Human Trafficking in the Emergency Department

Human trafficking continues to persist, affecting up to 200 million people worldwide. As clinicians in emergency departments commonly encounter victims of intimate partner violence, some of these encounters will be with trafficking victims. These encounters provide a rare opportunity for healthcare providers to intervene and help. This case report of a human trafficking patient from a teaching hospital illustrates the complexity in identifying these victims. Clinicians can better identify potential trafficking cases by increasing their awareness of this phenomenon, using qualified interpreters, isolating potential victims by providing privacy and using simple clear reassuring statements ensuring security. A multidisciplinary approach can then be mobilized to help these patients

Long-term outcomes of operatively treated medial epicondyle fractures in pediatric and adolescent patients

PURPOSE: Medial epicondyle fractures are among the most common pediatric elbow injuries. The management of these fractures continues to be debated. To better understand patient results with operative fixation, we reviewed the outcomes of operatively treated medial epicondyle fractures. METHODS: A retrospective review was performed to identify all patients less than 18 years of age at the time of injury who were treated surgically for medial epicondyle fractures. Outcomes were assessed based on the Patient-Reported Outcomes Measurement Information System (PROMIS) Upper Extremity and Pain Interference domains, Visual Analog Scale for pain, subjective range of motion, ulnar nerve function, and requirement for secondary surgery. RESULTS: We identified a cohort of 95 patients treated for a medial epicondyle fracture with open reduction and screw fixation. Of these, 39 patients with a mean age of 12.2 years (SD, 2.2 years; range, 7.6-16.0 years) at surgery were assessed for an average follow-up of 6.3 years (SD, 3.2 years; range, 2.2-13.9 years). Outcome measures and pain scores were excellent. The mean PROMIS Upper Extremity score was 56.9, the mean Pain Interference score was 38.5, and the mean Visual Analog Scale score was 0.4.Sixteen patients (41%) required secondary surgery for symptomatic hardware removal. Seven patients (18%) developed sensory complaints and 2 (5%) developed motor complaints consistent with ulnar nerve irritability. Three patients (8%) reported dissatisfaction with elbow range of motion. Patients who required secondary surgeries had higher (worse) PROMIS Pain Interference scores. CONCLUSIONS: At an average of 6.3 years after surgery, the clinical outcomes for medial epicondyle fracture were excellent. While operative treatment for medial epicondyle fractures in children leads to excellent clinical outcomes, patients and surgeons should be aware of high rates of hardware removal. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV

Effect of spatial confinement on magnetic hyperthermia via dipolar interactions in Fe3O4 nanoparticles for biomedical applications

In this work, the effect of nanoparticle confinement on the magnetic relaxation of iron oxide (Fe 3 O 4 ) nanoparticles (NP) was investigated by measuring the hyperthermia heating behavior in high frequency alternating magnetic field. Three different Fe 3 O 4 nanoparticle systems having distinct nanoparticle configurations were studied in terms of magnetic hyperthermia heating rate and DC magnetization. All magnetic nanoparticle (MNP) systems were constructed using equivalent~10 nm diameter NP that were structured differently in terms of configuration, physical confinement, and interparticle spacing. The spatial confinement was achieved by embedding the Fe 3 O 4 nanoparticles in the matrices of the polystyrene spheres of 100 nm, while the unconfined was the free Fe 3 O 4 nanoparticles well-dispersed in the liquid via PAA surface coating. Assuming the identical core MNPs in each system, the heating behavior was analyzed in terms of particle freedom (or confinement), interparticle spacing, and magnetic coupling (or dipole-dipole interaction). DC magnetization data were correlated to the heating behavior with different material properties. Analysis of DC magnetization measurements showed deviation from classical Langevin behavior near saturation due to dipole interaction modification of the MNPs resulting in a high magnetic anisotropy. It was found that the Specific Absorption Rate (SAR) of the unconfined nanoparticle systems were significantly higher than those of confined (the MNPs embedded in the polystyrene matrix). This increase of SAR was found to be attributable to high Néel relaxation rate and hysteresis loss of the unconfined MNPs. It was also found that the dipole-dipole interactions can significantly reduce the global magnetic response of the MNPs and thereby decrease the SAR of the nanoparticle systems

Glutamate indicators with improved activation kinetics and localization for imaging synaptic transmission

iGluSnFR variants with improved signal-to-noise ratios and targeting to postsynaptic sites have been developed, enabling the analysis of glutamatergic neurotransmission in vivo as illustrated in the mouse visual and somatosensory cortex. The fluorescent glutamate indicator iGluSnFR enables imaging of neurotransmission with genetic and molecular specificity. However, existing iGluSnFR variants exhibit low in vivo signal-to-noise ratios, saturating activation kinetics and exclusion from postsynaptic densities. Using a multiassay screen in bacteria, soluble protein and cultured neurons, we generated variants with improved signal-to-noise ratios and kinetics. We developed surface display constructs that improve iGluSnFR's nanoscopic localization to postsynapses. The resulting indicator iGluSnFR3 exhibits rapid nonsaturating activation kinetics and reports synaptic glutamate release with decreased saturation and increased specificity versus extrasynaptic signals in cultured neurons. Simultaneous imaging and electrophysiology at individual boutons in mouse visual cortex showed that iGluSnFR3 transients report single action potentials with high specificity. In vibrissal sensory cortex layer 4, we used iGluSnFR3 to characterize distinct patterns of touch-evoked feedforward input from thalamocortical boutons and both feedforward and recurrent input onto L4 cortical neuron dendritic spines

CIViCdb 2022: evolution of an open-access cancer variant interpretation knowledgebase

CIViC (Clinical Interpretation of Variants in Cancer; civicdb.org) is a crowd-sourced, public domain knowledgebase composed of literature-derived evidence characterizing the clinical utility of cancer variants. As clinical sequencing becomes more prevalent in cancer management, the need for cancer variant interpretation has grown beyond the capability of any single institution. CIViC contains peer-reviewed, published literature curated and expertly-moderated into structured data units (Evidence Items) that can be accessed globally and in real time, reducing barriers to clinical variant knowledge sharing. We have extended CIViC’s functionality to support emergent variant interpretation guidelines, increase interoperability with other variant resources, and promote widespread dissemination of structured curated data. To support the full breadth of variant interpretation from basic to translational, including integration of somatic and germline variant knowledge and inference of drug response, we have enabled curation of three new Evidence Types (Predisposing, Oncogenic and Functional). The growing CIViC knowledgebase has over 300 contributors and distributes clinically-relevant cancer variant data currently representing >3200 variants in >470 genes from >3100 publications

Revisiting the Sphere standards: comparing the revised Sphere standards to living standards in three urban informal settlements in Nairobi, Kenya

Abstract Background Humanitarian actors have long used the Sphere Handbook and its minimum standards to guide operational practice. The new revision attempts to update these standards partly to address urban crises that have challenged the humanitarian system. Yet, these indicators have never been based on a substantial body of evidence or data from the varied living standards found in cities or specifically informal settlements. This study aims to contextualize the Sphere standards for urban populations by comparing a sample of the revised key indicators to living standards in three urban informal settlements of Nairobi, Kenya, during a non-crisis period to examine their relevance and applicability, and discuss the implications. Methods Retrospective analysis of data sourced from randomized household surveys of three informal settlements in Nairobi across a range of living standards including a convenience sample of Sphere metrics is quantitatively compared to the newly revised Sphere standards. Results The results show that while some standards are met, many of the urban poor in these settlements live far below the prescribed minimum standards across many key sectors including water, sanitation, shelter, and food security. The data also reveal variations between and within individual informal settlements. Conclusion The Sphere standards are not informed enough by informality and remain largely aspirational for some populations and consensus rather than evidence-based. The revised handbook has made significant strides in highlighting the need for contextualization, market approaches, and incorporating stakeholder input. The new Sphere standards must be placed into context for use in the new urban agenda realigning humanitarian actions towards more locally contextualized and driven practice

Early Scandinavian stroke scale scores as a predictive tool for rehabilitation and discharge planning

Background and Rationale: Early prognostication regarding the need for inpatient rehabilitation or early discharge planning would be useful early in the course of a patient’s admission. Clinical tools are available to determine a patient’s current level of stroke severity, but it is unknown whether a stroke severity scale can accurately predict a patient’s discharge destination. Our centre uses the Scandinavian Stroke Scale (SSS) and we hypothesised that SSS would predict early discharge and the need for rehabilitation. Methods: Details of age, gender, history of previous stroke, SSS in first 24 hours of admission, and discharge destination from acute care were collected on consecutive patients over an 8 months period. SSS scores were divided into three groups: good (> 50), intermediate (30–49) and poor (< 30). Data were analysed to see how well the admission SSS scores predicted discharge destination. Results: In total, 162 strokes were analysed. Mean age was 72 years, 52.5% were male, and 33.3% had prior stroke. 88.9% of strokes were ischaemic. 69 (90.8%) of the 76 patients with an SSS of >50 were discharged directly home from acute care. 5 (6.6%) and 2 (2.6%) patients went to rehabilitation and residential care, respectively. Of the 30 patients with a SSS of <30, 60% had died or required residential care. No patient was discharged directly home from this group. Of the 56 patients with a SSS score between 30–49, 52% needed rehabilitation. Conclusion: An admission SSS of >50 was highly predictive of discharge home while a score of <30 was highly predictive of death or lack of early independence. Over 90% of all patients who died scored less than 30. A score of 30–49 correlated was not predictive of discharge destination. Further longitudinal studies are needed to validate the predictive potential of the SSS and other clinical stroke severity scales