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

Validation of a 5-item Tool to Measure Patient Assessment of Clinician Compassion in the Emergency Department.

BACKGROUND: To test if the 5-item compassion measure (a tool previously validated in the outpatient setting to measure patient assessment of clinician compassion) is a valid and reliable tool to quantify a distinct construct (i.e. clinical compassion) among patients evaluated in the emergency department (ED). METHODS: Cross-sectional study conducted in three academic emergency departments in the U.S. between November 2018 and April 2019. We enrolled adult patients who were evaluated in the EDs of the participating institutions and administered the 5-item compassion measure after completion of care in the ED. Validity testing was performed using confirmatory factor analysis. Cronbach\u27s alpha was used to test reliability. Convergent validity with patient assessment of overall satisfaction questions was tested using Spearman correlation coefficients and we tested if the 5-item compassion measure assessed a construct distinct from overall patient satisfaction using confirmatory factor analysis. RESULTS: We analyzed 866 patient responses. Confirmatory factor analysis found all five items loaded well on a single construct and our model was found to have good fit. Reliability was excellent (Cronbach\u27s alpha = 0.93) among the entire cohort. These results remained consistent on sub-analyses stratified by individual institutions. The 5-item compassion measure had moderate correlation with overall patient satisfaction (r = 0.66) and patient recommendation of the ED to friends and family (r = 0.57), but reflected a patient experience domain (i.e. compassionate care) distinctly different from patient satisfaction. CONCLUSIONS: The 5-item compassion measure is a valid and reliable tool to measure patient assessment of clinical compassion in the ED

Finishing the euchromatic sequence of the human genome

The sequence of the human genome encodes the genetic instructions for human physiology, as well as rich information about human evolution. In 2001, the International Human Genome Sequencing Consortium reported a draft sequence of the euchromatic portion of the human genome. Since then, the international collaboration has worked to convert this draft into a genome sequence with high accuracy and nearly complete coverage. Here, we report the result of this finishing process. The current genome sequence (Build 35) contains 2.85 billion nucleotides interrupted by only 341 gaps. It covers ∼99% of the euchromatic genome and is accurate to an error rate of ∼1 event per 100,000 bases. Many of the remaining euchromatic gaps are associated with segmental duplications and will require focused work with new methods. The near-complete sequence, the first for a vertebrate, greatly improves the precision of biological analyses of the human genome including studies of gene number, birth and death. Notably, the human enome seems to encode only 20,000-25,000 protein-coding genes. The genome sequence reported here should serve as a firm foundation for biomedical research in the decades ahead

Founder mutations characterise the mutation panorama in 200 Swedish index cases referred for Long QT syndrome genetic testing

Background: Long QT syndrome (LQTS) is an inherited arrhythmic disorder characterised by prolongation of the QT interval on ECG, presence of syncope and sudden death. The symptoms in LQTS patients are highly variable, and genotype influences the clinical course. This study aims to report the spectrum of LQTS mutations in a Swedish cohort. Methods: Between March 2006 and October 2009, two hundred, unrelated index cases were referred to the Department of Clinical Genetics, Umea University Hospital, Sweden, for LQTS genetic testing. We scanned five of the LQTS-susceptibility genes (KCNQ1, KCNH2, SCN5A, KCNE1, and KCNE2) for mutations by DHPLC and/or sequencing. We applied MLPA to detect large deletions or duplications in the KCNQ1, KCNH2, SCN5A, KCNE1, and KCNE2 genes. Furthermore, the gene RYR2 was screened in 36 selected LQTS genotype-negative patients to detect cases with the clinically overlapping disease catecholaminergic polymorphic ventricular tachycardia (CPVT). Results: In total, a disease-causing mutation was identified in 103 of the 200 (52%) index cases. Of these, altered exon copy numbers in the KCNH2 gene accounted for 2% of the mutations, whereas a RYR2 mutation accounted for 3% of the mutations. The genotype-positive cases stemmed from 64 distinct mutations, of which 28% were novel to this cohort. The majority of the distinct mutations were found in a single case (80%), whereas 20% of the mutations were observed more than once. Two founder mutations, KCNQ1 p.Y111C and KCNQ1 p.R518*, accounted for 25% of the genotype-positive index cases. Genetic cascade screening of 481 relatives to the 103 index cases with an identified mutation revealed 41% mutation carriers who were at risk of cardiac events such as syncope or sudden unexpected death. Conclusion: In this cohort of Swedish index cases with suspected LQTS, a disease-causing mutation was identified in 52% of the referred patients. Copy number variations explained 2% of the mutations and 3 of 36 selected cases (8%) harboured a mutation in the RYR2 gene. The mutation panorama is characterised by founder mutations (25%), even so, this cohort increases the amount of known LQTS-associated mutations, as approximately one-third (28%) of the detected mutations were unique

Flow Behaviour and Microstructure of a β-Glucan Concentrate

The extensional viscosity is an important rheological characteristic of polymer melts. It is however not as frequently reported on as the shear viscosity. The extensional viscosity is of special interest when considering polymeric materials for foaming and film blowing processes. Here, the extensional (and shear) viscosity along with the melt strength and the tensile properties of the corresponding solid film of a β-glucan concentrate are reported on. A capillary viscometer equipped with a hyperbolic die, yielding a contraction flow, was used to assess the extensional viscosity of the aqueous β-glucan compound at room temperature and at elevated temperatures (110 and 130 °C). In general, the extensional viscosity as well as the shear viscosity decreased with increasing deformation rate. The influence of two different amounts of added water (40 and 50%) was also examined. As expected, both types of viscosities decreased with increasing temperature. It is suggested that gelatinization of the starch fraction in the concentrate at 110 and 130 °C contributes to temperature dependence of the viscosity. To some extent, this is supported by light microscopy and confocal scanning laser microscopy studies of the microstructure of the materials. The results reported here indicate that the β-glucan concentrate might, after some modifications, be used as a complement to fossil-based polymers and processed by conventional manufacturing techniques.