Descriptive Analysis of Sexual Assault Nurse Examinations in Bethel, Homer, Kodiak, Kotzebue, Nome, and Soldotna

This project examined the characteristics of 172 sexual assault victimizations recorded by sexual assault nurse examiners — all those conducted in Bethel, Alaska in 2005 and 2006, and in Homer, Kodiak, Kotzebue, Nome, and Soldotna in 2005. The report documents the demographic characteristics of patients, pre-assault characteristics, assault characteristics, post-assault characteristics, exam characteristics and findings, suspect characteristics, and legal resolutions.National Institute of Justice, Office of Justice Programs, U.S. Department of Justice. Grant No. 2004-WB-GX-0003Index of Tables and Figures / Acknowledgments \ Executive Summary Descriptive Analysis / Sexual Assaults in Anchorage: 1996-2004 / Sexual Assault Nurse Examinations / Purpose of this Study / Methodology / Sample and Data Limitations / Demographic Characteristics of Patients / Pre-Assault Characteristics / Assault Characteristics / Post-Assault Characteristics / Exam Characteristics and Findings / Suspect Characteristics / Legal Resolutions / Appendix A – Data Collection Instrumen

Final Report: Alaska Sexual Assault Nurse Examiner Study

This project examined the characteristics of sexual assault victimizations in Alaska, as observed and recorded by sexual assault nurse examiners in Anchorage, Kodiak, Bethel, Soldotna, Nome, Fairbanks, Homer, and Kotzebue. The sample utilized for this study includes all sexual assault nurse examinations conducted in Anchorage from 1996 to 2004, in Bethel and Fairbanks in 2005 and 2006, and in Homer, Kodiak, Kotzebue, Nome, and Soldotna in 2005 (N = 1,699). This final report provides a thorough descriptive analysis of the sexual assault nurse examinations included in this study. This descriptive analysis focuses on demographic characteristics of patients; pre-assault, assault, and post-assault characteristics; exam characteristics and findings; suspect characteristics; and legal resolutions. The report then examines the predictors of genital injury. More specifically, it examines the effect of time elapsed from assault to report and of patient condition at the time of the assault. The effect of time elapsed from assault to report is examined by comparing the genital injuries of patients that reported to a sexual assault nurse examiner within 24 hours to the genital injuries of patients that did not. The effect of patient condition at the time of the assault is examined by comparing the genital injuries of patients that were sober, intoxicated, and incapacitated at the time of the assault. Results show that neither time elapsed from assault to report nor patient condition at the time of the assault impacted genital injury. The report also examines the effect of genital injury on legal resolutions. More specifically, it examines how the presence and frequency of genital injury impacts the likelihood that cases are referred for prosecution, the likelihood that cases are accepted by prosecutors, and the likelihood that cases result in a conviction. Results show that genital injury did not impact legal resolutions. Other factors, non-genital injury in particular, were significantly associated with both genital injury and legal resolutions. The relevance of these additional factors is discussedNational Institute of Justice, Office of Justice Programs, U.S. Department of Justice. Grant No. 2004-WB-GX-0003Index of Tables and Figures / Acknowledgments / Executive Summary / I.Final Report: Alaska Sexual Assault Nurse Examiner Study A.Sexual Assaults in Alaska; 1996-2006 B. Sexual Assault Nurse Examinations C. Purpose of this Study D.Review of Prior Research 1. Genital Injury 2. Predictors of Genital Injury 5. Predictors of Legal Resolutions E. Methodology F.Limitations of Sample and Data / II. Descriptive Analysis of Sexual Assault Nurse Examinations A.Demographic Characteristics of Patients B. Pre-Assault Characteristics C. Assault Characteristics D. Post-Assault Characteristics E. Exam Characteristics and Findings F. Suspect Characteristics G. Legal Resolutions / III. Predictors of Genital Injury and Legal Resolutions A. Goals of this Analysis B. Sample and Variables 1. Condition at Time of Assault 2. Time Elapsed from Assault to Report 3. Genital Injury 4. Legal Resolutions 5.Control Variables 6.Case Characteristics 7. Patient Characteristics 8. Assault Characteristics 9.Exam Characteristics 10. Exam Findings 11. Suspect Characteristics 12.Summary C. Methodology D. Bivariate Results E.Multivariate Results: Presence of Genital Injury 1. Main Effects: Presence of Genital Injury 2. Control Variables: Presence of Genital Injury 3. Final Model: Presence of Genital Injury F. Multivariate Results: Frequency of Genital Injury 1. Main Effects: Frequency of Genital Injury 2. Control Variables: Frequency of Genital Injury 3. Final Model: Frequency of Genital Injury G. Summary: Predictors of Genital Injury H. Multivariate Results: Referring a Case for Prosecution 1. Main Effects: Referring a Case for Prosecution 2. Control Variables: Referring a Case for Prosecution 3. Final Model: Referring a Case for Prosecution I. Multivariate Results: Accepting a Case for Prosecution 1. Main Effects: Accepting a Case for Prosecution 2. Control Variables: Accepting a Case for Prosecution 3. Final Model: Accepting a Case for Prosecution J. Multivariate Results: Securing a Conviction 1. Main Effects: Securing a Conviction 2. Control Variables: Securing a Conviction 3. Final Model: Securing a Conviction K. Summary: Predictors of Legal Resolutions L. Conclusions 1. Predictors of Genital Injury 2. Predictors of Legal Resolutions 3. Importance of Non-Genital Injuries / References / Appendix A – Data Collection Instrumen

Descriptive Analysis of Sexual Assault Nurse Examinations in Alaska

This project examined the characteristics of 1,699 sexual assault victimizations recorded by sexual assault nurse examiners — all those conducted in Anchorage, Alaska from 1996 to 2004, in Bethel and Fairbanks in 2005 and 2006, and in Homer, Kodiak, Kotzebue, Nome, and Soldotna in 2005. The report documents the demographic characteristics of patients, pre-assault characteristics, assault characteristics, post-assault characteristics, exam characteristics and findings, suspect characteristics, and legal resolutions.National Institute of Justice, Office of Justice Programs, U.S. Department of Justice. Grant No. 2004-WB-GX-0003Index of Tables and Figures / Acknowledgments / Executive Summary / Descriptive Analysis / Sexual Assaults in Alaska; 1996-2005 / Sexual Assault Nurse Examinations / Purpose of this Study / Methodology / Sample and Data Limitations / Demographic Characteristics of Patients / Pre-Assault Characteristics / Assault Characteristics / Post-Assault Characteristics / Exam Characteristics and Findings / Suspect Characteristics / Legal Resolutions / Appendix A – Data Collection Instrumen

Reporting Sexual Assault Victimizations to Law Enforcement

As part of a larger study examining the characteristics of sexual assault victimizations in Alaska as observed and recorded by sexual assault nurse examiners, 101 patients in Bethel, Fairbanks, Kodiak, Kotzebue, Nome, and Soldotna provided information about their decision to report their victimization to law enforcement. The report documents who these patients consulted prior to reporting, the actions and reactions that patients received from others, how patients initially attributed blame, and how concerned patients initially were about disbelief and negative reactions from others. The report also examines whether patients had begun to take control over the recovery process, the amount of time elapsed from assault to examination, and what factors predict the amount of time elapsed from assault to examination.National Institute of Justice, Office of Justice Programs, U.S. Department of Justice. Grant No. 2004-WB-GX-0003Index of Tables and Figures / Acknowledgments / Executive Summary / Reporting Sexual Assault Victimizations to Law Enforcement / Patient, Assault, and Suspect Characteristics / Characteristics of Reporting / Reasons for Time Elapsed from Assault to Repor

Molecular testing for Lynch syndrome in people with colorectal cancer: systematic reviews and economic evaluation

This is the final version of the article. Available from the publisher via the DOI in this record.BACKGROUND: Inherited mutations in deoxyribonucleic acid (DNA) mismatch repair (MMR) genes lead to an increased risk of colorectal cancer (CRC), gynaecological cancers and other cancers, known as Lynch syndrome (LS). Risk-reducing interventions can be offered to individuals with known LS-causing mutations. The mutations can be identified by comprehensive testing of the MMR genes, but this would be prohibitively expensive in the general population. Tumour-based tests - microsatellite instability (MSI) and MMR immunohistochemistry (IHC) - are used in CRC patients to identify individuals at high risk of LS for genetic testing. MLH1 (MutL homologue 1) promoter methylation and BRAF V600E testing can be conducted on tumour material to rule out certain sporadic cancers. OBJECTIVES: To investigate whether testing for LS in CRC patients using MSI or IHC (with or without MLH1 promoter methylation testing and BRAF V600E testing) is clinically effective (in terms of identifying Lynch syndrome and improving outcomes for patients) and represents a cost-effective use of NHS resources. REVIEW METHODS: Systematic reviews were conducted of the published literature on diagnostic test accuracy studies of MSI and/or IHC testing for LS, end-to-end studies of screening for LS in CRC patients and economic evaluations of screening for LS in CRC patients. A model-based economic evaluation was conducted to extrapolate long-term outcomes from the results of the diagnostic test accuracy review. The model was extended from a model previously developed by the authors. RESULTS: Ten studies were identified that evaluated the diagnostic test accuracy of MSI and/or IHC testing for identifying LS in CRC patients. For MSI testing, sensitivity ranged from 66.7% to 100.0% and specificity ranged from 61.1% to 92.5%. For IHC, sensitivity ranged from 80.8% to 100.0% and specificity ranged from 80.5% to 91.9%. When tumours showing low levels of MSI were treated as a positive result, the sensitivity of MSI testing increased but specificity fell. No end-to-end studies of screening for LS in CRC patients were identified. Nine economic evaluations of screening for LS in CRC were identified. None of the included studies fully matched the decision problem and hence a new economic evaluation was required. The base-case results in the economic evaluation suggest that screening for LS in CRC patients using IHC, BRAF V600E and MLH1 promoter methylation testing would be cost-effective at a threshold of £20,000 per quality-adjusted life-year (QALY). The incremental cost-effectiveness ratio for this strategy was £11,008 per QALY compared with no screening. Screening without tumour tests is not predicted to be cost-effective. LIMITATIONS: Most of the diagnostic test accuracy studies identified were rated as having a risk of bias or were conducted in unrepresentative samples. There was no direct evidence that screening improves long-term outcomes. No probabilistic sensitivity analysis was conducted. CONCLUSIONS: Systematic review evidence suggests that MSI- and IHC-based testing can be used to identify LS in CRC patients, although there was heterogeneity in the methods used in the studies identified and the results of the studies. There was no high-quality empirical evidence that screening improves long-term outcomes and so an evidence linkage approach using modelling was necessary. Key determinants of whether or not screening is cost-effective are the accuracy of tumour-based tests, CRC risk without surveillance, the number of relatives identified for cascade testing, colonoscopic surveillance effectiveness and the acceptance of genetic testing. Future work should investigate screening for more causes of hereditary CRC and screening for LS in endometrial cancer patients. STUDY REGISTRATION: This study is registered as PROSPERO CRD42016033879. FUNDING: The National Institute for Health Research Health Technology Assessment programme.Funding for this study was provided by the Health Technology Assessment programme of the National Institute for Health Researc

Perspectives on clinic attendance, medication and foot-care among people with diabetes in the Torres Stait Islands and Northern Peninsula area

Objective: To achieve a better understanding of the perspectives and needs of Indigenous people with diabetes in the Torres Strait and to identify ways to promote successful self-management of diabetes. Design: Descriptive study collecting qualitative data in focus groups and in-depth interviews. Analysis of three key areas of diabetes self-care, namely attending appointments at the clinic, monitoring blood glucose levels and taking medication and foot-care. Setting: Informal settings in remote communities of the Torres Strait and Northern Peninsula Area of Far North Queensland. Subjects: Sixty-seven Torres Strait Islanders (26 men and 41 women) with diabetes from eight Torres Strait and Northern Peninsula Area communities. Main outcome measures: A better understanding of the views, enabling factors and barriers that people experience when managing their diabetes in remote Torres Strait communities. Results: Participants who expressed satisfaction with clinical-initiated sessions when called highlighted positive relationships and encouraging feedback from doctors. People's attitudes and practices related to oral and injectable treatments varied widely, possibly linked to levels of understanding. Widespread knowledge of foot-care and fear of amputation in an environment highly conducive to foot sores and infection was evident. Generally, participants wanted more education and personal support in all areas of diabetes care. Service providers in health and other sectors need to place more emphasis on supporting self-management of diabetes within the family and community environment