Non-Accidental Trauma: Nature of Subsequent Encounters and Related Outcomes

Physical abuse results in a wide array of adverse outcomes, and victims of child abuse often require long-term, intensive care depending on the scope and severity of their trauma. The present study is an extension of a study which examined the services provided in the hospital to children with physical abuse that resulted in hospitalization (Kazandjian, et. al., 2016). It will examine the nature of subsequent hospital encounters in pediatric victims of Non-Accidental Trauma (NAT) at the Loma Linda University Children’s Hospital (LLUCH). Researchers will investigate the short-term and long-term physical, neurological, cognitive/developmental, behavioral, and social emotional effects experienced by pediatric NAT victims. Researchers will examine a random subset (n = 38) of the original 151 cases from the LLUCH trauma registry using an in-depth chart review of medical records to determine: the duration between initial discharge and first return to the hospital; the frequency with which children are returning to the hospital; and the nature of subsequent encounters, as well as the problems for which they are seeking care. Results will help identify more specific effects of severe child physical abuse following hospitalization compared to those currently outlined in the literature, and aid researchers in recognizing the health-related needs of these children with regard to their long-term trajectory. It is anticipated that the vast majority of survivors require long-term routine care, rather than short-term care, and that most children will present with an array of physical, psychological, neurological, cognitive/developmental, and behavioral or socio-emotional needs requiring intensive treatment post-discharge

Management of TB in the private sector in Khartoum, Sudan: quality and impact on TB control

IntroductionSudan has a large and growing private health sector. No survey was done in Sudan to show the extent of the use of private health care services by the population. Also precise data on tuberculosis (TB) diagnosis and treatment in the private sector are not available.Material and methodsA facility-based cross-sectional survey was carried out during February2007-June 2007 in Khartoum state, whereby consented private physicians working in the all private clinics (n=110) were interviewed.ResultsThis study showed that a large private sector exist in the country and deliver care to TB patients and reported the non-adherence of this sector to National Tuberculosis Program (NTP) guidelines. 59.1% of the interviewed physicians correctly mentioned the TB treatment regimens, only 8(12.3%) physicians that reported management of TB patients actually prescribed these regimens to their patients. Similarly, only 10(15.4%) physicians requested sputum smear examination for TBdiagnosis.ConclusionA considerable proportion of cases is inadequately managed by the private sector and is not notified to NTP. The information delivered by this study can be used to develop a workable Public-private mix (PPM) model with the private sector.Key words: Isoniazid, Rifampicin, Pyrazinamide, Ethambutol

Sudan Federal Ministry of Health. 3. World Health Organization, Khartoum, Sudan 4. Sudan Federal Ministry of Health. 5. World Health Organization

Abstract: Introduction Sudan has a large and growing private health sector. No survey was done in Sudan to show the extent of the use of private health care services by the population. Also precise data on tuberculosis (TB) diagnosis and treatment in the private sector are not available. Material and methods A facility-based cross-sectional survey was carried out during February2007-June 2007 in Khartoum state, whereby consented private physicians working in the all private clinics (n=110) were interviewed. Results This study showed that a large private sector exist in the country and deliver care to TB patients and reported the non-adherence of this sector to National Tuberculosis Program (NTP) guidelines. 59.1% of the interviewed physicians correctly mentioned the TB treatment regimens, only 8(12.3%) physicians that reported management of TB patients actually prescribed these regimens to their patients. Similarly, only 10(15.4%) physicians requested sputum smear examination for TB diagnosis. Conclusion A considerable proportion of cases is inadequately managed by the private sector and is not notified to NTP. The information delivered by this study can be used to develop a workable Public-private mix (PPM) model with the private sector

Análise ambiental do perfil de estruturas parasitárias encontradas no solo arenoso das praias do município de Santos, SP, Brasil

The environmental contamination by geohelminths represents a world public health problem and has been well documented by several authors. However, few papers describe the presence of such contamination in saline soils of coastal beaches. A study was performed on the beaches of the municipality of Santos in the period between May 2004 to April 2005 with the aim of determining the degree of contamination, and the correlation between contamination level and seasonal conditions and characteristics of the environment. Of the 2,520 samples analyzed, 18.2% (458) were contaminated, 32.3% (148) of which were localized in children's recreational areas (playgrounds). The parasite profile found in the analyzed samples indicated the presence of several zoonotic parasites: Ancylostoma larvae (82.5%), Toxocara sp. eggs (59.4%), Ancylostomidae-like eggs (37.1%), coccid oocysts (13.5%), Trichostrongylus sp. eggs and larvae, Ascaris lumbricoides eggs, (11.6%), Entamoeba sp. cysts (10.0%), Strongyloides sp. (4.8%), several free nematoids and some non-identified parasitic structures (3.3%). It was established that the highest frequency of parasitic structures occurred in the months between May and October 2004, and from February to March 2005. An increase in the diversity of parasitic forms was documented in the months between February to December 2004 and from January to April 2005, these periods having the highest rainfall.A contaminação ambiental por geohelmintos representa um problema mundial de saúde pública e tem sido bem documentada por diversos autores. No entanto, poucos trabalhos descrevem a presença de contaminação em solos salinos de praias litorâneas. Este estudo foi realizado nas praias do município de Santos no período entre maio de 2004 a abril de 2005 com o objetivo de determinar o grau de contaminação, e possíveis correlações entre sazonalidade e características ambientais. Das 2.520 amostras analisadas, 18,2% (458) estavam contaminadas, 32,3% (148) das quais foram localizadas em areas de lazer das crianças(playgrounds). O perfil parasitário encontrado nas amostras analisadas indicaram a presença de vários parasitos com potencial zoonótico: larvas de Ancylostoma (82,5%), ovos de Toxocara sp (59,4%), ovos semelhantes aos de Ancilostomídeos (37,1%), oocistos de coccídeos (13,5%), ovos de Trichostrongylus sp., ovos de Ascaris lumbricoides, (11,6%), cistos de Entamoeba sp. (10,0%), Strongyloides sp. (4,8%), vários nematóides de vida livre e algumas estruturas parasitárias não identificadas que podem corresponder a um parasita (3,3%). Foi estabelecido que a maior frequência de estruturas parasitárias ocorreu nos meses entre maio e outubro de 2004, e de fevereiro a março de 2005. Um aumento na diversidade de formas parasitárias foi documentado nos meses entre fevereiro a dezembro de 2004 e de janeiro a abril de 2005, esses períodos com a maior pluviosidade

Two fingerprinting sets for Humulus lupulus based on KASP and microsatellite markers

Verification of clonal identity of hop (Humulus lupulus L.) cultivars within breeding programs and germplasm collections is vital to conserving genetic resources. Accurate and economic DNA-based tools are needed in dioecious hop to confirm identity and parentage, neither of which can be reliably determined from morphological observations. In this study, we developed two fingerprinting sets for hop: a 9-SSR fingerprinting set containing high-core repeats that can be run in a single PCR reaction and a kompetitive allele specific PCR (KASP) assay of 25 single nucleotide polymorphisms (SNPs). The SSR set contains a sex-linked primer pair, HI-AGA7, that was used to genotype 629 hop accessions from the US Department of Agriculture (USDA) National Clonal Germplasm Repository (NCGR), the USDA Forage Seed and Cereal Research (FSCR), and the University of Nebraska-Lincoln (UNL) collections. The SSR set identified unique genotypes except for 89 sets of synonymous samples. These synonyms included: cultivars with different designations, the same cultivars from different sources, heat-treated clones, and clonal variants. Population structure analysis clustered accessions into wild North American (WNA) and cultivated groups. Diversity was slightly higher in the cultivated samples due to larger sample size. Parentage and sib-ship analyses were used to identify true-to-type cultivars. The HI-AGA7 marker generated two male- and nine female-specific alleles among the cultivated and WNA samples. The SSR and KASP fingerprinting sets were compared in 190 samples consisting of cultivated and WNA accession for their ability to confirm identity and assess diversity and population structure. The SSR fingerprinting set distinguished cultivars, selections and WNA accessions while the KASP assays were unable to distinguish the WNA samples and had lower diversity estimates than the SSR set. Both fingerprinting sets are valuable tools for identity confirmation and parentage analysis in hop for different purposes. The 9-SSR assay is cost efficient when genotyping a small number of wild and cultivated hop samples (\u3c96) while the KASP assay is easy to interpret and cost efficient for genotyping a large number of cultivated samples (multiples of 96)

Infiltração apical em obturações de canais realizadas após aplicação do laser Nd: YAG ou solução de EDTA nas paredes do canal radicular

Marginal apical leakage was evaluated in root canal filling performed with two sorts of cements after applying Nd:YAG laser or an EDTA solution in the root canal walls. Sixty-two human lower premolars had their canals instrumented through mechanical technique. Afterwards the external root surfaces were impermeabilized, except for the foramen. The roots were then divided into 4 groups of 15, according to the type of treatment performed on the root canal walls and the type of cement utilized in the filling. Group I - application of Nd:YAG laser and filling with AH Plus cement; Group II - application of Nd:YAG laser and filling with Endofill cement; Group III - application of EDTA for 5 minutes and filling with AH Plus cement; Group IV - application of EDTA for 5 minutes and filling with Endofill cement. Two teeth served as negative and positive controls. Afterwards, the roots were immersed in a 2%-methylene blue dye, for 48 hours. Wearing of the roots took place following the removal of impermeabilization for the reading of leakage magnitude, by means of a light microscope through planimetry technique The results indicated AH Plus cement as the one to allow the least apical leakage, as well as Nd:YAG laser application, when utilized in the treatment of root canal walls, prior to filling.Avaliou-se a infiltração marginal apical em obturações endodônticas utilizando dois tipos de cimentos após a aplicação do laser Nd:YAG ou solução de EDTA nas paredes do canal radicular. Utilizou-se sessenta e dois dentes pré-molares inferiores humanos que tiveram seus canais radiculares instrumentados por técnica mecanizada. Em seguida, as superfícies externas radiculares foram impermeabilizadas, exceto o forame apical. As raízes foram, então, divididas em 4 grupos de 15, de acordo com o tipo de tratamento realizado nas paredes dos canais radiculares e o tipo de cimento utilizado para a obturação. Grupo I - aplicação do laser Nd:YAG e obturação com cimento AH Plus; Grupo II - aplicação do laser Nd:YAG e obturação com cimento Endofill; Grupo III - aplicação de EDTA por 5 minutos e obturação com cimento AH Plus; Grupo IV - aplicação de EDTA por 5 minutos e obturação com cimento Endofill. Dois dentes serviram como controles positivo e negativo. Em seguida, as raízes foram imersas em solução de azul-de-metileno a 2%, durante 48 horas. Após remoção da impermeabilização foi realizado o desgaste das raízes para leitura da magnitude das infiltrações, por meio de um microscópio óptico pela técnica da planimetria. Os resultados indicaram que o cimento AH Plus foi o que permitiu menor infiltração apical, assim como a aplicação do laser Nd:YAG, quando utilizado no tratamento das paredes dos canais radiculares, anteriormente à obturação

Improving understanding of adjuvant therapy options by using simpler risk graphics

BACKGROUND: To help oncologists and breast cancer patients make informed decisions about adjuvant therapies, online tools such as Adjuvant! provide tailored estimates of mortality and recurrence risks. However, the graphical format used to display these results (a set of 4 horizontal stacked bars) may be suboptimal. The authors tested whether using simpler formats would improve comprehension of the relevant risk statistics. METHODS: A total of 1619 women, aged 40-74 years, completed an Internet-administered survey vignette about adjuvant therapy decisions for a patient with an estrogen receptor-positive tumor. Participants were randomized to view 1 of 4 risk graphics, a base version that mirrored the Adjuvant! format, an alternate graph that showed only 2 options (those that included hormonal therapy), a graph that used a pictograph format, or a graph that included both changes. Outcome measures included comprehension of key statistics, time required to complete the task, and graph-perception ratings. RESULTS: The simplifying format changes significantly improved comprehension, especially when both changes were implemented together. Compared with participants who viewed the base 4-option bar graph, respondents who, instead, viewed a 2-option pictograph version were more accurate when they reported the incremental risk reduction achievable from adding chemotherapy to hormonal therapy (77% vs 51%; P <[hairsp].001), answered that question more quickly (median time, 28 seconds vs 42 seconds; P <[hairsp].001), and liked the graph more (mean, 7.67 vs 6.88; P <[hairsp].001). CONCLUSIONS: Although most patients will only view risk calculators such as Adjuvant! in consultation with their clinicians, simplifying design graphics could significantly improve patients' comprehension of statistics essential for informed decision making about adjuvant therapies. Cancer 2008. Published 2008 by the American Cancer Society.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/61431/1/23959_ftp.pd

Bringing features of human dialogue to web surveys

When web survey respondents self-administer a questionnaire, what they are doing is in many ways similar to what goes on in human–human interviews. The studies presented here demonstrate that enabling web survey respondents to engage in the equivalent of clarification dialogue can improve respondents' comprehension of questions and thus the accuracy of their answers, much as it can in human–human interviews. In two laboratory experiments, web survey respondents (1) answered more accurately when they could obtain clarification, that is, ground their understanding of survey questions, than when no clarification was available, and (2) answered particularly accurately with mixed-initiative clarification, where respondents could initiate clarification or the system could provide unsolicited clarification when respondents took too long to answer. Diagnosing the need for clarification based on respondent characteristics—in particular, age—proved more effective than relying on a generic model of all respondents' need for clarification. Although clarification dialogue increased response times, respondents preferred being able to request clarification than not. The current results suggest that bringing features of human dialogue to web surveys can exploit the advantages of both interviewer- and self-administration of questionnaires. Copyright © 2007 John Wiley & Sons, Ltd.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/55951/1/1335_ftp.pd