A Systematic Review of Empirical Studies Measuring Training Effects on Biases Evidenced by Professionals toward Intimate Partner Violence

A professional's response to a client's disclosure of intimate partner violence (IPV) is shown to significantly impact client outcomes. The quality of a professional's response is largely influenced by that professional's beliefs or biases surrounding IPV. This systematic review examined empirical studies conducted in North America and published between 2000 and 2020 evaluating training effects on biases held by professional groups toward victim-survivors of IPV. Search and extraction were conducted in accordance with preferred reporting items for systematic reviews and meta-analyses standards across seven electronic databases. A total of 17 studies met inclusion criteria. Participant groups included professionals from medical, academic, and social/community service disciplines. All included studies reported significant gains on at least one measure of bias. Upon visual inspection, we found no correlations between characteristics of training interventions and reported outcomes on measures of bias. We discuss results in terms of challenges to measuring bias and functional relationships between training interventions, measures of bias, and professional behavior. Variation presented across studies within and between disciplines in regards to training methodology and measurement of bias. Experts in the field of IPV call for a more cohesive approach. We propose the behavior analytic conceptualization of bias as a framework through which interdisciplinary efforts might be unified toward addressing IPV-related biases. Through this lens, we discuss environmental cues within professional settings that might be influencing problematic IPV-related bias. We offer preliminary recommendations for curricular enhancements. We advocate for revision of terms commonly used in IPV-related research and intervention to better reflect and honor diversity across persons experiencing IPV.

The Effects of a Caregiver Implemented Toilet Training Package

Toileting skills are a milestone typically achieved by the age of four. For many caregivers, particularly those who have children diagnosed with autism spectrum disorder or other developmental disabilities, teaching toileting is a challenge resulting in delayed implementation. Delaying toileting increases the risk of challenges to acquiring this skill. Caregivers are fundamental and research shows that their involvement supports the maintenance and sustainability of this skill. Four caregivers were taught a 24-step toilet training program to teach toileting. Behaviors measured included urination success, urine accident frequency, and child requests for the bathroom. All caregivers learned the 24-step procedure and the toilet training package was effective in teaching three of the four children daytime urine continence.

264 Intertrochantic Hip Fracture Fixation at Musgrove Park Hospital

Background

Hip fractures, the commonest fragility fracture in the UK, carry a 6.7% 30-day mortality. NICE-CG124 guide advises extramedullary implants for trochanteric (AO3.1A1/2) and intramedullary nails for subtrochanteric fractures.

We carried out a retrospective study on the use of cephalomedullary nails (CMN) at MPH to determine compliance with CG124.

Method

National Hip Fracture Database (NHFD) from 2019 was reviewed. Trust records were used for fracture type, surgery, and reasons for deviation from CG124.

Results

201 fractures were identified. NHFD revealed 38 A3 fractures of which 36 underwent CMN, one SHS and one non-operative management. Of 163 A1/A2 fractures, 33 received CMN and 130 CHS.

Only 77% of the NHFD data was correct. Further analysis revealed 18 CMNs were used for AO1/2 injuries. All had justifiable reasons for deviation from CG124, although not documented.

Conclusions

There is scope to improve accuracy of NHFD data. Deviation from guidelines may be appropriate but reasons must be documented and, when appropriate, discussed with patient. Similar nationwide inaccuracy can have significant implications for research based upon NHFD data. To prevent input of incorrect data, our recommendations include: Consultant to confirm AO grade during trauma meetings Reason CMN used for AO1/2 fractures to be documented Monthly local NHFD data audit

Brief Report: Identifying Concerns of Military Caregivers with Children Diagnosed with ASD Following a Military Directed Relocation

Military families relocate three times more often than non-military families. Those whom have children diagnosed with Autism Spectrum Disorder face challenges related to inconsistencies in services, delay of services, and lack of continuity of care. The current study expands the limited research examining the experiences of military families with children with Autism by focusing on impact of relocation, specifically identifying potential causes of delays in services. An online survey of 25 military caregivers of children with autism suggests potential delays in service related to provider waitlists, obtaining new referrals, and lengthy intake processes. The impact of these inconsistencies is discussed in relation to child progress and the need for future research in this area.

A multi-terawatt two-color beam for high-power field-controlled nonlinear optics

Two-color laser beams are instrumental in light-field control and enhancement of high-order harmonic, spectral supercontinuum, and terahertz radiation generated in gases, plasmas, and solids. We demonstrate a multi-terawatt two-color beam produced using a relativistic plasma mirror, with 110 mJ at 800 nm and 30 mJ at 400 nm. Both color components have high spatial quality and can be simultaneously focused, provided that the plasma mirror lies within a Rayleigh range of the driving fundamental beam. Favorable scaling of second-harmonic generation by plasma mirrors at relativistic intensities suggests them as an excellent tool for multi-color waveform synthesis beyond the petawatt level.

A comprehensive analysis of deletions, multiplications, and copy number variations in PARK2

OBJECTIVES

To perform a comprehensive population genetic study of PARK2. PARK2 mutations are associated with juvenile parkinsonism, Alzheimer disease, cancer, leprosy, and diabetes mellitus, yet ironically, there has been no comprehensive study of PARK2 in control subjects; and to resolve controversial association of PARK2 heterozygous mutations with Parkinson disease (PD) in a well-powered study.

METHODS

We studied 1,686 control subjects (mean age 66.1 ± 13.1 years) and 2,091 patients with PD (mean onset age 58.3 ± 12.1 years). We tested for PARK2 deletions/multiplications/copy number variations (CNV) using semiquantitative PCR and multiplex ligation-dependent probe amplification, and validated the mutations by real-time quantitative PCR. Subjects were tested for point mutations previously. Association with PD was tested as PARK2 main effect, and in combination with known PD risk factors: SNCA, MAPT, APOE, smoking, and coffee intake.

RESULTS

A total of 0.95% of control subjects and 0.86% of patients carried a heterozygous CNV mutation. CNV mutations found in 16 control subjects were all in exons 1-4, sparing exons that encode functionally critical protein domains. Thirteen patients had 2 CNV mutations, 5 had 1 CNV and 1 point mutation, and 18 had 1 CNV mutation. Mutations found in patients spanned exons 2-9. In whites, having 1 CNV was not associated with increased risk (odds ratio 1.05, p = 0.89) or earlier onset of PD (64.7 ± 8.6 heterozygous vs 58.5 ± 11.8 normal).

CONCLUSIONS

This comprehensive population genetic study in control subjects fills the void for a PARK2 reference dataset. There is no compelling evidence for association of heterozygous PARK2 mutations, by themselves or in combination with known risk factors, with PD.

Creating and Sustaining Effective Partnerships to Advance Research on Youth With Serious Emotional and Behavioral Disorders

A key barrier to conducting research involving children and families is the difficulty of creating partnerships among researchers, treatment agencies, and schools. This article describes several key factors that were essential to establishing an effective research collaboration between practitioners and university-based researchers, including a mutual respect for the unique needs of research and practice; a strategy for joint decision making; a partnership model of incremental growth; a plan for mentoring junior faculty and students; a format for regular contact between the partners; and a plan for long-term sustainability. This collaboration has conducted over a dozen evaluation studies, as well as examined best practice issues surrounding the needs of children and families with serious emotional and behavioral needs. Even more important has been the lines of research that have been developed from this partnership which keeps the collaboration focused. The lessons learned from this research partnership should inform other collaborations.

Human PON1, a biomarker of risk of disease and exposure

Human paraoxonase 1 (PON1) is a high-density lipoprotein (HDL)-associated serum enzyme that exhibits a broad substrate specificity. In addition to protecting against exposure to some organophosphorus (OP) pesticides by hydrolyzing their toxic oxon metabolites, PON1 is important in protecting against vascular disease by metabolizing oxidized lipids. Recently, PON1 has also been shown to play a role in inactivating the quorum sensing factor N-(3-oxododecanoyl)-l-homoserine lactone (3OC12-HSL) of Pseudomonas aeruginosa. Native, untagged engineered recombinant human PON1 (rHuPON1) expressed in Escherichia coli and purified by conventional column chromatographic purification is stable, active, and capable of protecting PON1 knockout mice (PON1(-/-)) from exposure to high levels of the OP compound diazoxon. The bacterially derived rHuPON1 can be produced in large quantities and lacks the glycosylation of eukaryotic systems that can produce immunogenic complications when inappropriately glycosylated recombinant proteins are used as therapeutics. Previous studies have shown that the determination of PON1 status, which reveals both PON1(192) functional genotype and serum enzyme activity level, is required for a meaningful evaluation of PON1's role in risk of disease or exposure. We have developed a new two-substrate assay/analysis protocol that provides PON1 status without use of toxic OP substrates, allowing for use of this protocol in non-specialized laboratories. Factors were also determined for inter-converting rates of hydrolysis of different substrates. PON1 status also plays an important role in revealing changes in HDL-associated PON1 activities in male patients with Parkinson disease (PD). Immunolocalization studies of PONs 1, 2 and 3 in nearly all mouse tissues suggest that the functions of PONs 1 and 3 extend beyond the plasma and the HDL particle.

Multicenter analysis of glucocerebrosidase mutations in Parkinson's disease

BACKGROUND

Recent studies indicate an increased frequency of mutations in the gene encoding glucocerebrosidase (GBA), a deficiency of which causes Gaucher's disease, among patients with Parkinson's disease. We aimed to ascertain the frequency of GBA mutations in an ethnically diverse group of patients with Parkinson's disease.

METHODS

Sixteen centers participated in our international, collaborative study: five from the Americas, six from Europe, two from Israel, and three from Asia. Each center genotyped a standard DNA panel to permit comparison of the genotyping results across centers. Genotypes and phenotypic data from a total of 5691 patients with Parkinson's disease (780 Ashkenazi Jews) and 4898 controls (387 Ashkenazi Jews) were analyzed, with multivariate logistic-regression models and the Mantel-Haenszel procedure used to estimate odds ratios across centers.

RESULTS

All 16 centers could detect two GBA mutations, L444P and N370S. Among Ashkenazi Jewish subjects, either mutation was found in 15% of patients and 3% of controls, and among non-Ashkenazi Jewish subjects, either mutation was found in 3% of patients and less than 1% of controls. GBA was fully sequenced for 1883 non-Ashkenazi Jewish patients, and mutations were identified in 7%, showing that limited mutation screening can miss half the mutant alleles. The odds ratio for any GBA mutation in patients versus controls was 5.43 across centers. As compared with patients who did not carry a GBA mutation, those with a GBA mutation presented earlier with the disease, were more likely to have affected relatives, and were more likely to have atypical clinical manifestations.

CONCLUSIONS

Data collected from 16 centers demonstrate that there is a strong association between GBA mutations and Parkinson's disease.

Contractors’ experiences of integrated management systems

Integrated management systems (IMS) are an innovative method of handling the multitude of management functions and procedures that are applied throughout major construction projects. Quality, safety and environment are at the forefront of management systems evolution where the integration of these traditionally independent and dedicated organisational systems is expected to deliver a range of benefits through efficiency gains and operational effectiveness at both the company and project level. Building and civil engineering contracting organisations are implementing management integration in different ways and this makes the potential benefits of successful systems application difficult to identify and share widely throughout the industry. This paper reports on a government-funded PhD project that examined IMS developments in the construction industry. The research involved data obtained from a survey of 30 UK-based building and civil engineering companies together with interviews and case studies provided by five principal contractors at the leading-edge of management systems integration. The research found that IMS has the potential to deliver greater organisational effectiveness and efficiency and can improve project performance. It also identified that difficulties in system configuration and implementation are commonplace. The challenge is to establish a generic framework for IMS development which contractors can apply to their activities within the context of their core business.

Identification and haplotype analysis of LRRK2 G2019S in Japanese patients with Parkinson disease

LRRK2 G2019S is the most common known cause of Parkinson disease (PD) in patients of European origin, but little is known about its distribution in other populations. The authors identified two of 586 Japanese patients with PD heterozygous for the mutation who shared a haplotype distinct from that observed in Europeans. This suggests that G2019S originated from separate founders in Europe and Japan and is more widely dispersed than previously recognized.

A clinic-based study of the LRRK2 gene in Parkinson disease yields new mutations

Referral-based studies indicate that a mutation (G2019S) in exon 41 of the LRRK2 gene might be a common cause of Parkinson disease (PD). The authors sequenced leucine-rich repeat kinase 2 (LRRK2) exons 31, 35, and 41 in 371 consecutively recruited patients with PD and found mutations in six (1.6%) subjects, including two heterozygous for new putative pathogenic variants (R1441H, IVS31 + 3A-->G). These data confirm the important contribution of LRRK2 to PD susceptibility in a clinic-based population.

Transcytosis of gastrointestinal epithelial cells by Escherichia coli K1

Escherichia coli K1 is an important neonatal pathogen that is usually transferred from maternal to infant gastrointestinal tract at the time of parturition. Approximately 20% of neonates are colonized, and a proportion of colonized infants goes on to have systemic infection. Entry into the bloodstream from the gastrointestinal tract is hypothesized to occur via epithelial cell invasion. Invasion of multiple epithelial cell lines was studied using gentamicin protection assays and transcytosis of polarized monolayers. Electron microscopy was used to confirm cellular invasion. Cell lines used include two human gastrointestinal lines, Caco-2 and T84; a human respiratory cell line, A549; a human laryngeal cell line, HEp-2; and a canine kidney cell line, MDCK. A virulent E. coli K1 strain, RS218, readily invaded HEp-2, A549, and T84 cell lines in gentamicin protection assays, but was less invasive into MDCK and Caco-2 cells. RS218 also demonstrated transcytosis of both T84 and Caco-2 cells. Four clinical isolates of E. coli K1 demonstrated levels of transcytosis of T84 cells similar to RS218. Caco-2 invasiveness correlated with length of time in tissue culture with maximum invasiveness demonstrated at 11 d in culture, when cells were polarized and differentiated.

Managing pre-examination stress through remote counselling using a session script from a 'sentinel subject'

Twenty-five members of a class of 45 medical students preparing for final examinations were voluntary participants in a pre-examination stress-control exercise conducted four weeks before the start of examinations. The students completed short questionnaires before and after reading the typewritten script of a counselling session of a member of their class (the sentinel subject). In the pre-script questionnaires, 50% of the men and 35% of the women reported a high level of stress. On the post-script questionnaire, 68% identified with the subject being counselled. Only four persons (16%) reported a reduction in stress after reading the script and one person recorded an increase in stress. Seventy-two per cent of respondents (40% of students) indicated that they would use counselling services if they were available. The present study suggests that some form of counselling could be usefully included in distance education modules. The provision of counselling services before examinations may prevent failure. The remote approach by sentinel subject script is an inexpensive method of providing such a service.

Asymptomatic laryngeal malformations are common in patients with Pallister-Hall syndrome

Pallister-Hall syndrome (PHS) comprises hypothalamic hamartoma, polydactyly, pituitary dysfunction, laryngotracheal cleft, imperforate anus, and other anomalies. Some patients with PHS have a bifid epiglottis, a rare malformation. Greig cephalopolysyndactyly syndrome (GCPS) comprises polydactyly with craniofacial malformations without the PHS malformations. Both disorders are caused by mutations in the GLI3 gene. Laryngoscopy on 26 subjects with PHS showed that 15 had a bifid or cleft epiglottis (58%) and none of 14 subjects with GCPS had a cleft epiglottis. The malformed epiglottis was asymptomatic in all of the prospectively evaluated subjects. One additional PHS subject was found to have bifid epiglottis and a posterior laryngeal cleft on autopsy. We conclude that bifid epiglottis is common in PHS but not GCPS. Posterior laryngeal clefts are an uncommon manifestation of PHS and are identified only in severely affected patients. The diagnosis of a bifid epiglottis should prompt a thorough search for other sometimes asymptomatic anomalies of PHS to provide better medical care and recurrence risk assessment for affected individuals and families.

Modifier genes of hereditary hearing loss

Phenotypic variation between individuals with the same disease alleles may be attributable to the genotype at another locus, which is referred to as a modifier gene. Recent functional studies of modifier genes of hearing-loss loci have begun to refine our understanding of hearing processes and will guide the rational design of medical therapies for hearing loss.

Ligament reconstruction basal joint arthroplasty without tendon interposition

The necessity of tendon interposition for the maintenance of joint space after basal joint resection arthroplasty with ligament reconstruction has not been established. A prospective, randomized study was performed. In Group I (nine patients), ligament reconstruction was performed to suspend the first metacarpal in addition to placement of a rolled tendon interposition to fill the void created by resection of the trapezium. In Group II (11 patients), ligament reconstruction alone was performed, with use of a Mitek suture anchor. No tendon interposition was performed. This allowed use of a more limited incision and shorter length of tendon graft. Average followup was 23 months. There was no difference between the two groups in range of motion of the thumb, grip strength, lateral pinch strength, the ability to perform activities of daily living, or subjective satisfaction with the procedure. Two- and three-point pinch strength was statistically significantly greater in Group II. Lateral radiographs of the basal joint at followup, at rest and with pinch, showed maintenance of the joint space, and no difference between the two groups. Tendon interposition is not necessary for maintenance of joint space after basal joint resection arthroplasty if ligament reconstruction is performed.

Invasion of respiratory epithelial cells by Burkholderia (Pseudomonas) cepacia

Pulmonary infections caused by Burkholderia (Pseudomonas) cepacia are an important cause of morbidity and mortality in cystic fibrosis (CF) patients. Several features suggestive of cellular invasion and intracellular sequestration of B. cepacia in CF are persistence of infection in the face of antibiotic therapy to which the organism demonstrates in vitro susceptibility and a propensity to cause bacteremic infections in patients with CF. Epithelial cell invasion was demonstrated in vitro in A549 cells by a modified gentamicin protection assay. The kinetics of invasion appear to be saturable. Electron microscopy of invaded monolayers showed intracytoplasmic bacteria enclosed by membrane-bound vacuoles. No lysosomal fusion with these vacuoles was observed. Intraepithelial cell replication was suggested by electron microscopy and confirmed by both a quantitative assay and a visual assay. Cytochalasin D, but not colchicine, inhibited invasion, suggesting a role for microfilaments but not microtubules. The invasion phenotype in B. cepacia may be an important virulence factor for CF infections.

Computer-assisted trauma care prototype

Each year, civilian accidental injury results in 150,000 deaths and 400,000 permanent disabilities in the United States alone. The timely creation of and access to dynamically updated trauma patient information at the point of injury is critical to improving the state of care. Such information is often non-existent, incomplete, or inaccurate, resulting in less than adequate treatment by medics and the loss of precious time by medical personnel at the hospital or battalion aid station as they attempt to reassess and treat the patient. The Trauma Care Information Management System (TCIMS) is a prototype system for facilitating information flow and patient processing decisions in the difficult circumstances of civilian and military trauma care activities. The program is jointly supported by the United States Advanced Research Projects Agency (ARPA) and a consortium of universities, medical centers, and private companies. The authors' focus has been the human-computer interface for the system. We are attempting to make TCIMS powerful in the functions it delivers to its users in the field while also making it easy to understand and operate. To develop such a usable system, an approach known as user-centered design is being followed. Medical personnel themselves are collaborating with the authors in its needs analysis, design, and evaluation. Specifically, the prototype being demonstrated was designed through observation of actual civilian trauma care episodes, military trauma care exercises onboard a hospital ship, interviews with civilian and military trauma care providers, repeated evaluation of evolving prototypes by potential users, and study of the literature on trauma care and human factors engineering. This presentation at MedInfo '95 is still another avenue for soliciting guidance from medical information system experts and users. The outcome of this process is a system that provides the functions trauma care personnel desire in a manner that can be easily and accurately used in urban, rural, and military field settings. his demonstration will focus on the user interfaces for the hand-held computer device included in TCIMS, the Field Medic Associate (FMA). The FMA prototype is a ruggedized, water-resistant personal computer, weighing approximately 5 lbs. It has an LCD graphical user interface display for patient record input and output, pen-based and audio input, audio output, and wireless communications capabilities. Automatic recording and dynamic, graphical display of time-stamped trends in patient vital signs will be simulated during the demonstration. Means for accessing existing patient record information (e.g., allergies to particular medications) and updating the record with the nature of the injury, its cause, and the treatments that were administered will be shown. These will include use of an electronic pen to mark up anatoglyphs (standard drawings of human body appearing on computer screen) to show where injuries occurred and where treatments were applied, and to input textual descriptions of the nature of the injury, its cause, what treatments were administered, etc. Computer recognition of handwritten inputs will be shown. Likewise, voice annotation and audio playback of patient record information by medics and hospital personnel will be illustrated. These latter technologies free the care providers' hands to treat the patient; they can therefore provide inputs to the patient record while information is fresh in their minds. The audio playback option allows hospital personnel to select more detailed voice annotations of specific portions of the patient record by simply touching the electronic pen to a particular place where an electronic pen marking was made by a medic in the field and then listening to the medic's corresponding audio commentary. Finally, the FMA's means for assisting the medic in simultaneously managing several injured patients will be shown. (abstract truncated)

Molecular cloning of cDNA encoding Sm autoantigen: derivation of a cDNA for a B polypeptide of the U series of small nuclear ribonucleoprotein particles

The Sm snRNPs play a central role in the processing of pre-mRNA. Anti-Sm antibodies, the diagnostic hallmark of systemic lupus erythematosus, target the B'/B and D polypeptides of these snRNPs. We have used patient autoantibodies to clone a cDNA from a human fibroblast cDNA library that encodes the full length of a polypeptide identical with, or closely related to, polypeptide B. This cDNA is comprised of 1139 bases and contains an open reading frame of 855 nucleotides that is capable of encoding 285 amino acids. The first 223 amino acids at the NH2 terminus exhibit nearly complete homology with polypeptide N, a newly recognized brain- and heart-specific component of Sm snRNPs. The derived amino acid sequence for B differs from that of the N polypeptide primarily by a 50-amino acid insert 12 residues upstream from the homologous COOH termini of these polypeptides. The structural differences in these cDNAs for B and N may regulate tissue-specific alternative splicing mechanisms for mRNA. In addition, these clones make it possible to map in fine detail the most characteristic autoimmune responses of systemic lupus erythematosus.

Clonal origins of lymphoproliferative disease induced by Epstein-Barr virus

Analysis of immunoglobulin gene rearrangements in 16 B-cell lineages clonally propagated from two mononucleosis patients supported the notion that mononucleosis is a polyclonal B-lymphoproliferative disorder. Three of seven cell clones from a patient with a fatal B lymphoma revealed the same pattern of immunoglobulin gene rearrangement, indicating that this patient's disease was oligoclonal. The three similar clones were propagated from two sites (blood and spleen), indicating that they represent a metastatic cell lineage which arose during the patient's fatal B lymphoproliferation.

Epibulbar Papilloma

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