Commentary on Kempe, the Next 50 Years.

This paper provides a reflection on the evolution of child maltreatment systems and research across the globe during the time since the establishment of the Kempe Center for the Prevention and Treatment of Child Abuse and Neglect (Kempe Center) over 50 years ago. While research has demonstrated that children who are victims of maltreatment have poorer outcomes than their peers, it is also clear that the child welfare workforce faces workforce challenges, and the system established 50 years ago is not the same as it is today. Efforts to move this field of study forward in a changing world rely upon the understanding of child abuse and neglect in the broader culture of our world, including disentangling poverty and social structures from neglect, supporting underrepresented people and communities, and identifying how best to balance the role of child welfare with community services. The Kempe Center's continued commitment to a multidisciplinary approach to understanding, preventing, and treating child maltreatment, while challenging professional and social reticence to address complex contributing issues and the impact of historical actions, is at the core of its work looking forward to the next 50 years. The continued focus of centering research as a critical component in moving the field forward in just and equitable ways is demonstrated in this sampling of current efforts to support better outcomes for children and families.

Future Treatments in Melanoma.

Melanoma is a highly malignant tumor that is relatively common in the United States. Surgical extirpation is the mainstay in treatment, but a multimodal therapeutic approach is increasingly important in the era of highly effective immune and targeted therapies. Although resection of melanoma will continue to be the mainstay of management for the conceivable future, improvements in multimodality therapy have and will continue to rewrite the therapeutic playbook for this lethal and increasingly complex malignancy for head and neck surgeons treating patients with melanoma.

Contextualizing Risk Perception and Trust in the Community-Based Response to Ebola Virus Disease in Liberia.

The 2014-15 Ebola Virus Disease (EVD) outbreaks in Western Africa became widespread in primarily three countries, Guinea, Liberia, and Sierra Leone. Unlike all previous outbreaks in Central and East Africa, which were confined to rural areas, the virus spread rapidly through West Africa as a result of transmission through high-density urban centres coupled with the effects of public distrust in outbreak response teams and local government officials. Objective: In this study, we examine the EVD epidemic in Liberia, the first country to implement a community-based response that led to changes in the trajectory of the epidemic. The focus on the role of community-based initiatives in outbreak response is often neglected in conventional epidemiological accounts. In this light, we consider the manner in which community-based strategies enabled a more effective response based on the establishment of better trust relations and an enhanced understanding of the risks that EVD posed for the community. Methodology: We conducted qualitative research in five distinct communities in Liberia three years after the outbreaks subsided. Data collection procedures consisted of semi-structured interviews and focus group discussions with residents. Results: We found that the implementation of a community-based response, which included the participation of Ebola survivors and local leaders, helped curb and ultimately end the EVD epidemic in Liberia. As community members became more directly involved in the EVD response, the level of trust between citizens, local officials, and non-governmental organization response teams increased. In turn, this led to greater acceptance in abiding to safety protocols, greater receptiveness to risk information, and changes in mobility patterns-all of which played a significant role in turning the tide of the epidemic.

Adiposity and spinal cord injury.

The drastic changes in body composition following spinal cord injury (SCI) have been shown to play a significant role in cardiovascular and metabolic health. The pattern of storage and distribution of different types of adipose tissue may impact metabolic health variables similar to carbohydrate, lipid and bone metabolism. The use of magnetic resonance imaging provides insights on the interplay among different regional adipose tissue compartments and their role in developing chronic diseases. Regional adipose tissue can be either distributed centrally or peripherally into subcutaneous and ectopic sites. The primary ectopic adipose tissue sites are visceral, intramuscular and bone marrow. Dysfunction in the central nervous system following SCI impacts the pattern of distribution of adiposity especially between tetraplegia and paraplegia. The current editorial is focused primarily on introducing different types of adipose tissue and establishing scientific basis to develop appropriate dietary, rehabilitation or pharmaceutical interventions to manage the negative consequences of increasing adiposity after SCI. We have also summarized the clinical implications and future recommendations relevant to study adiposity after SCI.

Substance abuse and child maltreatment.

Pediatricians and other medical providers caring for children need to be aware of the dynamics in the significant relationship between substance abuse and child maltreatment. A caregiver's use and abuse of alcohol, marijuana, heroin, cocaine, methamphetamine, and other drugs place the child at risk in multiple ways. Members of the medical community need to understand these risks because the medical community plays a unique and important role in identifying and caring for these children. Substance abuse includes the abuse of legal drugs as well as the use of illegal drugs. The abuse of legal substances may be just as detrimental to parental functioning as abuse of illicit substances. Many substance abusers are also polysubstance users and the compounded effect of the abuse of multiple substances may be difficult to measure. Often other interrelated social features, such as untreated mental illness, trauma history, and domestic violence, affect these families.