Prevalence of Technology-Facilitated Abuse Among Sexual and Gender Minority Youths

Importance

Digital communication and imaging technologies have created new opportunities for technology-facilitated abuse (TFA) and necessitate a better understanding of how and why the risk for TFA varies across different groups of youths.

Objectives

To compare the prevalence of TFA among youths across 5 different sexual and gender identity groups, and to identify risk factors that may explain variations in TFA risk.

Design, Setting, and Participants

A US nationally representative online survey was conducted among 2639 young adults recruited from the KnowledgePanel online panel from November 19 to December 29, 2021. Individuals aged 18 to 28 years were asked retrospectively about TFA and a variety of other youth experiences in childhood (aged <18 years).

Main Outcomes and Measures

Participants were asked about their sexual and gender identities, 11 types of TFA occurring before the age of 18 years, and several potential risk factors. Prevalence rates of any TFA were compared across sexual and gender identity groups, and analyses were conducted to identify risk factors that help explain group differences. Weights were developed to compensate for gender, education, race and ethnicity, household income, census region, and metropolitan status disproportions.

Results

Among the 2510 respondents (mean [SD] age, 24.8 [2.8] years) who provided gender and sexual identity information, 46.5% (95% CI, 41.9%-51.1%) were cisgender heterosexual females, 25.2% (95% CI, 21.6%-29.1%) were cisgender sexual minority females, 18.3% (95% CI, 14.4%-22.9%) were cisgender heterosexual males, 6.8% (95% CI, 4.6%-9.9%) were cisgender sexual minority males, and 3.3% (95% CI, 2.0%-5.4%) were gender minority individuals. The prevalence of TFA occurring before the age of 18 years was highest among sexual minority females (55.3%; 95% CI, 48.0%-62.4%) and gender minority individuals (53.4%; 95% CI, 33.5%-72.2%). Rates of sexting were highest among cisgender sexual minority females (38.8%; 95% CI, 19.1%-58.8%) and gender minority individuals (36.7%; 95% CI, 19.1%-58.8%) and represented the strongest risk factor for TFA exposure (odds ratio, 5.7; 95% CI, 4.0-8.0). However, it explained little variation in TFA across groups once early in-person adversity, sexual abuse, bullying, and maltreatment were taken into account.

Conclusions and Relevance

This study demonstrates the risk of TFA among sexual and gender minority youths and the need to target prevention efforts toward these vulnerable groups. In addition to strategies to reduce risky behavior, efforts to lower the risk of early sexual abuse, bullying, and maltreatment are likely to also be effective in decreasing TFA among these marginalized groups.

Donor Diabetes and Steatosis Affects Recipient Survival Following Liver Transplantation Based on Etiology of Liver Cirrhosis

BACKGROUND

Liver transplantation (LT) offers patients with decompensated cirrhosis the best chance at long-term survival. With the rising prevalence of diabetes, further clarity is needed on the impact of receiving a liver allograft from a donor with diabetes on post-LT outcomes. This study aims to evaluate the impact of donor diabetes on clinical outcomes after LT.

METHODS

This is a retrospective analysis of the United Network for Organ Sharing registry data of LT recipients from January 1, 2000, to December 31, 2021. Outcomes analysis was performed using Cox proportional model for all-cause mortality and graft failure. Confounding was reduced by coarsened exact matching causal inference analysis.

RESULTS

Of 66 960 donors identified, 7178 (10.7%) had diabetes. Trend analysis revealed a longitudinal increase in the prevalence of donor diabetes ( P  < 0.001). Importantly, donor diabetes was associated with increased all-cause mortality (hazard ratio [HR]: 1.13; 95% confidence interval [CI], 1.07-1.19; P  < 0.001) and graft failure (HR: 1.16; 95% CI, 1.11-1.22; P  < 0.001). Receiving donor organ with diabetes reduced graft survival in patients who received LT for nonalcoholic steatohepatitis cirrhosis (HR: 1.26; 95% CI, 1.13-1.41; P  < 0.001) but not other etiologies of cirrhosis.

CONCLUSIONS

Donor diabetes was associated with worse outcomes post-LT, particularly in patients receiving LT for nonalcoholic steatohepatitis cirrhosis. Future studies are needed to better understand the mechanism underlying this association to develop better risk stratification and clinical practice to improve the outcomes of the transplanted patients.

Does ambient air pollution influence biochemical markers of liver injury? Findings of a cross-sectional population-based survey

BACKGROUND

There is limited evidence supporting an adverse effect of ambient air pollution on the liver.

OBJECTIVES

To test the association between exposure to residential air pollution and serum biochemical indicators of liver injury.

METHODS

We used a nationally representative sample of 32,989 participants aged 3-79 years old who participated in the Canadian Health Measures Survey between 2007 and 2019. Cross-sectional associations were assessed by generalized linear mixed models incorporating survey-specific sampling weights.

RESULTS

The joint effect of an interquartile range (IQR) increase in nitrogen dioxide (NO2), ozone (O3) and fine particulate matter (PM2.5) was positively and significantly associated with all measures of liver injury adjusting for age, sex, education, income, smoking, alcohol consumption, body mass index (BMI), total cholesterol, diabetes, hypertension, and physical activity. The ranking of effect sizes from largest to smallest percent increases were 8.72% (95% confidence interval [CI] 7.56, 9.88) for alanine aminotransferase (ALT), 5.54% (95%CI 3.31, 7.77) for gamma-glutamyl transferase (GGT), 4.81% (95%CI 3.87, 5.74) for aspartate aminotransferase (AST), 2.46% (95%CI 0.26, 4.65) for total bilirubin (TBIL) and 1.18% (95%CI 0.62, 1.75) for alkaline phosphatase (ALP). Findings were not significantly different when stratified by age (≤16, >16 yr), sex, smoking (current, other), cholesterol (≤6.18, >6.18 mmol/l) and BMI (<30, ≥30 kg/m2).

DISCUSSION

These findings suggest that ambient air pollution may have a relatively small impact on the liver, but these changes may have significant impact from a population health perspective, considering the ubiquitous nature of air pollution, or for individuals exposed to very high levels of air pollution.

Simultaneous extraction and detection of peptides, steroids, and proteins in small tissue samples

The detection and quantification of hormones are important to assess the reproductive and stress status of experimental models and for the diagnosis of diseases in human and veterinary clinics. Traditionally, steroid, peptide, and protein hormones are analyzed in individual experiments using different extraction methodologies. With the new advancement on HPLC sorbents, the simultaneous measurement of hormones from different categories becomes possible. In this study, we present a novel sample processing strategy for the simultaneous extraction and detection of peptides, steroids, and proteins using high-resolution liquid chromatography tandem mass spectrometry. We demonstrate the sensitivity of our method for small tissues by acquiring data from brain, pituitary gland, and gonads of single zebrafish samples. This approach promises to shed light on the hormonal pathways and their interrelationships, providing knowledge on the integration of hormone systems.

Do blood metals influence lipid profiles? Findings of a cross-sectional population-based survey

Dyslipidemia, an imbalance of lipids and a major risk factor for cardiovascular disease, has been associated with elevated blood and urine levels of several heavy metals. Using data from a Canadian Health Measures Survey (CHMS), we tested associations between blood levels of cadmium, copper, mercury, lead, manganese, molybdenum, nickel, selenium, and zinc, and the lipids triglycerides (TG), total cholesterol (TC), low density lipoproteins (LDL), high density lipoproteins (HDL) and apolipoproteins A1 (APO A1), and B (APO B). All adjusted associations between single metals and lipids were positive and significant, except for APO A1 and HDL. The joint effect of an interquartile range increase in heavy metals was positively associated with percentage increases of TC, LDL and APO B of 8.82% (95%CI: 7.06, 10.57), 7.01% (95%CI: 2.51, 11.51) and 7.15% (95%CI: 0.51, 13.78), respectively. Future studies are warranted to determine if reducing environmental exposure to heavy metals favorably influences lipid profiles and the risk of cardiovascular disease.

THE RESPONSIBLE DESIGNER: USING A HUMAN-CENTERED DESIGN APPROACH TO CREATE AN ASSISTIVE TECHNOLOGY FOR AD

Our interdisciplinary team of designers, computer scientists, and engineers have begun the development of a low-cost social robot called FRED (the Friendly Robot to Ease Dementia). FRED has a conversational capability which will allow the device to be used as assistive companions for people with AD, engaging conversation, assisting with reminders, playing simple games and music, and relieving caregivers of some of their responsibilities. FRED was created using 3-d printing technology and a single board computer based on raspberry Pi. Interaction between human and the system was implemented using the Mycroft open-source voice assistant. The overall cost of the robot is estimated to be less than $300, rendering it possible for wide distribution among the public. Our presentation will share results from our participatory focus group which helped assist in the design and interactions of FRED. This human-centered design approach included neurologists, healthy older adults, as well as ADRD patients and their caregivers. A common language of important terms (e.g., feedback, interface, training, cognitive assessment) to aid in initial conversations were implemented. A thinking-aloud protocol was adopted once we had a prototype of FRED, where users were able to express freely any problems and/or concerns during interaction. Insights from the thinking-aloud results were used to improve the user interface design to enable the users and robot to interact and collaborate in an effective, natural way. Feedback from the focus group were carefully documented and the results will be shared during our presentation.

Effect of zinc source (zinc sulfate or zinc hydroxychloride) on relative abundance of fecal Treponema spp. in lactating dairy cows

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Cows (n = 24) were fed typical lactating diets that only differed in zinc source inclusion.

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Fecal samples collected from cows were extracted for prokaryotic 16S gene DNA.

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Feeding zinc hydroxychloride decreased the Treponema spp. recovered from fecal samples compared with cows fed zinc sulfate.

Previous research revealed a potential effect of dietary trace mineral source on both ruminal and fecal microbiota. However, the effect of Zn source, specifically, has not previously been considered. Based on reported postruminal solubility, we hypothesized that Zn hydroxychloride would decrease Treponema spp. fecal excretion relative to cows fed Zn sulfate. To test this hypothesis, lactating Holstein cows (n = 24; 685 ± 9 kg of body weight; 159 ± 8 d in milk; parity 3 ± 0.2) were randomly assigned to 1 of 2 dietary treatments: control (75 mg/kg Zn from ZnSO₄) or Zn hydroxychloride (HYD; 75 mg/kg IntelliBond Z; Micronutrients USA LLC). Single fecal grab samples were collected on d 1 before dietary treatments and on d 27 after dietary treatments were applied. Fecal microbial DNA was extracted and sequenced to establish taxonomy using a universal primer for the 16S rRNA gene. Supplementation of HYD decreased the relative abundance of Treponema 2 by 3-fold (14.7% vs. 4.9%). Poor sequencing resolution at the species level limited inference of Treponema spp. toward management or gut health implications of HYD supplementation. However, the inclusion of pathogenic species among Treponema spp. indicates a potential implication of HYD feeding to reduce environmental exposure of the dairy cow to Treponema spp.

Designing Socially Assistive Robots for People With Alzheimer’s and Related Dementia

Alzheimer’s disease (AD) is the most common form of dementia and is associated with memory loss and cognitive impairments that affect daily life. Approximately 5.8 million older adults in the U.S. are living with AD. People with AD often require high levels of care and assistance to maintain daily activities. The majority of care provided to a person living with AD or other forms of dementia is from a family caregiver, representing 18.6 billion hours of unpaid care valued at $244 billion. The long duration, time-intensive nature of caregiving imposes high burdens on caregivers. We designed a socially assistive robot to engage in conversation with people with AD, by engaging in conversation, helping them conduct simple daily tasks, and relieving caregivers of some of their responsibilities. Using design-thinking methodology, a prototype social robot has been created using 3-d printing technology and a single board computer based on raspberry Pi. Interaction between human and robot is implemented using the Mycroft open source voice assistant. The authors demonstrated that the robot is able to have natural conversations with human users. The overall cost of the robot is estimated to be less than $300, rendering it possible for wide distribution among the public. Future research includes further implementation of various cognitive assessment and cognitive training programs using the social robot to improve the quality of life for people living with AD.

Youth Internet Safety Education: Aligning Programs With the Evidence Base

BACKGROUND

This review critically examines the messages of youth internet safety education programs in the light of research about both the dynamics of internet dangers and the efficacy of youth prevention education.

METHODS

Using terms "internet safety education" and "digital citizenship," a Google search identified 12 multi-topic safety programs. Review articles were identified via Google Scholar for six forms of online harm to youth that have been targeted by many of these programs: cyberbullying (19 articles); online sexual exploitation (23 articles); sexting (19 articles); online fraud, hacking, and identity theft (6 articles); online suicide and self-harm promotion (18 articles); and internet overuse or addiction (15 articles).

FINDINGS

There appear to be mismatches between dynamics revealed in the research about internet harms and the messages emphasized in educational programs, particularly on the issues of sexual exploitation and sexting. Overall, the review literature also suggests major advantages to integrating internet safety into already well-established and evidence-based programs currently addressing related off-line harms, for example, programs focusing on general bullying, dating abuse, or sexual abuse prevention. The advantages stem from four factors: (1) the considerable overlap between online harms and similar off-line harms, (2) the apparent greater prevalence of off-line harms, (3) the evidence that the same risk factors lie behind both online and off-line harms, and most importantly, (4) the substantially superior evidence base for the longer standing programs developed originally around the off-line harms.

Outcomes of short-duration antiviral prophylaxis for hepatitis C positive donor kidney transplants

Trials describing 4- to 12-week courses of direct-acting antiviral drugs (DAAs) to treat hepatitis C virus (HCV) transmission from infected donors to uninfected kidney transplant recipients (D+/R- transplants) may be limited in "real-world" application by costs and delayed access to DAAs. We previously reported HCV transmission of 13% among D+/R- transplants with 2- to 4-day pangenotypic sofosbuvir/velpatasvir (SOF/VEL) perioperative prophylaxis, where one patient with HCV transmission was a nonresponder to first-line full-course DAA. Here, we report new data with a 7-day prophylaxis protocol (N = 50), as well as cumulative treatment and outcome data on all HCV D+/R- transplants (N = 102). Overall, nine patients (9/102; 9%; 95% CI: 5%-16%) developed HCV transmission, with a significant decline noted in the 7-day group (2/50; 4%; 95% CI: 0%-13%) compared with 2- to 4-day prophylaxis (7/52; 13%; 95% CI: 5%-25%). All patients with HCV transmission achieved sustained virologic response post full-course therapy (including one nonresponder from initial trial). A 1:1 matched analysis (N = 102) with contemporary HCV D-/R- transplants (controls) showed that although the pretransplant wait time was significantly shorter for D+/R- compared with D-/R- (mean: 1.8 vs. 4.4 years; p < .001), there were no differences in infections, rejection, development of de novo donor-specific antibody, or transplant outcomes up to 6 months of transplant.

Teaching privacy: A flawed strategy for children's online safety

Teaching young people about "privacy" has serious defects if the goal is to promote children's online safety. This commentary points out some the key problems to programs and educational modules with this privacy orientation. Privacy is an abstract and complicated concept, whose norms are in flux, making it difficult to impart clear, relevant, consensus-based messages. We also know very little about how privacy concepts develop in childhood and at what age and in what sequence, making it hard to know what to teach and when. Privacy skills are not necessarily the most important ones for preventing most online harms, including the most serious ones, casting doubt on whether they should receive priority over other prevention skills. Research has also not clearly established connections between many privacy practices and reductions in harm. Most privacy messaging has not been evaluated for how well it is learned, applied and what forms of safety it enhances. As an alternative, the promotion of online safety is best organized, not around privacy, but around the specific harms that educators and children themselves are trying to prevent. The highest priority of these are sexual exploitation, peer bullying and harassment. Such educational safety programs are best built from the foundation of evidence-based programs related to parallel offline dangers.

The Association of Different Cyber-Victimization Types With Current Psychological and Health Status in Southern Appalachian Communities

Research on cyber-victimization has primarily focused on cyberbullying conducted in urban and suburban (metropolitan) settings. We explore a range of cyber-victimizations, including financially motivated offenses and cyberbullying, and their associations with current psychological and health status in a nonmetropolitan sample from southern Appalachia. The forms of cyber-victimization were drawn from focus groups and interviews, and then self-report data on 14 types of cyber-victimization were collected from 478 individuals (57.1% female; age M = 36.44, SD = 16.61). Approximately 3 out of 4 participants (74.7%) reported experiencing at least one cyber-victimization. Cyber-victimization made many participants feel "very upset" (average 55.7%). Many forms of cyber-victimization were associated with elevated trauma symptoms, and lower subjective well-being and health-related quality of life. Cyber-victimization is common in this southern Appalachian community, with financially motivated incidents leading to higher prevalence rates than found in many other studies. In these data, numerous specific types of victimization, including cyber-theft, fraud, and legal-but-intrusive privacy invasions, were associated with worse psychological and physical health. More research is needed on technology-mediated victimization and these types of victimization should be more routinely included in violence assessments.

Secretoneurin is a secretogranin-2 derived hormonal peptide in vertebrate neuroendocrine systems

Secretogranin-2 (SCG2) is a large precursor protein that is processed into several potentially bioactive peptides, with the 30-43 amino acid central domain called secretoneurin (SN) being clearly evolutionary conserved in vertebrates. Secretoneurin exerts a diverse array of biological functions including regulating nervous, endocrine, and immune systems in part due to its wide tissue distribution. Expressed in some neuroendocrine neurons and pituitary cells, SN is a stimulator of the synthesis and release of luteinizing hormone from both goldfish pituitary cells and the mouse LβT2 cell line. Neuroendocrine, paracrine and autocrine signaling pathways for the stimulation of luteinizing hormone release indicate hormone-like activities to regulate reproduction. Mutation of the scg2a and scg2b genes using TALENs in zebrafish reduces sexual behavior, ovulation, oviposition, and fertility. A single injection of the SNa peptide enhanced reproductive outcomes in scg2a/scg2b double mutant zebrafish. Evidence in goldfish suggests a new role for SN to stimulate food intake by actions on other feeding-related neuropeptides. Expression and regulation of the Scg2a precursor mRNA in goldfish gut also supports a role in feeding. In rodent models, SN has trophic-like properties promoting both neuroprotection and neuronal plasticity and has chemoattractant properties that regulate neuroinflammation. Data obtained from several cellular models suggest that SN binds to and activates a G-protein coupled receptor (GPCR), but a bona fide SN receptor protein needs to be identified. Other signaling pathways for SN have been reported which provides alternatives to the GPCR hypothesis. These include AMP-activated protein kinase (AMPK), extracellular signal-regulated kinases (ERK), mitogen-activated protein kinase (MAPK)and calcium/calmodulin-dependent protein kinase II in cardiomyocytes, phosphatidylinositol 3-kinase (PI3K) and Akt/Protein Kinase B (AKT, and MAPK in endothelial cells and Janus kinase 2/signal transducer and activator of transcription protein (JAK2-STAT) signaling in neurons. Some studies in cardiac cells provide evidence for cellular internalization of SN by an unknown mechanism. Many of the biological functions of SN remain to be fully characterized, which could lead to new and exciting applications.

Stereotactic Inverse Dose Planning After Yttrium-90 Selective Internal Radiation Therapy in Hepatocellular Cancer

Purpose

Selective internal radiation therapy (SIRT) is administered to treat tumors of the liver and is generally well tolerated. Although widely adopted for its therapeutic benefits, SIRT is rarely combined with external beam radiation therapy (EBRT) owing to the complexity of the dosimetry resulting from the combination of treatments with distinct radiobiological effects. The purpose of this study was to establish a dosimetric framework for combining SIRT and EBRT using clinical experience derived from representative patients with hepatocellular carcinoma (HCC) who received both therapies.

Methods and Materials

Treatments from 10 patients with HCC given EBRT either before or after SIRT were analyzed. The dosimetry framework used here considered differences in the radiobiological effects and fractionation schemes of SIRT versus EBRT, making use of the concepts of biological effective dose (BED) and equivalent dose (EQD). Absorbed dose from SIRT was calculated, converted to BED, and summed with BED from EBRT dose plans. Two of these patients were used in a virtual planning exercise to investigate the feasibility of combining stereotactic body radiation therapy and SIRT.

Results

The combination of EBRT and SIRT in 10 patients with HCC showed no major toxicity. No Child-Pugh scores went above 8 and albumin-bilirubin scores from only 1 patient worsened to grade 3 (> -1.39) from treatment through 3-months follow-up. A framework with radiobiological modeling was developed to manage the combined treatments in terms of their sum BED. The exploratory SIRT plus SABR inverse dose plans for 2 patients, incorporating radiobiologically informed ⁹⁰Y SIRT dosimetry, achieved dose distributions comparable to SBRT alone.

Conclusions

Treatment with both EBRT and SIRT can be given safely to patients with HCC. The BED and EQD concepts should be used in combined dosimetry to account for the differing radiobiological effects of EBRT and SIRT. Inverse dose planning of EBRT after SIRT could provide improved dose distributions and flexibility to the clinical workflow. Further research into combination therapy is needed through prospective trials.

Poly-victimization, Trauma, and Resilience: Exploring Strengths That Promote Thriving After Adversity

Although it is well known that victimization is associated with higher trauma symptoms, there is still limited information on the protective factors that can help people thrive after adversity. Using the Resilience Portfolio Model as a framework, this study explores a range of psychological and social strengths in a community sample of youth from the southern U.S.A sample of 440 youth aged 10 to 21 (average age 16.38, SD = 3.04) was recruited from youth-serving organizations. They completed a survey on trauma symptoms, victimization, other adversities, and 16 psychological and social strengths.Almost 9 in 10 (89.3%) youth reported one or more victimizations, with peer victimizations most common. Adult-perpetrated offenses were reported by almost half of youth (47.1%). Although several psychological and social strengths were inversely correlated with trauma symptoms at the bivariate level, hierarchical regressions indicated that a sense of purpose was the only strength that uniquely contributed to more resilient mental health in a model with all strengths and controlling for victimization, other adversities, poverty, age, and gender (total R² = .33). The variance explained by strengths (17%) was similar to the variance explained by adversities (15%).In this highly victimized sample of youth, many strengths were associated with lower trauma symptoms for youth, with a sense of purpose showing the most promise. Prevention and intervention programs may benefit from efforts to increase a sense of purpose or other meaning making activities, in addition to efforts that specifically target incidents of trauma.

Featured counter-trafficking program: Love146

This invited article is one of several comprising part of a special issue of Child Abuse and Neglect focused on child trafficking and health. The purpose of each invited article is to describe a specific program serving trafficked children. Featuring these programs is intended to raise awareness of innovative counter-trafficking strategies emerging worldwide and facilitate collaboration on program development and outcomes research. This article describes Love146, an international human rights organization based in the United States and dedicated to ending child sex trafficking and exploitation. Love146's work began in Southeast Asia and later expanded to the United Kingdom, Liberia and Madagascar. In the United States, Love146's Survivor Care Program serves as Connecticut's primary provider of specialized services for survivors of DMST. The purpose of the current paper is to detail the successes, challenges, and lessons learned by Love146 in facilitating U.S. survivor access to services that can improve medical and mental health outcomes.

Poly-Strengths and Peer Violence Perpetration: What Strengths Can Add to Risk Factor Analyses

Adolescence is a high-risk time for perpetration of different forms of peer-based violence including harassment, bullying, and sexual assault. Research documents a number of important risk factors but less understood are protective factors like sense of mattering or how combinations of strengths may reduce perpetration risk. The current study examined how protective factors (i.e., positive social norms), including a diversity of strengths (termed poly-strengths), influenced the perpetration of harassment, bullying, and sexual assault for young people, while accounting for the use of alcohol both cross-sectionally and over time. Youth (N = 2232, 52.6% female) in grades 7-10 enrolled in a study using active parental consent (53% response rate) and completed online surveys in school that asked about bullying and harassment, alcohol use, positive social norms related to violence prevention, and a composite of intra-personal strengths. Follow-up surveys took place 6 months later (N = 2150). Logistic regression analyses examined how social norms and poly-strengths influenced odds of perpetration after accounting for demographic variables and the risk factor of alcohol use. Use of alcohol increased the odds of perpetrating all forms of violence. Strengths were significantly related to lower perpetration at Time 1 but not Time 2. Positive social norms reduced perpetration at both time points. The findings suggest adolescent perpetration of bullying, harassment, and sexual violence is lower in the presence of positive social norms over time and more proximally, in the presence of a diverse strengths portfolio. Prevention efforts that incorporate positive social norms and alcohol reduction strategies may reduce peer violence.

Health-Related Quality of Life among Adolescents as a Function of Victimization, other Adversities, and Strengths

PURPOSE

Most children are exposed to violence (e.g., peer, family, or community violence), which makes children's exposure to violence one of our most urgent social problems. The objective of this project was to examine health-related quality of life (HRQOL) in a vulnerable community sample and identify promising psychological and social protective factors to promote HRQOL in youth.

DESIGN AND METHODS

The sample was 440 youth ages 10 to 21 (average age 16.38, SD = 3.04), recruited from youth-serving organizations. Participants completed a survey on HRQOL, victimization, other adversities, and a range of 16 psychological and social strengths.

RESULTS

Almost 9 in 10 (89.3%) youth reported at least one victimization during their lifetime, and impaired HRQOL was common, with more than half reporting some health impairment in the month prior to the survey. Although all psychological and social strengths were positively correlated with HRQOL at the bivariate level, hierarchical regression indicated that a sense of purpose and recovering positive affect uniquely contributed to better HRQOL, after controlling for victimization, other adversities, poverty, age, and gender (total R² = 0.21). Strengths accounted for more variance in HRQOL than did adversities.

CONCLUSIONS

In this highly victimized sample of youth, many strengths were associated with improved HRQOL for youth, with sense of purpose and recovering positive affect showing the most promise for future prevention and intervention.

PRACTICAL IMPLICATIONS

Programs aimed at reducing the negative impact of childhood exposure to violence may increase their impact by developing key strengths versus solely focusing on alleviating symptoms.

P4475Vasodilation- and blood pressure normalization-independent cardioprotective effects of endogenous, physical activity-induced alpha calcitonin gene-related peptide in chronic hypertension

Background

Alpha calcitonin gene-related peptide (αCGRP) is one of the strongest vasodilators and, as such, is cardioprotective in chronic hypertension when reducing the associated elevated blood pressure. However, we hypothesize that endogenous, physical activity-induced αCGRP has blood pressure independent cardioprotective effects in chronic hypertension.

Methods

Chronic hypertension was induced in WT and αCGRP−/− mice by one-kidney one-clip surgery. Chronic hypertensive WT and αCGRP−/− mice lived sedentarily or performed voluntary wheel running and were treated simultaneously with either vehicle, αCGRP or αCGRP receptor antagonist CGRP8–37. Cardiac function and tissue phenotype were evaluated echocardiographically and by ddPCR, Western blotting and histology, respectively.

Results

Blood pressure was similar among all hypertensive experimental groups. Endogenous αCGRP limited pathological cardiac remodeling and symptomatic heart failure already in sedentary, chronic hypertensive WT mice. In these mice, voluntary wheel running significantly improved cardiac tissue phenotype and function, that was abolished by CGRP8–37 treatment. In αCGRP−/− mice, αCGRP treatment, in contrast to voluntary wheel running, improved cardiac tissue phenotype and function. Specific inhibition of proliferation and myofibroblast differentiation of primary murine cardiac fibroblasts by αCGRP suggests involvement of these cells in αCGRP-mediated blunting of pathological cardiac remodeling.

Conclusion

Endogenous, physical activity-induced αCGRP has blood pressure independent cardioprotective effects and is crucial for maintaining cardiac function in chronic hypertension. Consequently, permanently inhibiting endogenous αCGRP signaling, as currently approved for migraine prophylaxis, could endanger hypertensive patients.

Acknowledgement/Funding

Swiss National Science Foundation, Novartis Foundation for Medical-biological Research

New measures to assess the social ecology of youth: A mixed-methods study

OBJECTIVE

This project used mixed methods to expand the understanding of social ecological constructs important to youth and develop measures to assess these constructs.

METHODS

Eight focus groups and 24 cognitive interviews were conducted with adolescents and caregivers. These were followed by a survey completed by 440 youth ages 10-21 (average age: 16.38, standard deviation[SD] = 3.04).

RESULTS

Qualitative data revealed social ecological constructs that have received little prior research attention. These include three psychosocial strengths: relational motivation (inspiration from key adults), group connectedness (bonded to others in teams or organizations), and mattering (knowing your importance to significant others). One outcome was also identified: family well-being (subjective psychological functioning of the family). Psychometric analyses indicated that the new quantitative measures have good to excellent reliability and validity.

IMPLICATIONS

The social ecology is complex and extends beyond commonly studied constructs such as social support and collective efficacy. More comprehensive assessments can further research.

Digital poly-victimization: The increasing importance of online crime and harassment to the burden of victimization

Many forms of victimization, including bullying and property crime, are increasingly moving online, but most studies of poly-victimization still primarily focus on in-person crime and violence. Few studies have examined the importance of incorporating technology-based victimizations for assessing the true burden of violence. The purpose of this study is to explore whether digital poly-victimization contributes to post-traumatic stress and anxiety/dysphoria symptoms after controlling for in-person poly-victimization. Given that technology use and technology-based victimization are changing rapidly, a mixed methods approach was adopted. In the first two phases, focus groups and cognitive interviews (89 total participants) were used to identify the range of digital victimization and develop the Digital Poly-Victimization Scale. In the third phase, the new measure was included in a community survey (n = 478, 57.5% female; 62.6% earning under $50,000 per year) in a rural Southern region, along with measures of in-person poly-victimization, posttraumatic stress and anxiety/dysphoria symptoms, and other outcomes and personal characteristics. A comprehensive measure of digital poly-victimization indicated that almost 3 in 4 participants (72.3%) had experienced at least one form of digital victimization. The results indicated that digital poly-victimization contributed unique variance to post-traumatic stress and anxiety/dysphoria symptoms (p < .001), health-related quality of life (p < .01), and subjective and family well-being (both p < .001), even after controlling for demographics and in-person poly-victimization. Digital victimization often presents fewer risks to perpetrators and can be expected to represent an increasing share of the societal burden of violence. Future research on poly-victimization should pay more attention to the role of digital victimization.

Vitamin D supplementation in pregnancy-a survey of compliance with recommendations

BACKGROUND

Vitamin D deficiency in pregnancy has important maternal and fetal implications, with increased risk of developing gestational diabetes, preeclampsia, preterm birth and small for gestational age birthweight. It is recommended that every pregnant woman should take 5 μg (200 IU) of vitamin D per day during pregnancy and lactation.

AIMS

This study aimed to determine the prevalence of women taking vitamin D supplementation and to identify the reasons for patients not taking supplementation within women attending an antenatal clinic in Dublin.

METHODS

Survey of women attending the antenatal clinic of the National Maternity Hospital Dublin during 2 weeks in January 2017. Women were asked to record demographics, medical comorbidities and use of vitamin D supplementation or any other supplements in pregnancy, as well as reasons for non-use if appropriate.

RESULTS

Three hundred women were invited to participate and 175 completed the questionnaire (58%). Overall, 38.9% (n = 68) reported to be taking vitamin D supplementation. Of the women that reported not to be taking vitamin D supplementation, 57.9% (n = 62) were taking a pregnancy multivitamin that contained vitamin D, and 28.0% (n = 30) did not know that it was recommended in pregnancy. Therefore, a total of 45 women (25.7%) in our cohort were taking no vitamin D supplementation during pregnancy. There was no difference in non-use based on maternal age, BMI, parity, or country of origin.

CONCLUSIONS

Of the women surveyed, 74.3% reported supplementation with vitamin D, either knowingly or unknowingly. Public health initiatives need to utilize this relatively safe, low-cost intervention to maximize maternal and fetal health. This could reduce the rates of antenatal conditions with associated high morbidity and healthcare burden such as gestational diabetes and preeclampsia.

Ultrasonographic findings in two sheep with enzootic calcinosis

INTRODUCTION

This report describes 2 sheep with enzootic calcinosis characterized by abnormal cardiovascular and respiratory findings and ascites causing abdominal distension. Both sheep were anorexic and listless and had increased heart and respiratory rates. Auscultation of the heart revealed a gallop rhythm in sheep 1 and a loud systolic heart murmur in sheep 2. The activities of liver enzymes were severely increased in both sheep. Abdominal ultrasonography showed severe ascites and congestion of the liver and caudal vena cava. Echocardiography in sheep 2 showed hyperechoic and markedly thickened mitral and aortic valves with moderate-severe mitral insufficiency and generalized cardiomegaly. Both sheep were euthanized and examined postmortem. In addition to ascites and pleural effusion, the principal lesions were nodular thickening of the heart valves and calcification of the aorta and other arteries. Nutrition of the sheep did not include hay pellets, but the sheep were kept together with alpacas and lamas and had access to the hay pellets of these animals. In addition visitors were allowed to feed the sheep with hay pellets offered by the zoo in a dispenser. The two types of hay pellets had Vit D concentrations of 9'900 IU VitD3/kg and 7'000 IU Vit D2/kg, respectively. The definitive diagnosis was enzootic calcinosis.

Poly-victimization and resilience portfolios: Trends in violence research that can enhance the understanding and prevention of elder abuse

This literature review assesses the current state of knowledge about elder abuse and mistreatment, focusing on the lack of incorporation of all forms of elder victimization and the benefits of a poly-victimization framework. This review also includes existing knowledge on risk factors and calls for a greater focus on protective factors and a greater inclusion on family and community factors. Future research, prevention, and intervention would benefit from considering the true burden of elder victimization and a greater implementation of strengths-based approaches to programs.

Perceptions and Practices of Mass Bat Exposure Events in the Setting of Rabies Among U.S. Public Health Agencies

Current guidelines in the setting of exposures to potentially rabid bats established by the Advisory Committee on Immunization Practices (ACIP) address post-exposure prophylaxis (PEP) administration in situations where a person may not be aware that a bite or direct contact has occurred and the bat is not available for diagnostic testing. These include instances when a bat is discovered in a room where a person awakens from sleep, is a child without an adult witness, has a mental disability or is intoxicated. The current ACIP guidelines, however, do not address PEP in the setting of multiple persons exposed to a bat or a bat colony, otherwise known as mass bat exposure (MBE) events. Due to a dearth of recommendations for response to these events, the reported reactions by public health agencies have varied widely. To address this perceived limitation, a survey of 45 state public health agencies was conducted to characterize prior experiences with MBE and practices to mitigate the public health risks. In general, most states (69% of the respondents) felt current ACIP guidelines were unclear in MBE scenarios. Thirty-three of the 45 states reported prior experience with MBE, receiving an average of 16.9 MBE calls per year and an investment of 106.7 person-hours annually on MBE investigations. PEP criteria, investigation methods and the experts recruited in MBE investigations varied between states. These dissimilarities could reflect differences in experience, scenario and resources. The lack of consistency in state responses to potential mass exposures to a highly fatal disease along with the large contingent of states dissatisfied with current ACIP guidance warrants the development of national guidelines in MBE settings.

Virtual Environments, Online Racial Discrimination, and Adjustment among a Diverse, School-Based Sample of Adolescents

Given the recent rise in online hate activity and the increased amount of time adolescents spend with media, more research is needed on their experiences with racial discrimination in virtual environments. This cross-sectional study examines the association between amount of time spent online, traditional and online racial discrimination and adolescent adjustment, including depressive symptoms, anxiety and externalizing behaviors. The study also explores the role that social identities, including race and gender, play in these associations. Online surveys were administered to 627 sixth through twelfth graders in K-8, middle and high schools. Multiple regression results revealed that discrimination online was associated with all three outcome variables. Additionally, a significant interaction between online discrimination by time online was found for externalizing behaviors indicating that increased time online and higher levels of online discrimination are associated with more problem behavior. This study highlights the need for clinicians, educational professionals and researchers to attend to race-related experiences online as well as in traditional environments.

Does rapid assessment shorten the amount of time patients spend in the emergency department?

BACKGROUND

Overcrowding in the emergency department is a common phenomenon. This study assessed the impact of introducing a consultant-supported rapid assessment model, known as EDIT, and point of care testing upon the length of time patients spend in the emergency department.

METHODS

A prospective, observational cohort study was conducted in an emergency department in a district general hospital in the UK. The study consisted of two phases. Patients who attended the emergency department during phase 1 were assessed using a nurse-led triage model with blood samples being analysed in a centralized hospital laboratory. Phase 2 patients were assessed by a consultant-supported rapid assessment model with blood tests being analysed using point of care testing. The time from patient arrival in the emergency department to the time that care was complete and the patient was ready to move on to the next destination of care was recorded. These times from the two phases were compared using the Wilcoxon rank sum test.

RESULTS

A total of 11 213 patients attended the emergency department during the whole study period, of whom 4622 patients were eligible for the study. Phase 1 contained 3835 patients and phase 2 had 787 patients. The median time for patients to be declared ready to leave the emergency department in phase 1 was 129 minutes compared to 76 minutes for phase 2 (P=0.0025). This was a reduction in the median of 53 minutes or 41.1% (95% confidence interval 39.7-42.3%).

CONCLUSIONS

This study demonstrates that a consultant-supported rapid assessment model using point of care testing significantly shortens the time patients spend in the emergency department.

Concordance of the mini-Psychiatric Assessment Schedule for Adults who have Developmental Disabilities (PASADD) and the Brief Symptom Inventory

BACKGROUND

When assessing the mental health needs of people who have intellectual disabilities (ID) it is important to use measures that have good validity and reliability to ensure accurate case recognition and reliable and valid outcome data. Measures developed for this purpose tend to be self-report or by informant report. Multi-trait screening tools developed to identify psychological and psychiatric disorders in people who have ID tend to be informant based. Research examining the concordance of different tools has found this to be high but not for specific diagnoses. Multi-trait self-report measures are fewer and have not been compared with informant approaches. This study aims to examine the concordance between two multi-trait measures of mental health used with people who have ID. One administered to informants [the Mini-Psychiatric Assessment Schedule for Adults who have Developmental Disabilities (PASADD)] and one self-report [Brief Symptom Inventory (BSI)]

METHOD

The measures were completed with 109 adults who have ID and with someone who knows them well.

RESULTS

Level of agreement across the four scales in common was good for three. The poorest convergence was for the obsessive compulsive disorder sub-scales. However, a high level of concordance was found between most sub-scales.

CONCLUSION

The BSI and the PASSAD seem to be good indicators of psychiatric problems and psychological distress; however, similar to other multi-trait measures they did not demonstrate appropriate specificity for particular disorders.

Systemic oxygen extraction during exercise at high altitude

Background

Classic teaching suggests that diminished availability of oxygen leads to increased tissue oxygen extraction yet evidence to support this notion in the context of hypoxaemia, as opposed to anaemia or cardiac failure, is limited.

Methods

At 75 m above sea level, and after 7–8 days of acclimatization to 4559 m, systemic oxygen extraction [C(a−v)O₂] was calculated in five participants at rest and at peak exercise. Absolute [C(a−v)O₂] was calculated by subtracting central venous oxygen content (CcvO₂) from arterial oxygen content (CaO2) in blood sampled from central venous and peripheral arterial catheters, respectively. Oxygen uptake (V˙O2) was determined from expired gas analysis during exercise.

Results

Ascent to altitude resulted in significant hypoxaemia; median (range) SpO2 87.1 (82.5–90.7)% and PaO2 6.6 (5.7–6.8) kPa. While absolute C(a−v)O₂ was reduced at maximum exercise at 4559 m [83.9 (67.5–120.9) ml litre⁻¹vs 99.6 (88.0–151.3) ml litre⁻¹ at 75 m, P=0.043], there was no change in oxygen extraction ratio (OER) [C(a−v)O₂/CaO₂] between the two altitudes [0.52 (0.48–0.71) at 4559 m and 0.53 (0.49–0.73) at 75 m, P=0.500]. Comparison of C(a−v)O₂ at peak V˙O2 at 4559 m and the equivalent V˙O2 at sea level for each participant also revealed no significant difference [83.9 (67.5–120.9) ml litre¹vs 81.2 (73.0–120.7) ml litre⁻¹, respectively, P=0.225].

Conclusion

In acclimatized individuals at 4559 m, there was a decline in maximum absolute C(a−v)O₂ during exercise but no alteration in OER calculated using central venous oxygen measurements. This suggests that oxygen extraction may have become limited after exposure to 7–8 days of hypoxaemia.