presence of platelet dysfunction in patients with traumatic brain injury (TBI). The mechanisms underlying the coagulopathy associated with TBI remain elusive. The question of platelet dysfunction in TBI is unclear. METHODS: This was a prospective observational study conducted at Memorial Hospital of South Bend, IN, and Denver Health Medical Center, CO. A total of 50 patients sustaining TBI, and not under treatment with anticoagulants or platelet inhibitors, were analyzed utilizing modified thromboelastography (TEG) with platelet mapping (TEG/PM), along with standard coagulation tests. RESULTS: Compared to normal controls, patients with severe TBI had a significantly increased percentage of platelet ADP and arachidonic acid (AA) receptor inhibition. Furthermore, the percentage of ADP inhibition distinguished between survivors and non-survivors in patients with TBI (Mann-Whitney test, P = 0.035). ADP inhibition correlates strongly with severity of TBI (Mann-Whitney test, P = 0.014), while AA inhibition did not. CONCLUSION: These data indicate that early platelet dysfunction is prevalent after severe TBI, can be measured in a point-of-care setting using TEG/PM, and correlates with mortality. The mechanism responsible for this platelet dysfunction and associated implications for TBI management remains to be defined.

Blood component therapy in trauma guided with the utilization of the perfusionist and thromboelastography.

25-35% of all seriously injured multiple trauma patients are coagulopathic upon arrival to the emergency department, and therefore early diagnosis and intervention on this subset of patients is important. In addition to standard plasma based tests of coagulation, the thromboelastogram (TEG) has resurfaced as an ideal test in the trauma population to help guide the clinician in the administration of blood components in a goal directed fashion. We describe how thromboelastographic analysis is used to assist in the management of trauma patients with coagulopathies presenting to the emergency department, in surgery, and in the postoperative period. Indications for the utilization of the TEG and platelet mapping as point of care testing that can guide blood component therapy in a goal directed fashion in the trauma population are presented with emphasis on the more common reasons such as massive transfusion protocol, the management of traumatic brain injury with bleeding, the diagnosis and management of trauma in patients on platelet antagonists, the utilization of recombinant FVIIa, and the management of coagulopathy in terminal trauma patients in preparation for organ donation. The TEG allows for judicious and protocol assisted utilization of blood components in a setting that has recently gained acceptance. In our program, the inclusion of the perfusionist with expertise in performing and interpreting TEG analysis allows the multidisciplinary trauma team to more effectively manage blood products and resuscitation in this population.

Society of Trauma Nurses position statement on the role of the clinical nurse specialist in trauma.

The clinical nurse specialist (CNS) is included in the collective term advanced practice nurse. Preparation of the CNS involves completion of a graduate program with a clinical focus, specialty certification, and state-defined requirements for licensure.The trauma CNS demonstrates advanced clinical knowledge based on an in-depth understanding of the pathophysiology of trauma combined with extensive practical experience observing human responses to injury. The trauma CNS assumes the traditional subroles as expert practitioner, educator, consultant, and researcher with the proportion of time spent in each subrole based on the needs of the trauma program. The CNS's ability to minimize variances in care and prevent adverse outcomes directly support performance improvement. The Society of Trauma Nurses recognizes and supports the utilization of CNSs in trauma programs.

Reducing missed injuries at a level II trauma center.

The phenomenon of missed injury in trauma patients has been recognized for some time. Tertiary examination has been proposed as one strategy to decrease the incidence of missed injuries. The tertiary examination is a comprehensive reevaluation that includes a repeated head-to-toe examination and review of all laboratory and radiologic studies, completed within 24 hours of admission. The purpose of this study was to assess the statistical significance of missed injuries discovered through tertiary examinations at a level II trauma center. Over a period of 6 months, a tertiary examination was completed before discharge of admitted patients who met activation criteria. Of the 90 patients, 13 had a missed injury (incidence of 14%), which was significant. The 16 missed injuries represented only 2.7% of the total 589 injuries, which was not significant. The most commonly missed injuries were fractures of the extremities. We propose that tertiary examinations be adopted as a standard of care for patients admitted to level II trauma centers.

Informing the future: 2. Developing the role of community IPCNs.

This paper is the second in a two-part series summarising the main findings and conclusions of a review of the roles and responsibilities of infection prevention and control nurses commissioned by the Department of Health. It describes the core work of IPCNs, discusses the strengths and constraints of the current role and makes suggestions for future development.