The Care Of The Sexual Assault Patient

Survivors of sexual assault (SA) experience a range of physical and mental health consequences. Despite universal agreement that follow-up care improves outcomes, studies demonstrate only one-third of survivors receive assault related follow-up care. This study aims to describe the patient population presenting after SA, characteristics of their acute care, and rates of follow-up within one-year at two sites of the Yale New Haven Hospital, which includes an urban tertiary care hospital (York Street Campus, YSC), and its satellite community hospital (St Raphael Campus, SRC). A retrospective medical record review was conducted of patients older than 12 years presenting after sexual assault at emergency departments and outpatient clinics from Jan 2014 to Feb 2017. Differences between groups based on assault characteristics, such as assailant relation and substance use, were analyzed using Chi Square. Correlations with age were analyzed with linear regression. Of the 466 patient encounters that met inclusion, the mean patient age was 25.5 years (=12y); 95% were female; 46% were White and 35% were Black. The overall follow-up rate within one year after index visit was 35% (165/466). Patients older than 18 years had significantly lower rates of follow-up (23%, 73/318) than adolescents 13 to 18 years old (61%, 91/148) (p\u3c0.05). Younger patients were more likely to receive recommended testing (p\u3c0.05), and follow-up (p\u3c0.001). Within adolescents, assault by a known individual significantly increases rates of follow-up (69% vs 41%, p\u3c0.05), especially if by a family member (9/9, 100%). Follow-up after SA at our institution are low, consistent with the national average, and significantly lower in older survivors. Adolescent victims receive protocolized follow-up at a designated sex abuse clinic, are more likely to have the involvement of a case manager. Implementation of a standardized discharge protocol that involves follow-up at the Women’s Center—the ambulatory OBGYN clinic—and a designated care coordinator for navigation, may improve rates of follow-up of older survivors of SA

Autonomous control of terminal erythropoiesis via physical interactions among erythroid cells

AbstractIn vitro erythropoiesis has been studied extensively for its application in the manufacture of transfusable erythrocytes. Unfortunately, culture conditions have not been as effective as in vivo growth conditions, where bone marrow macrophages are known to be a key regulator of erythropoiesis. This study focused on the fact that some erythroblasts are detached from macrophages and only contact other erythroblasts. We hypothesized that additional factors regulate erythroblasts, likely through either physical contact or secreted factors. To further elucidate these critical factors, human erythroblasts derived from cord blood were cultured at high density to mimic marrow conditions. This growth condition resulted in a significantly increased erythroid enucleation rate and viability. We found several novel contact-related signals in erythroblasts: intercellular adhesion molecule-4 (ICAM-4) and deleted in liver cancer-1 (DLC-1). DLC-1, a Rho-GTPase-activating protein, has not previously been reported in erythroid cells, but its interaction with ICAM-4 was demonstrated here. We further confirmed the presence of a secreted form of human ICAM-4 for the first time. When soluble ICAM-4 was added to media, cell viability and enucleation increased with decreased nuclear dysplasia, suggesting that ICAM-4 is a key factor in contact between cells. These results highlight potential new mechanisms for autonomous control of erythropoiesis. The application of these procedures to erythrocyte manufacturing could enhance in vitro erythrocyte production for clinical use

Technology-based self-management interventions for women with breast cancer: a systematic review

Purpose Since technology-based interventions can facilitate convenient access to healthcare for women with breast cancer, it is crucial to understand innovative approaches to maintaining the effectiveness of these interventions. Therefore, we conducted a systematic review of technology-based self-management interventions for women with breast cancer in six countries. We analyzed the characteristics of these interventions and examined their diverse health outcomes. Methods Six databases were systematically searched to extract research articles using the keywords “breast cancer,” “technology,” and “self-management.” The search was carried out up until June 12, 2023. From the 1,288 studies retrieved from the database search, 10 eligible papers were identified based on inclusion/exclusion criteria. Two authors independently extracted and compared the data from these articles, resolving any discrepancies through discussion. Results Most of the 10 studies utilized web- or mobile-based technology, and one used artificial intelligence-based technology. Among the 12 health-related outcome variables, quality of life and symptom distress were the most frequently mentioned, appearing in six articles. Furthermore, an analysis of the intervention programs revealed a variety of common constructs and the involvement of managers in the self-management intervention. Conclusion Incorporating key components such as self-management planning, diary keeping, and communication support in technology-based interventions could significantly improve the self-management process for breast cancer survivors. The practical application of technology has the potential to empower women diagnosed with breast cancer and improve their overall quality of life, by providing timely and sustainable interventions, and by leveraging available resources and tools

The Dendritic magnetic avalanches in carbon-free MgB2_2 thin films with and without a deposited Au layer

From the magneto optics images (MOI), the dendritic magnetic avalanche is known to appear dominantly for thin films of the newly discovered MgB$_2$. To clarify the origin of this phenomenon, we studied in detail the MOI of carbon-free MgB$_2$ thin films with and without a deposited gold layer. The MOI indicated carbon contamination was not the main source of the avalanche. The MOI clearly showed that the deposition of metallic gold deposition on top of a MgB$_2$ thin film improved its thermal stability and suppressed the sudden appearance of the dendritic flux avalanche. This is consistent with the previous observation of flux noise in the magnetization.Comment: 9 pages, 4 figeure

Differential effect of corn oil-based low trans structured fat on the plasma and hepatic lipid profile in an atherogenic mouse model: comparison to hydrogenated trans fat

<p>Abstract</p> <p>Background</p> <p><it>Trans </it>fat are not desirable in many aspects on health maintenance. Low <it>trans </it>structured fats have been reported to be relatively more safe than <it>trans </it>fats.</p> <p>Methods</p> <p>We examined the effects of low <it>trans </it>structured fat from corn oil (LC), compared with high <it>trans </it>fat shortening, on cholesterol and fatty acid metabolism in apo E deficient mice which is an atherogenic animal model. The animals were fed a high <it>trans </it>fat (10% fat: commercial shortening (CS)) or a low <it>trans </it>fat (LC) diet for 12 weeks.</p> <p>Results</p> <p>LC decreased apo B and hepatic cholesterol and triglyceride concentration compared to the CS group but significantly increased plasma total cholesterol and triglyceride concentration and fecal lipids with a simultaneous increase in HDL-cholesterol level, apo A-I, and the ratio of HDL-cholesterol to total cholesterol (HTR). Reduction of hepatic lipid levels by inclusion of LC intake was observed alongside modulation of hepatic enzyme activities related to cholesterol esterification, fatty acid metabolism and fecal lipids level compared to the CS group. The differential effects of LC intake on the plasma and hepatic lipid profile seemed to be partly due to the fatty acid composition of LC which contains higher MUFA, PUFA and SFA content as well as lower content of <it>trans </it>fatty acids compared to CS.</p> <p>Conclusions</p> <p>We suggest that LC may exert a dual effect on plasma and hepatic lipid metabolism in an atherogenic animal model. Accordingly, LC, supplemented at 10% in diet, had an anti-atherogenic effect on these <it>apo E</it>^{<it>-/- </it>}mice, and increased fecal lipids, decreased hepatic steatosis, but elevated plasma lipids. Further studies are needed to verify the exact mode of action regarding the complex physiological changes and alteration in lipid metabolism caused by LC.</p

The role of Qa-2, the functional homolog of HLA-G, in a Behcet's disease-like mouse model induced by the herpes virus simplex

<p>Abstract</p> <p>Background</p> <p>It has been suggested that the HLA-G molecule is a genetic risk factor for Behcet's disease (BD). In this study, we evaluated the level of Qa-2, a murine nonclassical class I MHC molecule and possible functional homolog of HLA-G, to determine if it was associated with various symptoms of BD-like mice. In addition, we investigated siRNA (small interfering RNA) treatment to determine if it inhibited Qa-2 expression, thereby changing the symptoms of mice.</p> <p>Methods</p> <p>RNA interference (RNAi) and vector transfection were employed to manipulate gene expression <it>in vivo </it>in mice. siRNA (small interfering RNA) or Qa-2 expression vector was applied to inhibit or up-regulate Qa-2 expression, respectively.</p> <p>Results</p> <p>The Qa-2 levels in granulocytes were lower in BD-like mice than in normal controls. The silencing of Qa-2 by intravenous injection of siRNA (500 nmol/mouse, 4 times at 3-day intervals) specifically reduced the Qa-2 levels and worsened the BD-like symptoms.</p> <p>Conclusions</p> <p>Silencing Qa-2 by injecting siRNA into mice resulted in deterioration of symptoms in BD-like mice.</p

Comparison of cytokine expression profiles in infants with a rhinovirus induced lower respiratory tract infection with or without wheezing: a comparison with respiratory syncytial virus

PurposeThe aim of this study was to evaluate whether infants with rhinovirus (RV) infection-induced wheezing and those with respiratory syncytial virus (RSV) infection-induced wheezing have different cytokine profiles in the acute stage.MethodsOf the infants with lower respiratory tract infection (LRTI) between September 2011 and May 2012, 88 were confirmed using reverse transcription polymerase chain reaction and hospitalized. Systemic interferon-gamma (IFN-γ), interleukin (IL)-2, IL-12, IL-4, IL-5, IL-13, and Treg-type cytokine (IL-10) responses were examined with multiplex assay using acute phase serum samples.ResultsOf the 88 patients, 38 had an RV infection (RV group) and 50 had an RSV infection (RSV group). In the RV group, the IFN-γ and IL-10 concentrations were higher in the patients with than in the patients without wheezing (P=0.022 and P=0.007, respectively). In the RSV group, the differences in IFN-γ and IL-10 concentrations did not reach statistical significance between the patients with and the patients without wheezing (P=0.105 and P=0.965, respectively). The IFN-γ and IL-10 concentrations were not significantly different between the RV group with wheezing and the RSV group with wheezing (P=0.155 and P=0.801, respectively), in contrast to the significant difference between the RV group without wheezing and the RSV group without wheezing (P=0.019 and P=0.035, respectively).ConclusionIn comparison with RSV-induced LRTI, RV-induced LRTI combined with wheezing showed similar IFN-γ and IL-10 levels, which may have an important regulatory function