Trends in US Emergency Department Use After Sexual Assault, 2006-2019

IMPORTANCE: Adult sexual assault (SA) survivors experience numerous emergent health problems, yet few seek emergency medical care. Quantifying the number and types of survivors presenting to US emergency departments (EDs) after SA can inform health care delivery strategies to reduce survivor morbidity and mortality. OBJECTIVE: To quantify ED use and factors that influenced seeking ED care for adult SA from 2006 through 2019. DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study used SA data from the Nationwide Emergency Department Sample from 2006 through 2019, which includes more than 35.8 million observations of US ED visits from 989 hospitals, a 20% stratified sample of hospital-based EDs. The study also used the Federal Bureau of Investigation\u27s Uniform Crime Reporting Program, which includes annual crime data from more than 18 000 law enforcement agencies representing more than 300 million US inhabitants. The study sample included any adult aged 18 to 65 years with an ED visit in the Nationwide Emergency Department Sample coded as SA. The data were analyzed between January 2020 and June 2022. MAIN OUTCOMES AND MEASURES: Annual SA-related ED visits, subsequent hospital admissions, and associated patient-related factors (age, sex, race and ethnicity, income quartile, and insurance) were analyzed using descriptive statistics. RESULTS: Data were from 120 to 143 million weighted ED visits reported annually from 2006 through 2019. Sexual assault-related ED visits increased more than 1533.0% from 3607 in 2006 to 55 296 in 2019. Concurrently, admission rates for these visits declined from 12.6% to 4.3%. Female, younger, and lower-income individuals were more likely to present to the ED after SA. Older and Medicaid-insured patients were more likely to be admitted. Overall, the rate of ED visits for SA outpaced law enforcement reporting. CONCLUSIONS AND RELEVANCE: This cross-sectional study found that US adult SA ED visits increased from 2006 through 2019 and highlighted the populations who access emergency care most frequently and who more likely need inpatient care. These data can inform policies and the programming needed to support this vulnerable population

Establishment of invasive Black Carp (\u3ci\u3eMylopharyngodon piceus\u3c/i\u3e) in the Mississippi River basin: identifying sources and year classes contributing to recruitment

Black Carp (Mylopharyngodon piceus) was imported to the USA to control aquaculture pond snails. This species has escaped captivity and occurs in parts of the Mississippi River, several tributaries, and floodplain lakes, which is concerning due to potential competition with native fishes and predation on native mussels, many of which are imperiled. However, Black Carp captures have primarily been incidental by commercial fishers, and evidence of reproduction in the wild is limited. The objectives of this study were to assess relative abundance of aquaculture- origin and wild Black Carp using ploidy and otolith stable isotope analysis, identify spatial extent of natural reproduction using otolith microchemistry, assess age distributions of wild and aquaculturesource Black Carp to infer years in which natural reproduction occurred and timing of aquaculture escapement or introductions, and estimate size and age at maturation to assess whether recruitment to adulthood has occurred. Results revealed that Black Carp are established in parts of the Mississippi River basin based on findings that: (1) non-captive Black Carp primarily consist of fertile, naturally-reproduced fish, (2) reproduction has occurred in several rivers, (3) multiple year classes of wild fish are present, and (4) wild fish have recruited to adulthood. Multiple introductions or escapements of aquaculture-source fish into the wild, including both fertile and functionally sterile individuals, were also inferred. Individual growth appears to be rapid, although considerable variation was observed among fish. Additional study is suggested to refine understanding of where and when Black Carp reproduction is occurring in the Mississippi River basin

Building the new international science of the agriculture–food–water–environment nexus in China and the world

The multiple, complex and systemic problems of the agriculture–food–water–environment nexus (“Nexus”) are among the most significant challenges of the 21st century. China is a key site for Nexus research amidst profound socio-environmental problems. The policy implications of these problems have been authoritatively summarized elsewhere. This study presents discussions at an international workshop in Guangzhou that asked instead “What science is needed to deliver the growing policy commitments regarding these challenges? And, What changes are needed to the science itself?” Understanding and effective intervention regarding the Nexus calls for a paradigm shift: to a new kind of science of (capacity for) international, interdisciplinary, and impactful research working with and within complex socio-natural systems. We here argue that science must become proactive in approach, striving only for “minimal harm” not “silver bullet” solutions, and adopting an explicitly long-term strategic perspective. Together, these arguments lead to calls for reorienting science and science policy in three ways: from short-term remediation to longer-term optimization; from a focus on environmental threats to one on the opportunities for international collaborative learning; and toward supporting new forms of scientific career. We bring these points together by recommending a new form of scientific institution: a global network of collaborative Nexus Centres, under the umbrella of a global Food Nexus Organization akin to those of the human genome and proteome

The effectiveness, acceptability and cost-effectiveness of psychosocial interventions for maltreated children and adolescents: an evidence synthesis.

BACKGROUND: Child maltreatment is a substantial social problem that affects large numbers of children and young people in the UK, resulting in a range of significant short- and long-term psychosocial problems. OBJECTIVES: To synthesise evidence of the effectiveness, cost-effectiveness and acceptability of interventions addressing the adverse consequences of child maltreatment. STUDY DESIGN: For effectiveness, we included any controlled study. Other study designs were considered for economic decision modelling. For acceptability, we included any study that asked participants for their views. PARTICIPANTS: Children and young people up to 24 years 11 months, who had experienced maltreatment before the age of 17 years 11 months. INTERVENTIONS: Any psychosocial intervention provided in any setting aiming to address the consequences of maltreatment. MAIN OUTCOME MEASURES: Psychological distress [particularly post-traumatic stress disorder (PTSD), depression and anxiety, and self-harm], behaviour, social functioning, quality of life and acceptability. METHODS: Young Persons and Professional Advisory Groups guided the project, which was conducted in accordance with Cochrane Collaboration and NHS Centre for Reviews and Dissemination guidance. Departures from the published protocol were recorded and explained. Meta-analyses and cost-effectiveness analyses of available data were undertaken where possible. RESULTS: We identified 198 effectiveness studies (including 62 randomised trials); six economic evaluations (five using trial data and one decision-analytic model); and 73 studies investigating treatment acceptability. Pooled data on cognitive-behavioural therapy (CBT) for sexual abuse suggested post-treatment reductions in PTSD [standardised mean difference (SMD) -0.44 (95% CI -4.43 to -1.53)], depression [mean difference -2.83 (95% CI -4.53 to -1.13)] and anxiety [SMD -0.23 (95% CI -0.03 to -0.42)]. No differences were observed for post-treatment sexualised behaviour, externalising behaviour, behaviour management skills of parents, or parental support to the child. Findings from attachment-focused interventions suggested improvements in secure attachment [odds ratio 0.14 (95% CI 0.03 to 0.70)] and reductions in disorganised behaviour [SMD 0.23 (95% CI 0.13 to 0.42)], but no differences in avoidant attachment or externalising behaviour. Few studies addressed the role of caregivers, or the impact of the therapist-child relationship. Economic evaluations suffered methodological limitations and provided conflicting results. As a result, decision-analytic modelling was not possible, but cost-effectiveness analysis using effectiveness data from meta-analyses was undertaken for the most promising intervention: CBT for sexual abuse. Analyses of the cost-effectiveness of CBT were limited by the lack of cost data beyond the cost of CBT itself. CONCLUSIONS: It is not possible to draw firm conclusions about which interventions are effective for children with different maltreatment profiles, which are of no benefit or are harmful, and which factors encourage people to seek therapy, accept the offer of therapy and actively engage with therapy. Little is known about the cost-effectiveness of alternative interventions. LIMITATIONS: Studies were largely conducted outside the UK. The heterogeneity of outcomes and measures seriously impacted on the ability to conduct meta-analyses. FUTURE WORK: Studies are needed that assess the effectiveness of interventions within a UK context, which address the wider effects of maltreatment, as well as specific clinical outcomes. STUDY REGISTRATION: This study is registered as PROSPERO CRD42013003889. FUNDING: The National Institute for Health Research Health Technology Assessment programme

The RNA uridyltransferase Zcchc6 is expressed in macrophages and impacts innate immune responses

<div><p>Alveolar macrophages orchestrate pulmonary innate immunity and are essential for early immune surveillance and clearance of microorganisms in the airways. Inflammatory signaling must be sufficiently robust to promote host defense but limited enough to prevent excessive tissue injury. Macrophages in the lungs utilize multiple transcriptional and post-transcriptional mechanisms of inflammatory gene expression to delicately balance the elaboration of immune mediators. RNA terminal uridyltransferases (TUTs), including the closely homologous family members Zcchc6 (TUT7) and Zcchc11 (TUT4), have been implicated in the post-transcriptional regulation of inflammation from studies conducted <i>in vitro</i>. <i>In vivo</i>, we observed that Zcchc6 is expressed in mouse and human primary macrophages. Zcchc6-deficient mice are viable and born in Mendelian ratios and do not exhibit an observable spontaneous phenotype under basal conditions. Following an intratracheal challenge with <i>S</i>. <i>pneumoniae</i>, Zcchc6 deficiency led to a modest but significant increase in the expression of select cytokines including IL-6, CXCL1, and CXCL5. These findings were recapitulated <i>in vitro</i> whereby Zcchc6-deficient macrophages exhibited similar increases in cytokine expression due to bacterial stimulation. Although loss of Zcchc6 also led to increased neutrophil emigration to the airways during pneumonia, these responses were not sufficient to impact host defense against infection.</p></div

Antiinflammatory Therapy with Canakinumab for Atherosclerotic Disease

Background: Experimental and clinical data suggest that reducing inflammation without affecting lipid levels may reduce the risk of cardiovascular disease. Yet, the inflammatory hypothesis of atherothrombosis has remained unproved. Methods: We conducted a randomized, double-blind trial of canakinumab, a therapeutic monoclonal antibody targeting interleukin-1β, involving 10,061 patients with previous myocardial infarction and a high-sensitivity C-reactive protein level of 2 mg or more per liter. The trial compared three doses of canakinumab (50 mg, 150 mg, and 300 mg, administered subcutaneously every 3 months) with placebo. The primary efficacy end point was nonfatal myocardial infarction, nonfatal stroke, or cardiovascular death. RESULTS: At 48 months, the median reduction from baseline in the high-sensitivity C-reactive protein level was 26 percentage points greater in the group that received the 50-mg dose of canakinumab, 37 percentage points greater in the 150-mg group, and 41 percentage points greater in the 300-mg group than in the placebo group. Canakinumab did not reduce lipid levels from baseline. At a median follow-up of 3.7 years, the incidence rate for the primary end point was 4.50 events per 100 person-years in the placebo group, 4.11 events per 100 person-years in the 50-mg group, 3.86 events per 100 person-years in the 150-mg group, and 3.90 events per 100 person-years in the 300-mg group. The hazard ratios as compared with placebo were as follows: in the 50-mg group, 0.93 (95% confidence interval [CI], 0.80 to 1.07; P = 0.30); in the 150-mg group, 0.85 (95% CI, 0.74 to 0.98; P = 0.021); and in the 300-mg group, 0.86 (95% CI, 0.75 to 0.99; P = 0.031). The 150-mg dose, but not the other doses, met the prespecified multiplicity-adjusted threshold for statistical significance for the primary end point and the secondary end point that additionally included hospitalization for unstable angina that led to urgent revascularization (hazard ratio vs. placebo, 0.83; 95% CI, 0.73 to 0.95; P = 0.005). Canakinumab was associated with a higher incidence of fatal infection than was placebo. There was no significant difference in all-cause mortality (hazard ratio for all canakinumab doses vs. placebo, 0.94; 95% CI, 0.83 to 1.06; P = 0.31). Conclusions: Antiinflammatory therapy targeting the interleukin-1β innate immunity pathway with canakinumab at a dose of 150 mg every 3 months led to a significantly lower rate of recurrent cardiovascular events than placebo, independent of lipid-level lowering. (Funded by Novartis; CANTOS ClinicalTrials.gov number, NCT01327846.

CMS physics technical design report : Addendum on high density QCD with heavy ions

Peer reviewe

Liberal conservatism, ‘boardization’ and the government of civil servants

Drawing inspiration from the loosely coupled genre of studies of governmentality, this article explores the emergence in Britain during the early years of the millennium of a distinctive liberal conservative scheme for the government of civil servants. The term ‘boardization’ has been used to characterize the trend to reproduce the technology of the board of directors in central government. Conservatives currently assign a distinctive role to the work of departmental ‘boards’ in the effective management of the Civil Service. Intimating the costs and risks of the Conservatives’ programme, we explore the role of diverse governmental forces in the emergence of the boards of the Civil Service as an object for action and intervention during the early years of the new millennium. We explore a mutation in the application of practices and techniques drawn from the domain of the business enterprise to the organization of the Civil Service. </jats:p