The Commercial Sexual Exploitation and Sex Trafficking of Minors in the Boston Metropolitan Area: Experiences and Challenges Faced by Front-Line Providers and Other Stakeholders

Objectives: The commercial sexual exploitation of children (CSEC), including sex trafficking of minors, is considered a severe form of abuse and violence against minors. We use a public health lens to examine perceptions regarding the context and process of CSEC and sex trafficking of minors in the Boston area, the response of the health care sector, and opportunities to improve the health and well-being of exploited/trafficked minors. Methods: Using case study methodology, we conducted 22 semi-structured qualitative interviews of 25 key anti-trafficking stakeholders active in the Boston area. Results: Key informants identified CSEC involving boys, girls, and transgender youth as a local problem. Many social and economic factors facilitate sex trafficking, including child sexual abuse, domicile instability, and financial insecurity. The health needs of commercially sexually exploited minors are numerous, and local health care services are variable, particularly in the realm of mental health. Various factors function as barriers to a greater health care sector response, including low awareness of CSEC and sex trafficking of minors among health care providers. Gaps in CSEC prevention and response include early recognition of signs and symptoms, CSEC-knowledgeable trauma-sensitive health care services, and emergency shelter. Conclusions: CSEC, including sex trafficking of minors, is a recognized occurrence in the Boston area that requires a multidisciplinary response across multiple sectors. A more robust health care system response in coordination with other active stakeholders could help enhance the overall impact of local anti-CSEC/trafficking efforts. Increased health trainings, policy advocacy, and the use of multidisciplinary teams may be an effective way to partner across sectors and ensure wraparound services for exploited youth

An International Comparative Public Health Analysis of Sex Trafficking of Women and Girls in Eight Cities: Achieving a More Effective Health Sector Response

Sex trafficking, trafficking for the purpose of forced sexual exploitation, is a widespread form of human trafficking that occurs in all regions of the world, affects mostly women and girls, and has far-reaching health implications. Studies suggest that up to 50 % of sex trafficking victims in the USA seek medical attention while in their trafficking situation, yet it is unclear how the healthcare system responds to the needs of victims of sex trafficking. To understand the intersection of sex trafficking and public health, we performed in-depth qualitative interviews among 277 antitrafficking stakeholders across eight metropolitan areas in five countries to examine the local context of sex trafficking. We sought to gain a new perspective on this form of gender-based violence from those who have a unique vantage point and intimate knowledge of push-and-pull factors, victim health needs, current available resources and practices in the health system, and barriers to care. Through comparative analysis across these contexts, we found that multiple sociocultural and economic factors facilitate sex trafficking, including child sexual abuse, the objectification of women and girls, and lack of income. Although there are numerous physical and psychological health problems associated with sex trafficking, health services for victims are patchy and poorly coordinated, particularly in the realm of mental health. Various factors function as barriers to a greater health response, including low awareness of sex trafficking and attitudinal biases among health workers. A more comprehensive and coordinated health system response to sex trafficking may help alleviate its devastating effects on vulnerable women and girls. There are numerous opportunities for local health systems to engage in antitrafficking efforts while partnering across sectors with relevant stakeholders

Innovative package for frontline maternal, newborn and child health workers in South Sudan

Improving maternal, newborn, and child health is a leading priority worldwide. It is a particularly urgent issue in South Sudan, which suffers from the world’s worst maternal mortality and among the worst newborn and child mortalities. A leading barrier to improving these health indices is limited frontline health worker capacity. In partnership with the Ministry of Health, the Division of Global Health and Human Rights (Department of Emergency Medicine, Massachusetts General Hospital, Boston, USA) has developed and is currently implementing its novel Maternal, Newborn, and Child Survival (MNCS) Initiative throughout much of South Sudan. The purpose of MNCS is to build frontline health worker capacity through a training package that includes:1. A participatory training course2. Pictorial checklists to guide prevention, care, and referral3. Re-useable medical equipment and commodities.Program implementation began in November 2010 utilizing a training-of-trainers model. To date, 72 local trainers and 632 frontline health workers have completed the training and received their MNCS checklists and commodities. Initial monitoring and evaluation results are encouraging as further evaluation continues. This innovative training package may also serve as a model for building capacity for maternal, newborn, and child health in other resource limited settings beyond South Sudan

From Galaxy Clusters to Ultra-Faint Dwarf Spheroidals: A Fundamental Curve Connecting Dispersion-supported Galaxies to Their Dark Matter Halos

We examine scaling relations of dispersion-supported galaxies over more than eight orders of magnitude in luminosity by transforming standard fundamental plane parameters into a space of mass (M1/2), radius (r1/2), and luminosity (L1/2). We find that from ultra-faint dwarf spheroidals to giant cluster spheroids, dispersion-supported galaxies scatter about a one-dimensional "fundamental curve" through this MRL space. The weakness of the M1/2-L1/2 slope on the faint end may imply that potential well depth limits galaxy formation in small galaxies, while the stronger dependence on L1/2 on the bright end suggests that baryonic physics limits galaxy formation in massive galaxies. The mass-radius projection of this curve can be compared to median dark matter halo mass profiles of LCDM halos in order to construct a virial mass-luminosity relationship (Mvir-L) for galaxies that spans seven orders of magnitude in Mvir. Independent of any global abundance or clustering information, we find that (spheroidal) galaxy formation needs to be most efficient in halos of Mvir ~ 10^12 Msun and to become inefficient above and below this scale. Moreover, this profile matching technique is most accurate at the high and low luminosity extremes (where dark matter fractions are highest) and is therefore quite complementary to statistical approaches that rely on having a well-sampled luminosity function. We also consider the significance and utility of the scatter about this relation, and find that in the dSph regime observational errors are almost at the point where we can explore the intrinsic scatter in the luminosity-virial mass relation. Finally, we note that purely stellar systems like Globular Clusters and Ultra Compact Dwarfs do not follow the fundamental curve relation. This allows them to be easily distinguished from dark-matter dominated dSph galaxies in MRL space. (abridged)Comment: 27 pages, 18 figures, ApJ accepted. High-res movies of 3D figures are available at http://www.physics.uci.edu/~bullock/fcurve/movies.htm

Genome-wide association studies of autoimmune vitiligo identify 23 new risk loci and highlight key pathways and regulatory variants

Vitiligo is an autoimmune disease in which depigmented skin results from the destruction of melanocytes1, with epidemiological association with other autoimmune diseases2. In previous linkage and genome-wide association studies (GWAS1 and GWAS2), we identified 27 vitiligo susceptibility loci in patients of European ancestry. We carried out a third GWAS (GWAS3) in European-ancestry subjects, with augmented GWAS1 and GWAS2 controls, genome-wide imputation, and meta-analysis of all three GWAS, followed by an independent replication. The combined analyses, with 4,680 cases and 39,586 controls, identified 23 new significantly associated loci and 7 suggestive loci. Most encode immune and apoptotic regulators, with some also associated with other autoimmune diseases, as well as several melanocyte regulators. Bioinformatic analyses indicate a predominance of causal regulatory variation, some of which corresponds to expression quantitative trait loci (eQTLs) at these loci. Together, the identified genes provide a framework for the genetic architecture and pathobiology of vitiligo, highlight relationships with other autoimmune diseases and melanoma, and offer potential targets for treatment

Genome-wide analysis identifies 12 loci influencing human reproductive behavior.

The genetic architecture of human reproductive behavior-age at first birth (AFB) and number of children ever born (NEB)-has a strong relationship with fitness, human development, infertility and risk of neuropsychiatric disorders. However, very few genetic loci have been identified, and the underlying mechanisms of AFB and NEB are poorly understood. We report a large genome-wide association study of both sexes including 251,151 individuals for AFB and 343,072 individuals for NEB. We identified 12 independent loci that are significantly associated with AFB and/or NEB in a SNP-based genome-wide association study and 4 additional loci associated in a gene-based effort. These loci harbor genes that are likely to have a role, either directly or by affecting non-local gene expression, in human reproduction and infertility, thereby increasing understanding of these complex traits

Comprehensive Rare Variant Analysis via Whole-Genome Sequencing to Determine the Molecular Pathology of Inherited Retinal Disease

Inherited retinal disease is a common cause of visual impairment and represents a highly heterogeneous group of conditions. Here, we present findings from a cohort of 722 individuals with inherited retinal disease, who have had whole-genome sequencing (n = 605), whole-exome sequencing (n = 72), or both (n = 45) performed, as part of the NIHR-BioResource Rare Diseases research study. We identified pathogenic variants (single-nucleotide variants, indels, or structural variants) for 404/722 (56%) individuals. Whole-genome sequencing gives unprecedented power to detect three categories of pathogenic variants in particular: structural variants, variants in GC-rich regions, which have significantly improved coverage compared to whole-exome sequencing, and variants in non-coding regulatory regions. In addition to previously reported pathogenic regulatory variants, we have identified a previously unreported pathogenic intronic variant in $\textit{CHM}$ in two males with choroideremia. We have also identified 19 genes not previously known to be associated with inherited retinal disease, which harbor biallelic predicted protein-truncating variants in unsolved cases. Whole-genome sequencing is an increasingly important comprehensive method with which to investigate the genetic causes of inherited retinal disease.This work was supported by The National Institute for Health Research England (NIHR) for the NIHR BioResource – Rare Diseases project (grant number RG65966). The Moorfields Eye Hospital cohort of patients and clinical and imaging data were ascertained and collected with the support of grants from the National Institute for Health Research Biomedical Research Centre at Moorfields Eye Hospital, National Health Service Foundation Trust, and UCL Institute of Ophthalmology, Moorfields Eye Hospital Special Trustees, Moorfields Eye Charity, the Foundation Fighting Blindness (USA), and Retinitis Pigmentosa Fighting Blindness. M.M. is a recipient of an FFB Career Development Award. E.M. is supported by UCLH/UCL NIHR Biomedical Research Centre. F.L.R. and D.G. are supported by Cambridge NIHR Biomedical Research Centre

Youth engagement within integrated youth services: A needs assessment

Aim: Youth engagement (YE) is a practice that enhances youth leadership skills and wellbeing while also supporting youth civic contribution. Engagement of youth perspectives is critical to the development of programs and policy directions that affect them and YE practice has been widely adopted within integrated youth services (IYS). Frayme is an international network that brings people together from across disciplines to increase the uptake of IYS. Some of Frayme’s main objectives are to synthesize knowledge regarding best practices of YE within IYS and to stimulate changes in practice toward better standards of YE. The purpose of this paper is to: 1) describe YE practice and how it relates to IYS and system transformation in youth services and 2) to present findings from a needs assessment examining how youth and adult allies define effective YE within IYS. Methods: Frayme facilitated a ProAction Café to collect youth and adult ally feedback with regard to how they define YE within IYS. Specifically, the participants were asked to respond to questions examining their experience of effective YE processes and how they apply to IYS. Results: Through a thematic analysis, three over-arching themes were identified: positive relationships, dynamic opportunities for capacity-building and meaningful engagement. Conclusions: Results are discussed in relation to current research in YE and recommendations are made to enhance YE practice within youth services. Findings will be used to inform Frayme’s strategy to enhance YE practice within IYS. The findings also contribute to the literature within YE, IYS and system transformation