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

Second IVIg course in Guillain-Barré syndrome with poor prognosis. The non-randomised ISID study

Objective To compare disease course in patients with Guillain-Barré syndrome (GBS) with a poor prognosis who were treated with one or with two intravenous immunoglobulin (IVIg) courses. Methods From the International GBS Outcome Study, we selected patients whose modified Erasmus GBS Outcome Score at week 1 predicted a poor prognosis. We compared those treated with one IVIg course to those treated with two IVIg courses. The primary endpoint, the GBS disability scale at 4 weeks, was assessed with multivariable ordinal regression. Results Of 237 eligible patients, 199 patients received a single IVIg course. Twenty patients received an α early' second IVIg course (1-2 weeks after start of the first IVIg course) and 18 patients a α late' second IVIg course (2-4 weeks after start of IVIg). At baseline and 1 week, those receiving two IVIg courses were more disabled than those receiving one course. Compared with the one course group, the adjusted OR for a better GBS disability score at 4 weeks was 0.70 (95%CI 0.16 to 3.04) for the early group and 0.66 (95%CI 0.18 to 2.50) for the late group. The secondary endpoints were not in favour of a second IVIg course. Conclusions This observational study did not show better outcomes after a second IVIg course in GBS with poor prognosis. The study was limited by small numbers and baseline imbalances. Lack of improvement was likely an incentive to start a second IVIg course. A prospective randomised trial is needed to evaluate whether a second IVIg course improves outcome in GBS

Intravenous immunoglobulin treatment for mild Guillain-Barré syndrome. An international observational study

Objective: To compare the disease course in patients with mild Guillain-Barré syndrome (GBS) who were treated with intravenous immunoglobulin (IVIg) or supportive care only. Methods: We selected patients from the prospective observational International GBS Outcome Study (IGOS) who were able to walk independently at study entry (mild GBS), treated with one IVIg course or supportive care. The primary endpoint was the GBS disability score four weeks after study entry, assessed by multivariable ordinal regression analysis. Results: Of 188 eligible patients, 148 (79%) were treated with IVIg and 40 (21%) with supportive care. The IVIg group was more disabled at baseline. IVIg treatment was not associated with lower GBS disability scores at 4 weeks (adjusted OR (aOR) 1.62, 95% CI 0.63 to 4.13). Nearly all secondary endpoints showed no benefit from IVIg, although the time to regain full muscle strength was shorter (28 vs 56 days, p=0.03) and reported pain at 26 weeks was lower (n=26/121, 22% vs n=12/30, 40%, p=0.04) in the IVIg treated patients. In the subanalysis with persistent mild GBS in the first 2 weeks, the aOR for a lower GBS disability score at 4 weeks was 2.32 (95% CI 0.76 to 7.13). At 1 year, 40% of all patients had residual symptoms. Conclusion: In patients with mild GBS, one course of IVIg did not improve the overall disease course. The certainty of this conclusion is limited by confounding factors, selection bias and wide confidence limits. Residual symptoms were often present after one year, indicating the need for better treatments in mild GBS

Genomic and epigenomic landscapes of adult de novo acute myeloid leukemia

BACKGROUND: Many mutations that contribute to the pathogenesis of acute myeloid leukemia (AML) are undefined. The relationships between patterns of mutations and epigenetic phenotypes are not yet clear. METHODS: We analyzed the genomes of 200 clinically annotated adult cases of de novo AML, using either whole-genome sequencing (50 cases) or whole-exome sequencing (150 cases), along with RNA and microRNA sequencing and DNA-methylation analysis. RESULTS: AML genomes have fewer mutations than most other adult cancers, with an average of only 13 mutations found in genes. Of these, an average of 5 are in genes that are recurrently mutated in AML. A total of 23 genes were significantly mutated, and another 237 were mutated in two or more samples. Nearly all samples had at least 1 nonsynonymous mutation in one of nine categories of genes that are almost certainly relevant for pathogenesis, including transcription-factor fusions (18% of cases), the gene encoding nucleophosmin (NPM1) (27%), tumor-suppressor genes (16%), DNA-methylation-related genes (44%), signaling genes (59%), chromatin-modifying genes (30%), myeloid transcription-factor genes (22%), cohesin-complex genes (13%), and spliceosome-complex genes (14%). Patterns of cooperation and mutual exclusivity suggested strong biologic relationships among several of the genes and categories. CONCLUSIONS: We identified at least one potential driver mutation in nearly all AML samples and found that a complex interplay of genetic events contributes to AML pathogenesis in individual patients. The databases from this study are widely available to serve as a foundation for further investigations of AML pathogenesis, classification, and risk stratification. (Funded by the National Institutes of Health.) Copyright © 2013 Massachusetts Medical Society