The prevalence of child sexual abuse with online sexual abuse added

BACKGROUND AND OBJECTIVE

Research efforts are measuring various forms of online sexual abuse. There is a need to incorporate such measures of online sexual abuse into the calculation of overall prevalence rates for child sexual abuse.

PARTICIPANTS

A sample of 2639 respondents aged 18-to-28 was recruited from a nationally representative online panel.

METHODS

Using an online questionnaire, respondents were assessed via self-report about 9 types of online sexual abuse in childhood and were also assessed with 2 questions that have been used to assess generic child sexual abuse prevalence in previous surveys.

RESULTS

The addition of the online abuse to the generic questions about child sexual abuse raised the overall prevalence rate from 13.5 % to 21.7 %. The rate for females increased from 19.8 % to 31.6 % and for males from 6.2 % to 10.8 %. The largest independent contribution to the overall combined increase were the offenses involving non-consensual image sharing and voluntary online sexual interactions with an impermissibly older adult partner. The inclusion of the online sexual abuse exposures also increased the ability to identify the survivors with the highest levels of current psychological distress.

CONCLUSION

The study highlights the importance of counting and including online sexual abuse in efforts to estimate the overall prevalence of childhood sexual abuse. The paper proposes 2 or 3 questions that could be added to sexual abuse questionnaires to assess these online offenses efficiently.

How Risky is Online Sexting by Minors?

What proportion of minors who engage in sexting find themselves involved in an episode of image abuse? The data come from a US nationally representative sample of 2639 respondents aged 18-28 reporting about experiences before the age of 18, of whom 23% had engaged in sexting as minors. Among those who sexted the rate of image abuse was 37%, a risk ratio of 13.2 compared to those who did not engage in sexting. For females who sexted the victimization rate was particularly high, but sexting increased risk for females and males. Among the minors who only sexted occasionally (vs those who sexted frequently) the rate of abuse was still high (35%) and the reduction in risk modest. When we controlled for other background and demographic risk factors like adversities and prior sexual abuse, it did not substantially reduce the large risk entailed with sexting. Various harm reduction strategies may be needed to supplement messages about dangers and risks.

Characteristics and Dynamics of Cyberstalking Victimization Among Juveniles and Young Adults

Using the nationally representative Ipsos online KnowledgePanel, the sample included three hundred thirty-six 18- to 28-year-olds who retrospectively reported first cyberstalking incidents as juveniles (9- to 17-year-olds) or adults. Half of the sample first experienced cyberstalking as juveniles and half first experienced it as adults. Juveniles were more likely to have more than two perpetrators in the same episode, to experience more violent threats, and to avoid people because of what happened. Few reported the incident to the police, with juveniles less likely to report it to the police. Cyberstalking of juveniles appears just as or more serious than cyberstalking of adults.

Effects of empagliflozin on progression of chronic kidney disease: a prespecified secondary analysis from the empa-kidney trial

BACKGROUND

Sodium-glucose co-transporter-2 (SGLT2) inhibitors reduce progression of chronic kidney disease and the risk of cardiovascular morbidity and mortality in a wide range of patients. However, their effects on kidney disease progression in some patients with chronic kidney disease are unclear because few clinical kidney outcomes occurred among such patients in the completed trials. In particular, some guidelines stratify their level of recommendation about who should be treated with SGLT2 inhibitors based on diabetes status and albuminuria. We aimed to assess the effects of empagliflozin on progression of chronic kidney disease both overall and among specific types of participants in the EMPA-KIDNEY trial.

METHODS

EMPA-KIDNEY, a randomised, controlled, phase 3 trial, was conducted at 241 centres in eight countries (Canada, China, Germany, Italy, Japan, Malaysia, the UK, and the USA), and included individuals aged 18 years or older with an estimated glomerular filtration rate (eGFR) of 20 to less than 45 mL/min per 1·73 m2, or with an eGFR of 45 to less than 90 mL/min per 1·73 m2 with a urinary albumin-to-creatinine ratio (uACR) of 200 mg/g or higher. We explored the effects of 10 mg oral empagliflozin once daily versus placebo on the annualised rate of change in estimated glomerular filtration rate (eGFR slope), a tertiary outcome. We studied the acute slope (from randomisation to 2 months) and chronic slope (from 2 months onwards) separately, using shared parameter models to estimate the latter. Analyses were done in all randomly assigned participants by intention to treat. EMPA-KIDNEY is registered at ClinicalTrials.gov, NCT03594110.

FINDINGS

Between May 15, 2019, and April 16, 2021, 6609 participants were randomly assigned and then followed up for a median of 2·0 years (IQR 1·5-2·4). Prespecified subgroups of eGFR included 2282 (34·5%) participants with an eGFR of less than 30 mL/min per 1·73 m2, 2928 (44·3%) with an eGFR of 30 to less than 45 mL/min per 1·73 m2, and 1399 (21·2%) with an eGFR 45 mL/min per 1·73 m2 or higher. Prespecified subgroups of uACR included 1328 (20·1%) with a uACR of less than 30 mg/g, 1864 (28·2%) with a uACR of 30 to 300 mg/g, and 3417 (51·7%) with a uACR of more than 300 mg/g. Overall, allocation to empagliflozin caused an acute 2·12 mL/min per 1·73 m2 (95% CI 1·83-2·41) reduction in eGFR, equivalent to a 6% (5-6) dip in the first 2 months. After this, it halved the chronic slope from -2·75 to -1·37 mL/min per 1·73 m2 per year (relative difference 50%, 95% CI 42-58). The absolute and relative benefits of empagliflozin on the magnitude of the chronic slope varied significantly depending on diabetes status and baseline levels of eGFR and uACR. In particular, the absolute difference in chronic slopes was lower in patients with lower baseline uACR, but because this group progressed more slowly than those with higher uACR, this translated to a larger relative difference in chronic slopes in this group (86% [36-136] reduction in the chronic slope among those with baseline uACR <30 mg/g compared with a 29% [19-38] reduction for those with baseline uACR ≥2000 mg/g; ptrend<0·0001).

INTERPRETATION

Empagliflozin slowed the rate of progression of chronic kidney disease among all types of participant in the EMPA-KIDNEY trial, including those with little albuminuria. Albuminuria alone should not be used to determine whether to treat with an SGLT2 inhibitor.

FUNDING

Boehringer Ingelheim and Eli Lilly.

Impact of primary kidney disease on the effects of empagliflozin in patients with chronic kidney disease: secondary analyses of the EMPA-KIDNEY trial

BACKGROUND

The EMPA-KIDNEY trial showed that empagliflozin reduced the risk of the primary composite outcome of kidney disease progression or cardiovascular death in patients with chronic kidney disease mainly through slowing progression. We aimed to assess how effects of empagliflozin might differ by primary kidney disease across its broad population.

METHODS

EMPA-KIDNEY, a randomised, controlled, phase 3 trial, was conducted at 241 centres in eight countries (Canada, China, Germany, Italy, Japan, Malaysia, the UK, and the USA). Patients were eligible if their estimated glomerular filtration rate (eGFR) was 20 to less than 45 mL/min per 1·73 m2, or 45 to less than 90 mL/min per 1·73 m2 with a urinary albumin-to-creatinine ratio (uACR) of 200 mg/g or higher at screening. They were randomly assigned (1:1) to 10 mg oral empagliflozin once daily or matching placebo. Effects on kidney disease progression (defined as a sustained ≥40% eGFR decline from randomisation, end-stage kidney disease, a sustained eGFR below 10 mL/min per 1·73 m2, or death from kidney failure) were assessed using prespecified Cox models, and eGFR slope analyses used shared parameter models. Subgroup comparisons were performed by including relevant interaction terms in models. EMPA-KIDNEY is registered with ClinicalTrials.gov, NCT03594110.

FINDINGS

Between May 15, 2019, and April 16, 2021, 6609 participants were randomly assigned and followed up for a median of 2·0 years (IQR 1·5-2·4). Prespecified subgroupings by primary kidney disease included 2057 (31·1%) participants with diabetic kidney disease, 1669 (25·3%) with glomerular disease, 1445 (21·9%) with hypertensive or renovascular disease, and 1438 (21·8%) with other or unknown causes. Kidney disease progression occurred in 384 (11·6%) of 3304 patients in the empagliflozin group and 504 (15·2%) of 3305 patients in the placebo group (hazard ratio 0·71 [95% CI 0·62-0·81]), with no evidence that the relative effect size varied significantly by primary kidney disease (pheterogeneity=0·62). The between-group difference in chronic eGFR slopes (ie, from 2 months to final follow-up) was 1·37 mL/min per 1·73 m2 per year (95% CI 1·16-1·59), representing a 50% (42-58) reduction in the rate of chronic eGFR decline. This relative effect of empagliflozin on chronic eGFR slope was similar in analyses by different primary kidney diseases, including in explorations by type of glomerular disease and diabetes (p values for heterogeneity all >0·1).

INTERPRETATION

In a broad range of patients with chronic kidney disease at risk of progression, including a wide range of non-diabetic causes of chronic kidney disease, empagliflozin reduced risk of kidney disease progression. Relative effect sizes were broadly similar irrespective of the cause of primary kidney disease, suggesting that SGLT2 inhibitors should be part of a standard of care to minimise risk of kidney failure in chronic kidney disease.

FUNDING

Boehringer Ingelheim, Eli Lilly, and UK Medical Research Council.

Victimization and abuse among children with disabilities: Age adjusted rates in a US national sample

BACKGROUND

Research has indicated that children with disabilities are at higher risk for victimization although the literature on this topic is limited.

OBJECTIVE

We examined rates of assault, sexual victimization, peer-sibling victimization, property crime, maltreatment, and poly-victimization among youth in the United States with and without disabilities. We examined these rates for three age groups (children ages 0-4 years, ages 5-11 years, and ages 12-17 years).

PARTICIPANTS AND SETTING

We use data from the National Survey of Children's Exposure to Violence (NatSCEV), waves I (2008), II (2011), and III (2014). These are cross-sectional nationally representative samples of children and youth ages one month to 17 years (N = 12,634).

RESULTS

Considering children of all ages together, children in all disability categories, except for physical disability, were at higher risk for poly-victimization. Victimization exposure overall is higher among older children (except for assault among very young children with developmental or learning disabilities), though the disparity between children with and without disabilities generally narrows as children get older. Age of the child impacted the relationships between disability and victimization. Very young children with physical disabilities were at heightened risk for most types of victimization while children with internalizing disabilities were at heightened risk for assault, property crime, and maltreatment in middle childhood and adolescence. Children with externalizing disabilities were at heightened risk for most types of victimization across all ages while developmental disabilities appeared to be risk factor for very young children and a potentially protective factor at later ages though these varied by type of victimization.

CONCLUSION

Victimization risk varied by victimization and disability types. This study demonstrates the importance of controlling for demographic characteristics, especially age of the child in estimating the prevalence of victimization among children with disabilities and establishes the importance of type-specific analyses by victimization type, disability type, and age of the child.

Child sexual abuse images and youth produced images: The varieties of Image-based Sexual Exploitation and Abuse of Children

BACKGROUND AND OBJECTIVE

This paper presents a categorization of sexual image crimes and abuse that occur against children, and it compares their frequency, dynamics, and emotional impact.

PARTICIPANTS

A national sample of 2639 respondents aged 18-to-28 disclosed 369 childhood episodes involving a variety of image abuse.

METHODS

Online self-administered questionnaire.

RESULTS

The analysis classified the cases into five incident types: 1) adult made images (child sexual abuse images), 2) images non-consensually made by other youth, 3) voluntarily provided self-made images that were non-consensually shared by other youth, 4) voluntarily provided self-made images non-consensually shared by adults, and 5) voluntarily provided self-made images to adults that entailed an illegal age difference or were part of a commercial transaction. We propose to refer to this aggregation of types as Image Based Sexual Exploitation and Abuse of Children (IBSEAC). Only 12 % of the image episodes qualified as adult produced, child sexual abuse images. Such adult produced image experiences were also not higher in negative emotional impact than the youth produced images. Only 10 % of the episodes involved images of children under age 13.

CONCLUSION

The study highlights the predominance of youth made sexual images among the image exploitation and abuse affecting youth according to self-report. It also highlights the difference between what victim surveys reveal about the problem and what is inferred from police record studies.

Which dynamics make online child sexual abuse and cyberstalking more emotionally impactful: Perpetrator identity and images?

BACKGROUND

The migration of offenses against children to the online environment requires a revised understanding of how episode dynamics aggravate the harm.

OBJECTIVE

To assess the contribution of various online offense episode elements to the overall negative emotional impact.

PARTICIPANTS AND SETTINGS

The sample comprised 2639 IPSOS KnowledgePanel members aged 18 to 28, 1215 of whom reported episodes of online sexual abuse or cyberstalking that occurred prior to the age of 18. The analysis was based on 2056 episodes with detailed follow-up information.

METHODS

Participants were recruited online and filled out online questionnaires about online sexual abuse and cyberstalking episodes, their characteristics, and the negative emotional impact (NEI) associated with each episode. NEI was derived from a factor analysis of 8 impact items.

RESULTS

Higher negative emotional impact was associated with forms of sexual image misuse: non-consensual sharing, non-consensual taking and threatened sharing/sextortion. Peers made up a majority of offenders, and their impact was just as great as adult offenders. Known perpetrators, including intimate partners, also made up the largest proportion of offenders and their impact was just as great as online strangers or anonymous offenders.

CONCLUSION

Online safety awareness and prevention need a larger focus on peer and acquaintance offenses, particularly around the misuse of sexual images.

Prevalence of Online Sexual Offenses Against Children in the US

IMPORTANCE

Sexual abuse is increasingly facilitated by technology, but the prevalence and dynamics of such offenses have not been well delineated, making it difficult to design prevention strategies.

OBJECTIVE

To examine the frequency and characteristics of online and technology-facilitated sexual abuse against children and youth.

DESIGN, SETTING, AND PARTICIPANTS

In this nationally representative online survey study performed from November 19 to December 29, 2021, young adults aged 18 to 28 years were asked retrospectively about their childhood (<18 years) experiences of online and technology-facilitated abuse. The 2639 participants were sampled from an online panel.

MAIN OUTCOMES AND MEASURES

Participants were asked questions about 11 different kinds of online and technology-facilitated sexual abuse with follow-up questions about their dynamics and offenders. Prevalence rates were calculated for several cross-cutting concepts (online child sexual abuse, image-based sexual abuse, self-produced child sexual abuse images, nonconsensual sexting, online grooming by adults, revenge pornography, sextortion, and online commercial sexual exploitation). Survey weights were applied to obtain population prevalence estimates.

RESULTS

A total of 2639 individuals (48.5% male, 49.8% female, and 1.8% other gender; 23.7% Hispanic, 12.6% non-Hispanic Black, 53.9% non-Hispanic White, 4.8% other race, and 5.0% ≥2 races) were surveyed. Childhood (before 18 years of age) prevalence rates were as follows: online child sexual abuse, 15.6% (SE, 1.0%); image-based sexual abuse, 11.0% (SE, 0.9%); self-produced child sexual abuse images, 7.2% (SE, 0.7%); nonconsensual sexting, 7.2% (SE, 0.7%); online grooming by adults, 5.4% (SE, 0.5%); revenge pornography, 3.1% (SE, 0.5%); sextortion, 3.5% (SE, 0.6%); and online commercial sexual exploitation, 1.7% (SE, 0.3%). The prime age of vulnerability across all categories was 13 to 17 years. Perpetrators in most categories were predominantly dating partners, friends, and acquaintances, not online strangers.

CONCLUSIONS AND RELEVANCE

The results of this national survey study suggest that a considerable portion of youth have experienced online child sexual abuse. Professionals planning prevention and intervention strategies for online sexual abuse should understand that dynamics include diverse episodes that are often extensions of dating abuse, sexual bullying, and sexual harassment, not only events perpetrated by adult internet predators.

Ten simple rules to host an inclusive conference

Conferences are spaces to meet and network within and across academic and technical fields, learn about new advances, and share our work. They can help define career paths and create long-lasting collaborations and opportunities. However, these opportunities are not equal for all. This article introduces 10 simple rules to host an inclusive conference based on the authors’ recent experience organizing the 2021 edition of the useR! statistical computing conference, which attracted a broad range of participants from academia, industry, government, and the nonprofit sector. Coming from different backgrounds, career stages, and even continents, we embraced the challenge of organizing a high-quality virtual conference in the context of the Coronavirus Disease 2019 (COVID-19) pandemic and making it a kind, inclusive, and accessible experience for as many people as possible. The rules result from our lessons learned before, during, and after the organization of the conference. They have been written mainly for potential organizers and selection committees of conferences and contain multiple practical tips to help a variety of events become more accessible and inclusive. We see this as a starting point for conversations and efforts towards building more inclusive conferences across the world. * Translated versions of the English abstract and the list of rules are available in 10 languages in S1 Text: Arabic, French, German, Italian, Japanese, Korean, Portuguese, Spanish, Tamil, and Thai.

Abstract TP90: Challenges Implementing An Innovative Home Health Evaluations And Active Living Program

Introduction: Approximately 50% of stroke patients are discharged to home from the hospital. Post stroke transitional care is fragmented and unorganized leading to poor patient outcomes, hospital readmissions, decreased functional status, and increased caregiver burden. We discuss our experience implementing a multidisciplinary team-based post stroke transitional telehealth program.

Methods: Acute stroke patients discharged home were invited to participate in a 90-day telehealth program, iHEAL, upon discharge. Inclusion criteria included 2 or more uncontrolled risk factors requiring medication management, two or more therapy needs, WiFi at home, knowledge of technology, and agreement to follow up with iHEAL program providers. Patients were discharged with remote monitoring devices (blood pressure monitor, medication adherence device) and an iPad for telehealth visits with the stroke NP and both the neurology pharmacist and therapists. Surveys were completed by participants during and after completion of the program.

Results: Of approximately 167 patients discharged home within the initial 9 months, 6 patients enrolled in iHEAL. The most common reasons for ineligibility were lack of two therapy needs and lack of two risk factors in need of medication adjustment excluding 69% of patients when combined in addition to limited internet access in the home. There have been no readmissions. Medications were scanned 50% of the time. Blood pressure readings were maintained or decreased for all patients. Telehealth visit completion: 50% NP, 40% Pharmacist , 40% PT, 20% OT and 40% SLP. Most reported feeling comfortable using the iHEAL equipment (80%) and 100% reported satisfaction with the program and would recommend to others.

Conclusion: Enrollment in iHEAL has been unexpectedly difficult due to overly stringent enrollment criteria and limited broadband internet access in Central Virginia and surrounding regions. These difficulties led to changing criteria in Month 10 to one therapy need and removing the requirement for medication management of the two identified risk factors. Follow up data to be included in final presentation.

A de novo paradigm for male infertility

De novo mutations are known to play a prominent role in sporadic disorders with reduced fitness. We hypothesize that de novo mutations play an important role in severe male infertility and explain a portion of the genetic causes of this understudied disorder. To test this hypothesis, we utilize trio-based exome sequencing in a cohort of 185 infertile males and their unaffected parents. Following a systematic analysis, 29 of 145 rare (MAF < 0.1%) protein-altering de novo mutations are classified as possibly causative of the male infertility phenotype. We observed a significant enrichment of loss-of-function de novo mutations in loss-of-function-intolerant genes (p-value = 1.00 × 10^-5) in infertile men compared to controls. Additionally, we detected a significant increase in predicted pathogenic de novo missense mutations affecting missense-intolerant genes (p-value = 5.01 × 10^-4) in contrast to predicted benign de novo mutations. One gene we identify, RBM5, is an essential regulator of male germ cell pre-mRNA splicing and has been previously implicated in male infertility in mice. In a follow-up study, 6 rare pathogenic missense mutations affecting this gene are observed in a cohort of 2,506 infertile patients, whilst we find no such mutations in a cohort of 5,784 fertile men (p-value = 0.03). Our results provide evidence for the role of de novo mutations in severe male infertility and point to new candidate genes affecting fertility.

Exposure to parent assault on a sibling as a childhood adversity

BACKGROUND

Children's exposure to parental violence against another parent has been widely studied as an adverse childhood experience and source of childhood trauma. Exposure to parental violence against a sibling could be equally as traumatizing, but the literature on this exposure is sparse, by comparison. We examined the frequency of exposure to parental assault on a sibling (EPAS) and its demographic distributions. We also investigated the links between EPAS and symptoms of distress.

METHOD

From three combined surveys of the National Survey on Children's Exposure to Violence, based on telephone interviews with parents, and in the case of those 10-17 years old, adolescents, we examined children living with a juvenile sibling (N = 7, 029; 49% female).

RESULTS

Lifetime EPAS was 3.7%, and sibling assault was more common by fathers (70%) than by mothers (30%). Exposure was greatest for boys and adolescents, highest for those whose parents had some college education, and for those living with other non-parental adults, single parents, and stepfamilies. Rates did not differ by ethnicity. Most exposed youth felt afraid (83%), and fear was greater when witnessing fathers than mothers assaulting a sibling. Controlling for child maltreatment and exposure to interparental violence, those exposed to EPAS showed higher current levels of mental distress (anger, depression, and anxiety; F (10, 6146) = 140.44, p = .001; R² = 0.19).

CONCLUSIONS

Clinical work and parent education programs should address the occurrence of EPAS and the adverse association between EPAS and mental health to reduce its potential negative impact.

Medical Treatment Following Violence Exposure in a National Sample of Children and Youth

IMPORTANCE

Children and youth experience high rates of exposure to violence, which is associated with later poor physical and mental health outcomes. The immediate injuries and impacts from these exposures are often treated in emergency departments and medical offices.

OBJECTIVE

To characterize, using nationally representative data, the size and characteristics of the child and youth population being seen by medical authorities in the wake of violence exposure.

DESIGN, SETTING, AND PARTICIPANTS

The survey study used a representative sample of children and youth aged 2 to 17 years, from 2 waves (2011 and 2014) of the National Survey of Children Exposed to Violence, drawn from a mix of random digit dialing and address-based sampling. Interviews were conducted (1) over the phone with caregivers of young children or (2) directly with the youth aged 10 to 17 years. Data analysis was performed from September to December 2020.

MAIN OUTCOMES AND MEASURES

Violence exposures were assessed with the 53-item Juvenile Victimization Questionnaire, which had follow-up questions that asked about injury and going "to the hospital, a doctor's office, or some kind of health clinic because of what happened." Additional questions were asked about lifetime and past-year childhood adversities and current trauma symptoms using the Trauma Symptom Checklist and the Trauma Symptom Checklist for Young Children.

RESULTS

The combined 2-survey sample had 5187 children and youth who reported a lifetime violence exposure, of whom 45.6% (95% CI, 43.1%-48.2%) were aged 2 to 9 years, and 54.4% (95% CI, 51.8%-56.9%) were aged 10 to 17 years; 53.6% (95% CI, 51.0%-56.2%) were male. Based on the full sample of 8503 children and youth, 3.4% (95% CI, 2.6%-4.4%) had a violence-related medical visit at some time in their lives. The rate of past-year medical visits due to a violence exposure was 1.9% (95% CI, 1.2%-2.7%), equivalent to a point estimate of approximately 1.4 million children and youth. Of those with medical visits, 33.3% (95% CI, 23.1%-45.4%) were aged 2 to 9 years. Those with a past-year visit had higher levels of trauma symptoms (risk ratio, 1.71; 95% CI, 1.44-2.03) adverse childhood experiences (risk ratio, 2.55; 95% CI, 2.34-2.78) and multiple violence exposures (risk ratio, 3.91; 95% CI, 3.22-4.76) compared with the general sample of children and youth.

CONCLUSIONS AND RELEVANCE

The estimated large number of violence-related visits with medical professionals offers an opportunity to address a source of frequent injury, and provide counseling and referral for a high-risk segment of the population to treat and prevent further physical and mental health and social consequences.

60 Front Door Specialist Frailty MDT Working at MFT NHS Trust—The Therapy Team Poster Presentation

Introduction

The therapy team consists of physiotherapists, Occupational therapists and therapy technicians working generically to deliver a comprehensive therapy assessment to patients presenting in our Emergency Department, Clinical Decisions Unit and Medical Admissions Unit between the hours of 08:00–18:00 7 days a week. The therapists provide the hospitals frailty service in ED and MAU with early therapy assessment and intervention, supporting the provision of a Comprehensive Geriatric Assessment. The aims of our service are to provide early therapy assessment of our most vulnerable patients to avoid unnecessary hospital admissions and reduce readmission rates, and for those requiring hospital care to provide early mobilisation and discharge planning to reduce length of stay and complications associated with hospital admission. We provide the therapy component of the CGA as part of the specialist frailty MDT service and act as an interface with local community health and social services.

Method

A full review of our frailty MDT service was undertaken and a re-allocation of our resources and staff was piloted in July 2019.

During this pilot our therapy staff presence was re-distributed allowing greater patient numbers to be assessed promptly on their arrival to ED.

This adjustment supported the Frailty MDT actions of:

Results

Data collection showed total referrals to therapy increased from 67 (June 2019) to 160 (July 2019). In July same day discharges were at 43%; discharges ≥72 hours 24%; 7 day readmission at 9%; 28 day readmissions at 11% and 38% were referred to community services.

Conclusion

These changes enabled us to provide a full MDT frailty service to frail older people presenting at our ED in a timely manner and to a larger number of suitable patients.

Medicine in motion: Opportunities, challenges and data analytics-based solutions for traditional medicine integration into western medical practice

ETHNOPHARMACOLOGICAL RELEVANCE

Traditional pharmacopeias have been developed by multiple cultures and evaluated for efficacy and safety through both historical/empirical iteration and more recently through controlled studies using Western scientific paradigms and an increasing emphasis on data science methodologies for network pharmacology. Traditional medicines represent likely sources of relatively inexpensive drugs for symptomatic management as well as potential libraries of new therapeutic approaches. Leveraging this potential requires hard evidence for efficacy that separates science from pseudoscience.

MATERIALS AND METHODS

We performed a review of non-Western medical systems and developed case studies that illustrate the epistemological and practical translative barriers that hamper their transition to integration with Western approaches. We developed a new data analytics approach, in silico convergence analysis, to deconvolve modes of action, and potentially predict desirable components of TM-derived formulations based on computational consensus analysis across cultures and medical systems.

RESULTS

Abstraction, simplification and altered dose and delivery modalities were identified as factors that influence actual and perceived efficacy once a medicine is moved from a non-Western to Western setting. Case studies on these factors highlighted issues with translation between non-Western and Western epistemologies, including those where epistemological and medicinal systems drive markets that can be epicenters for zoonoses such as the novel Coronavirus. The proposed novel data science approach demonstrated the ability to identify and predict desirable medicinal components for a test indication, pain.

CONCLUSIONS

Relegation of traditional therapies to the relatively unregulated nutraceutical industry may lead healthcare providers and patients to underestimate the therapeutic potential of these medicines. We suggest three areas of emphasis for this field: First, vertical integration and embedding of traditional medicines into healthcare systems would subject them to appropriate regulation and evidence-based practice, as viable integrative implementation mode. Second, we offer a new Bradford-Hill-like framework for setting research priorities and evaluating efficacy, with the goal of rescuing potentially valuable therapies from the nutraceutical market and discrediting those that are pseudoscience. Third, data analytics pipelines offer new capacity to generate new types of TMS-inspired medicines that are rationally-designed based on integrated knowledge across cultures, and also provide an evaluative framework against which to test claims of fidelity and efficacy to TMS made for nutraceuticals.

Receipt of Behavioral Health Services Among US Children and Youth With Adverse Childhood Experiences or Mental Health Symptoms

Importance

Epidemiological literature on children's mental health and children's adverse childhood experiences (ACEs) have consistently pointed to widespread, unaddressed, and treatable high-risk conditions among children.

Objective

To estimate the proportion of children with either high levels of ACEs and/or high levels of mental health symptoms who were not receiving services from behavioral health professionals.

Design, Setting, and Participants

This cross-sectional study included 11 896 children who participated in 3 National Surveys of Children's Exposure to Violence (NatSCEV), which were nationally representative surveys conducted in 2008, 2011, and 2014. The surveys entailed telephone interviews with youth aged 10 to 17 years and caregivers of children aged 2 to 9 years. Data were analyzed from February to August 2020.

Main Outcomes and Measures

Nationally representative samples were obtained from a mix of random digit dial and address-based sampling methods. The primary outcome was the proportion of children with high ACEs, high distress symptoms, and both who were receiving clinical contact, broken down by demographic characteristics.

Results

Of the 11 896 children, 4045 (34.0%) participated in the 2008 NatSCEV; 4112 (34.6%) in the 2011 NatSCEV; and 3738 (31.4%) in the 2014 NatSCEV; 5532 (46.5%) were aged 2 to 9 years (2785 [50.4%] aged 2-5 years; 2693 [48.7%] girls; 3521 [63.7%] White children), and 6365 (53.5%) were aged 10 to 17 years (3612 [56.7%] aged 14-17 years; 3117 [49.0%] female participants; 4297 [67.5%] White individuals). Among participants aged 2 to 9 years, no clinical contact was reported for 57% (95% CI, 51%-62%) of the high ACE group, 53% (95% CI, 48%-58%) of the high distress symptom group, and 41% (95% CI, 32%-51%) of the group with high levels on both indicators. Among participants aged 10 to 17 years, the group with no clinical contact comprised 63% (95% CI, 56%-69%) of the high ACE group, 52% (95% CI, 46%-57%) of the high distress symptom group, and 62% (95% CI, 51%-71%) of youth scoring high on both indicators. Among racial groups, odds of contact were very low for Black children aged 2 to 9 years with high ACEs compared with non-Hispanic White children with the same age and exposure (odds ratio, 0.26; 95% CI, 0.14-0.49).

Conclusions and Relevance

In this cross-sectional study combining findings from 3 US national surveys, large portions of children at high risk because of adversity or mental health symptoms were not receiving clinical services. Better ways are needed to find these at-risk populations and help them obtain relevant intervention resources.

SDH-deficient renal cell carcinoma: a clinicopathological analysis highlighting the role of genetic counselling

Succinate dehydrogenase (SDH)-deficient renal cell carcinoma (RCC) accounts for 0.05-2% of all RCCs. The majority of patients have germline mutations, most frequently in the SDHB gene. People with these mutations are predisposed to developing paragangliomas, phaeochromocytomas and gastrointestinal stromal tumours. Patients should be referred to genetic services for further workup and close surveillance imaging due to the risk of development of further tumours. We present a woman with SDH-deficient RCC and review the literature associated with this uncommon entity.

In vitro exposure to Hymenoptera venom and constituents activates discrete ionotropic pathways in mast cells

Calcium entry is central to the functional processes in mast cells and basophils that contribute to the induction and maintenance of inflammatory responses. Mast cells and basophils express an array of calcium channels, which mediate responses to diverse stimuli triggered by small bioactive molecules, physicochemical stimuli and immunological inputs including antigens and direct immune cell interactions. These cells are also highly responsive to certain venoms (such as Hymenoptera envenomations), which cause histamine secretion, cytokine release and an array of pro-inflammatory functional responses. There are gaps in our understanding of the coupling of venom exposure to specific signaling pathways such as activation of calcium channels. In the present study, we performed a current survey of a model mast cell line selected for its pleiotropic responsiveness to multiple pro-inflammatory inputs. As a heterogenous stimulus, Hymenoptera venom activates multiple classes of conductance at the population level but tend to lead to the measurement of only one type of conductance per cell, despite the cell co-expressing multiple channel types. The data show that I_CRAC, I_ARC, and TRPV-like currents are present in the model mast cell populations and respond to venom exposure. We further assessed individual venom components, specifically secretagogues and arachidonic acid, and identified the conductances associated with these stimuli in mast cells. Single-cell calcium assays and immunofluorescence analysis show that there is heterogeneity of channel expression across the cell population, but this heterogeneity does not explain the apparent selectivity for specific channels in response to exposure to venom as a composite stimulus.

The Importance of Second-Generation Antipsychotic-Related Weight Gain and Adherence Barriers in Youth with Bipolar Disorders: Patient, Parent, and Provider Perspectives

Objectives: The objective of this research was to understand physician, patient, and parent perspectives on barriers to second-generation antipsychotic (SGA) medication adherence in youth with bipolar spectrum disorders, and attitudes toward treatment of SGA-related weight gain. Methods: Patients diagnosed with bipolar disorder before age 18, parents of children diagnosed before 18, and clinicians with experience prescribing SGAs for these patients completed surveys regarding SGA-related side effects, adherence barriers, and acceptability of weight management strategies. Results: Patients (n = 225), parents (n = 128), and clinicians (n = 54) reported weight gain as the most concerning SGA-related side effect (45.6%, 38.9%, and 70.4%, respectively). Weight gain was also the top adherence barrier for patients (35.9%), but was ranked fourth (41.8%) by parents. Patients (61.5%) were more likely "definitely" willing to co-initiate another medication to manage weight gain upon SGA initiation than parents (20.1%) or clinicians (1.9%). Conversely, parents (54.9%) and clinicians (84.9%) were "definitely" willing to accept/prescribe a second medication aiming to reverse weight gain of ≥10 lbs., and patients (61.1%) were willing to add another medication to reverse any weight gain. Conclusion: SGA-related weight gain impairs medication adherence in young patients with bipolar disorder. Many young patients would start pharmacologic treatment to mitigate SGA-related weight gain at treatment initiation, parents and clinicians are more hesitant. This research informs patient-centered perspectives on SGA adherence barriers and strategies to minimize potential side effects, which may improve adherence in this vulnerable patient population.

Evidence for penetrance in patients without a family history of disease: a systematic review

Family-based penetrance is frequently cited as a major challenge for translating penetrance estimates from familial populations to asymptomatic populations. A systematic review was performed to assess the literature evidencing penetrance estimates in patients without a family history of disease, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) framework. Initially 1592 papers were identified, which were filtered to a final nine, through application of inclusion and exclusion criteria. Fundamental differences in the identified papers prevented combination of papers using meta-analysis, so thematic analysis to produce a narrative synthesis was performed. Key themes included disease risk modifiers, evidence, study limitations and bias. A methodological appraisal too was used to assess quality of included studies. It is evident from the findings that the evidence base for penetrance estimates in individuals without a family history of disease is limited. Future work is needed to refine design of penetrance studies and the impact of incorrect estimates.

Family predictors of sibling versus peer victimization

Though peer victimization has received more attention than sibling victimization, they both have negative associations with mental health and may share common family origins. We explore whether there are common family characteristics (family climate, interparental conflict, parenting) in the prediction of sibling and peer victimization. We employ a nationally representative sample of U.S. children ages 5-17 (N = 2,659; 51% male, mean age = 10.60 years, 58% White). A telephone interview was conducted with a parent of children ages 5-9 and with children ages 10-17. Multinomial logistic regression showed that sibling and peer victimization are both associated with exposure to family adversity, family violence, and child maltreatment. Sibling victimization is also associated with inconsistent or harsh parenting. The odds ratios of the family characteristics of interest did not differ for sibling versus peer victimization, suggesting overlap in the family etiology of sibling and peer victimization. However, in this study, sibling victimization does appear to have unique associations to demographic characteristics; sibling victimization is most common in White and educated families. Knowledge of shared familial elements of sibling and peer victimization could benefit family violence and antibullying programs to promote positive interactions and lessen and stop aggression in both sibling and peer relationships. (PsycINFO Database Record (c) 2020 APA, all rights reserved).

Family and friend social support as mediators of adolescent sibling victimization and mental health, self-esteem, and delinquency

Sibling victimization is associated with adjustment problems. Protective factors that reduce the detrimental effects of sibling victimization are unknown. We examined the mediating role of social support from family and friends in the relationship between sibling victimization and adolescents' mental health distress, self-esteem, and delinquency. A telephone survey (N = 850; 49% female) was conducted with a nationally representative sample of United States adolescents (Aged 10 to 17). Three mediation models were tested exploring (a) the unique effects of family and friend support, (b) the relative effects of each type of support, and (c) the effects of total support (family and friend support summed). The three models demonstrated partial mediation of adolescents' mental health and self-esteem. Family and total support, but not friend support, partially mediated the relationship between sibling victimization and delinquency. Findings showed that family and friend social support, in combination and sometimes uniquely, reduced the adverse effects sibling victimization associated with adolescents' mental health, self-esteem, and delinquency. Efforts aimed at promoting social support from family and friends as protective factors may reduce the risk of sibling victimization experiences for adolescent well-being difficulties. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Myrcene and terpene regulation of TRPV1

Nociceptive Transient Receptor Potential channels such as TRPV1 are targets for treating pain. Both antagonism and agonism of TRP channels can promote analgesia, through inactivation and chronic desensitization. Since plant-derived mixtures of cannabinoids and the Cannabis component myrcene have been suggested as pain therapeutics, we screened terpenes found in Cannabis for activity at TRPV1. We used inducible expression of TRPV1 to examine TRPV1-dependency of terpene-induced calcium flux responses. Terpenes contribute differentially to calcium fluxes via TRPV1 induced by Cannabis-mimetic cannabinoid/terpenoid mixtures. Myrcene dominates the TRPV1-mediated calcium responses seen with terpenoid mixtures. Myrcene-induced calcium influx is inhibited by the TRPV1 inhibitor capsazepine and Myrcene elicits TRPV1 currents in the whole-cell patch-clamp configuration. TRPV1 currents are highly sensitive to internal calcium. When Myrcene currents are evoked, they are distinct from capsaicin responses on the basis of Imax and their lack of shift to a pore-dilated state. Myrcene pre-application and residency at TRPV1 appears to negatively impact subsequent responses to TRPV1 ligands such as Cannabidiol, indicating allosteric modulation and possible competition by Myrcene. Molecular docking studies suggest a non-covalent interaction site for Myrcene in TRPV1 and identifies key residues that form partially overlapping Myrcene and Cannabidiol binding sites. We identify several non-Cannabis plant-derived sources of Myrcene and other compounds targeting nociceptive TRPs using a data mining approach focused on analgesics suggested by non-Western Traditional Medical Systems. These data establish TRPV1 as a target of Myrcene and suggest the therapeutic potential of analgesic formulations containing Myrcene.

Diverse TRPV1 responses to cannabinoids

Cannabinoid compounds are potential analgesics. Users of medicinal Cannabis report efficacy for pain control, clinical studies show that cannabis can be effective and opioid sparing in chronic pain, and some constituent cannabinoids have been shown to target nociceptive ion channels. Here, we explore and compare a suite of cannabinoids for their impact upon the physiology of TRPV1. The cannabinoids tested evoke differential responses in terms of kinetics of activation and inactivation. Cannabinoid activation of TRPV1 displays significant dependence on internal and external calcium levels. Cannabinoid activation of TRPV1 does not appear to induce the highly permeant, pore-dilated channel state seen with Capsaicin, even at high current amplitudes. Finally, we analyzed cannabinoid responses at nociceptive channels other than TRPV1 (TRPV2, TRPM8, and TRPA1), and report that cannabinoids differentially activate these channels. On the basis of response activation and kinetics, state-selectivity and receptor selectivity, it may be possible to rationally design approaches to pain using single or multiple cannabinoids.

Calcium-dependent, non-apoptotic, large plasma membrane bleb formation in physiologically stimulated mast cells and basophils

Large membrane derangements in the form of non-detaching blebs or membrane protrusions occur in a variety of cell stress and physiological situations and do not always reflect apoptotic processes. They have been studied in model mast cells under conditions of cell stress, but their potential physiological relevance to mast cell function and formation in primary mast cells or basophils have not been addressed. In the current study, we examine the large, non-detaching, non-apoptotic, membrane structures that form in model and primary mast cells under conditions of stimulation that are relevant to allergy, atopy and Type IV delayed hypersensitivity reactions. We characterized the inflation kinetics, dependency of formation upon external free calcium and striking geometric consistency of formation for large plasma membrane blebs (LPMBs). We describe that immunologically stimulated LPMBs in mast cells are constrained to form in locations where dissociation of the membrane-associated cytoskeleton occurs. Mast cell LPMBs decorate with wheat germ agglutinin, suggesting that they contain plasma membrane (PM) lectins. Electrophysiological capacitance measurements support a model where LPMBs are not being formed from internal membranes newly fused into the PM, but rather arise from stretching of the existing membrane, or inflation and smoothing of a micro-ruffled PM. This study provides new insights into the physiological manifestations of LPMB in response to immunologically relevant stimuli and in the absence of cell stress, death or apoptotic pathways.

Rates of neglect in a national sample: Child and family characteristics and psychological impact

BACKGROUND

Childhood neglect is an understudied form of childhood maltreatment despite being the most commonly reported to authorities.

OBJECTIVE

This study provides national estimates of neglect subtypes, demographic variations in exposure to neglect subtypes, and examines the psychological impact.

PARTICIPANTS AND SETTING

Pooled data from two representative U.S. samples from the National Surveys of Children's Exposure to Violence (NatSCEV) survey conducted in 2011 and 2014, representing the experiences of children and youth aged 1 month to 17 years (N = 8503).

METHODS

Telephone surveys were used to obtain sociodemographic characteristics, six measures of past year and lifetime exposure to neglect, and assessments of trauma symptoms, suicidal ideation, alcohol use, and illicit drug use.

RESULTS

More than 1 in 17 U.S. children (6.07%) experienced some form of neglect in the past year, and more than 1 in 7 (15.14%) experienced neglect at some point in their lives. Supervisory neglect, due to parental incapacitation or parental absence, was most common. Families with two biological parents had lower rates (4.29% in the past year) than other household configurations (range from 7.95% to 14.10%; p < .05). All types of neglect were associated with increased trauma symptoms and suicidal ideation (for 10-17 year olds), and several were associated with increased risk of underage alcohol and illicit drug use.

CONCLUSION

More attention needs to be paid to the impact of supervisory neglect. These results underscore the importance of prevention strategies that provide the supports necessary to build safe, stable, and nurturing relationships and environments that help children thrive.

Disability weights for infectious diseases in four European countries: comparison between countries and across respondent characteristics

Background

In 2015, new disability weights (DWs) for infectious diseases were constructed based on data from four European countries. In this paper, we evaluated if country, age, sex, disease experience status, income and educational levels have an impact on these DWs.

Methods

We analyzed paired comparison responses of the European DW study by participants’ characteristics with separate probit regression models. To evaluate the effect of participants’ characteristics, we performed correlation analyses between countries and within country by respondent characteristics and constructed seven probit regression models, including a null model and six models containing participants’ characteristics. We compared these seven models using Akaike Information Criterion (AIC).

Results

According to AIC, the probit model including country as covariate was the best model. We found a lower correlation of the probit coefficients between countries and income levels (range r_s: 0.97–0.99, P < 0.01) than between age groups (range r_s: 0.98–0.99, P < 0.01), educational level (range r_s: 0.98–0.99, P < 0.01), sex (r_s = 0.99, P < 0.01) and disease status (r_s = 0.99, P < 0.01). Within country the lowest correlations of the probit coefficients were between low and high income level (range r_s = 0.89–0.94, P < 0.01).

Conclusions

We observed variations in health valuation across countries and within country between income levels. These observations should be further explored in a systematic way, also in non-European countries. We recommend future researches studying the effect of other characteristics of respondents on health assessment.

Abstract WP358: Lightning Fast Stroke Treatment: Recognition Makes a Difference

Background: For acute ischemic stroke patients, reduced door-to-needle (DTN) times are associated with better clinical outcomes. Our Stroke Center evaluated DTN time for thrombolysis cases since 2004 to identify opportunities to reduce time to treatment. In October 2014, the American Heart Association/American Stroke Association introduced Target: Stroke Phase II to challenge Get With the Guidelines-Stroke participating hospitals to reduce time to tPA. In January 2015 our center adopted the goal DTN time of 45 minutes. Many best practice strategies outlined in Target: Stroke Phase II were previously implemented, including: EMS pre-notification, single call activation, rapid evaluation by the Stroke Team, and rapid completion and interpretation of brain imaging. In 2015, our stroke center was able to administer tPA within 45 minutes of Emergency Department (ED) arrival in 29% of cases (n=35).

Purpose: The purpose of this project is reduce DTN times by recognizing the efforts of the interdisciplinary team in cases of timely thrombolysis.

Methods: A team-based approach is used for all ED Stroke Alerts. Starting January 2016, for each case of tPA administration within 45 minutes of arrival, every team member was recognized for their contribution in providing “Lightning Fast Stroke Care.” A flyer was developed highlighting details of the case, clinical outcome, and recognizing every team member who participated in the care of the patient. Persons recognized include: EMS, ED nurses, techs and physicians, registration, radiology techs, laboratory staff, pharmacists, Stroke Team physicians and trainees. Flyers were distributed and displayed publically. Each team member recognized received a lightning bolt pin, in addition to a copy of the flyer.

Results: In 2016, over 500 pins were awarded for Lightning Fast Stroke Treatment, and the lightning bolt pin became a badge of honor recognized throughout the medical center. Our Stroke Center was able to administer tPA within 45 minutes of ED arrival in 58% of cases (n=40). Without making other changes to the process our percent of cases achieving DTN within 45 minutes doubled.

Conclusion: Recognition and feedback are important to providing team-based care and have made a significant sustainable impact on DTN times.

Transcriptional Characterization of Compounds: Lessons Learned from the Public LINCS Data

The NIH-funded LINCS program has been initiated to generate a library of integrated, network-based, cellular signatures (LINCS). A novel high-throughput gene-expression profiling assay known as L1000 was the main technology used to generate more than a million transcriptional profiles. The profiles are based on the treatment of 14 cell lines with one of many perturbation agents of interest at a single concentration for 6 and 24 hours duration. In this study, we focus on the chemical compound treatments within the LINCS data set. The experimental variables available include number of replicates, cell lines, and time points. Our study reveals that compound characterization based on three cell lines at two time points results in more genes being affected than six cell lines at a single time point. Based on the available LINCS data, we conclude that the most optimal experimental design to characterize a large set of compounds is to test them in duplicate in three different cell lines. Our conclusions are constrained by the fact that the compounds were profiled at a single, relative high concentration, and the longer time point is likely to result in phenotypic rather than mechanistic effects being recorded.

Family abduction in a national sample of US children

This study examined the prevalence and characteristics of family abduction episodes occurring in a nationally representative sample of US children ages 0-17. It drew on the experiences of 13,052 children and youth from the aggregation of three cross-sectional waves (2008, 2011, and 2014) of the National Surveys of Children Exposed to Violence. The overall prevalence rate was 4.1% for a lifetime and 1.2% for a past year episode. Rates were higher for younger than older children. Parents constituted 90% of the abductors with females outnumbering males 60% to 40%, although men outnumbered women as perpetrators for certain types of abductions. A bit less than half of the episodes (43%) were reported to police. The experience of a lifetime family abduction had an independent association with traumatic stress symptoms independent of exposure to other kinds of victimization including child maltreatment and witnessing family violence.

Abstract 28: Virginia Stroke Coordinators Successfully Collaborate to Improve Door to Needle Times and EMS Relationships

Background and Issues: The Virginia Stroke Coordinators Consortium (VSCC) was founded in 2009 with a stated goal of striving for high-level evidence based stroke care for all Virginians.

Purpose: In CY2015, the VSCC set two specific goals, to improve arrival to IV TPA administration (“Door to Needle”-DTN) times in Virginia and to improve our stroke team relationships with EMS.

DTN Time Methods: We shared the Target Stroke Phase 2information and best practices, we regularly shared our own best practices at our monthly meetings (one live meeting per quarter) through formal presentations and informal discussion, we reviewed current journal publications related to decreasing DTN times and we shared information about and encouraged participation in nationally offered webinars on improving arrival to CT and DTN times.

DTN Time Results: 29 of the 60 hospitals represented within the VSCC participate in Get with the Guidelines so we used that data as a sample of our work. To measure our success, we compared CY2014 Target Stroke Honor Roll reports to CY2015 for the state of Virginia and saw improvement (beyond the level of improvement seen at the national level) in every measure including percent of ischemic strokes that received thrombolysis, percent of patients with a DTN time of 60m or less and percent of patients with a DTN time of 45m or less (including and excluding patients with documented reasons for delay.)

EMS Methods: Again, shared Target Stroke and our own best practices, shared EMS feedback methods and standardized feedback forms, included EMS in our meetings and presentations, encouraged communication with local EMS providers, worked with state wide EMS to develop template for post TPA transport.

EMS Results: The VSCC was surveyed in April of 2014(n-34) and again in April 2015(n-31). We saw that the number of coordinators interacting with EMS increased to 100% of respondents, frequency of EMS interaction increased, those with monthly interaction doubled, EMS feedback increased and 48% of respondents felt their relationships with EMS had improved. (43% already felt they had a good relationship.)

Conclusion: Working together, Stroke Coordinators can significantly lower door to IV TPA times and improve stroke team relationships with EMS throughout the state.

A Behaviorally Specific, Empirical Alternative to Bullying: Aggravated Peer Victimization

PURPOSE

To test a behaviorally specific measure of serious peer victimization, called aggravated peer victimization (APV), using empirically derived aggravating elements of episodes (injury, weapon, bias content, sexual content, multiple perpetrators, and multiple contexts) and compare this measure with the conventional Olweus bullying (OB) measure, which uses repetition and power imbalance as its seriousness criteria.

METHODS

The data for this study come from The National Survey of Children's Exposure to Violence 2014, a study conducted via telephone interviews with a nationally representative sample. This analysis uses the 1,949 youth ages 10-17 from that survey.

RESULTS

The APV measure identified twice as many youth with serious episodes involving injury, weapons, sexual assaults, and bias content as the OB measure. In terms of demographic and social characteristics, the groups were very similar. However, the APV explained significantly more of the variation in distress than the OB (R² = .19 vs. .12).

CONCLUSIONS

An empirical approach to identifying the most serious incidents of peer victimization has advantages in identifying more of the youth suffering the effects of peer victimization. Moreover, its behaviorally specific criteria also bypass the difficult challenge of trying to reliably assess what is truly bullying with its ambiguous definitional element of power imbalance.

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.

Children Exposed to Abuse in Youth-Serving Organizations: Results From National Sample Surveys

IMPORTANCE

Protecting children in youth-serving organizations is a national concern.

OBJECTIVE

To provide clinicians, policymakers, and parents with estimates of children's exposure to abuse in youth-serving organizations.

DESIGN, SETTING, AND PARTICIPANTS

Telephone survey data from the 3 National Surveys of Children's Exposure to Violence (2008, 2011, and 2014) were combined to create a sample of 13,052 children and youths aged 0 to 17 years. The survey participants included youths aged 10 to 17 years and caregivers of children aged 0 to 9 years.

MAIN OUTCOMES AND MEASURES

Items from the Juvenile Victimization Questionnaire.

RESULTS

In the combined sample of 13 052 children and youths aged 0 to 17 years, the rate of abuse by persons in youth-serving organizations was 0.4% (95% CI, 0.2-0.7) for the past year and 0.8% (95% CI, 0.5-1.1) over the lifetime. Most of the maltreatment (63.2%) was verbal abuse and only 6.4% was any form of sexual violence or assault.

CONCLUSIONS AND RELEVANCE

Abuse in youth-serving organizations was a relatively rare form of abuse, dwarfed by abuse by family members and other adults.

Osteitis and chronic rhinosinusitis: a review of the current literature

Chronic rhinosinusitis is a common debilitating condition characterized by inflammation of the nose and paranasal sinuses. Osteitis is an associated finding but it is not clear whether it is cause or effect. This review will report on studies that have examined the role of osteitis in CRS, with the ultimate aim of clarifying the definition, pathogenesis and clinical implications of this relatively new clinical entity. Literature searches of Medline, EMBASE and CENTRAL using the search terms osteitis, rhinosinusitis, sinusitis, rhinitis, chronic disease, and recurrence were performed. 21 articles were identified and reviewed. The papers highlighted key pathological features including periosteal thickening, new woven bone formation, bone resorption, fibrosis and inflammatory cell infiltration. Radiological grading systems and basic science research into the role of matrix metalloproteinases and P-glycoprotein were also identified and reviewed.

A revised inventory of Adverse Childhood Experiences

This study examines whether the items from the original Adverse Childhood Experiences (ACE) scale can be improved in their prediction of health outcomes by adding some additional widely recognized childhood adversities. The analyses come from the National Survey of Children's Exposure to Violence 2014, a telephone survey conducted from August 2013 through April 2014 with a nationally representative sample of 1,949 children and adolescents aged 10-17 and their caregivers who were asked about adversities, physical health conditions and mental health symptoms. The addition of measures of peer victimization, peer isolation/rejection, and community violence exposure added significantly to the prediction of mental health symptoms, and the addition of a measure of low socioeconomic status (SES) added significantly to the prediction of physical health problems. A revised version of the ACES scale is proposed.

Differential regulation of calcium signalling pathways by components of Piper methysticum ('Awa)

Kava is a soporific, anxiolytic and relaxant in widespread ritual and recreational use throughout the Pacific. Traditional uses of kava by indigenous Pacific Island peoples reflect a complex pharmacopeia, centered on GABA-ergic effects of the well-characterized kavalactones. However, peripheral effects of kava suggest active components other than the CNS-targeted kavalactones. We have previously shown that immunocytes exhibit calcium mobilization in response to traditionally prepared kava extracts, and that the kavalactones do not induce these calcium responses. Here, we characterize the complex calcium-mobilizing activity of traditionally prepared and partially HPLC-purified kava extracts, noting induction of both calcium entry and store release pathways. Kava components activate intracellular store depletion of thapsigargin-sensitive and -insensitive stores that are coupled to the calcium release activated (CRAC) current, and cause calcium entry through non-store-operated pathways. Together with the pepper-like potency reported by kava users, these studies lead us to hypothesize that kava extracts contain one or more ligands for the transient receptor potential (TRP) family of ion channels. Indeed, TRP-like conductances are observed in kava-treated cells under patch clamp. Thus TRP-mediated cellular effects may be responsible for some of the reported pharmacology of kava.

Can child injury prevention include healthy risk promotion?

To reflect on the role of risk-taking and risky play in child development and consider recommendations for the injury prevention field, a symposium was held prior to the November 2013 Canadian Injury Prevention and Safety Promotion Conference. Delegates heard from Canadian and international researchers, practitioners and play safety experts on child development, play space design and playground safety, provision of recreation, and legal and societal perceptions of risk and hazard. The presenters provided multidisciplinary evidence and perspectives indicating the potential negative effect on children's development of approaches to injury prevention that prioritise safety and limit children's opportunities for risky play. Delegates considered the state of the field of injury prevention and whether alternative approaches were warranted. Each presenter prepared a discussion paper to provide the opportunity for dialogue beyond attendees at the symposium. The resulting discussion papers provide a unique opportunity to consider and learn from multiple perspectives in order to develop a path forward.

Sibling and peer victimization in childhood and adolescence

This study examined how victimizations by either a sibling or peer are linked to each other and to mental health in childhood and adolescence. The data were from the National Survey of Children's Exposure to Violence which includes a sample of children aged 3-9 (N=1,536) and adolescents aged 10-17 (N=1,523) gathered through telephone interviews. An adult caregiver (usually a parent) provided the information for children while self-reports were employed for adolescents. Fifteen percent of each age group reported victimization by both a sibling and peer. Victimization by a sibling alone was more common in childhood than adolescence. Victimization by a sibling was predictive of peer victimization. Children and adolescents victimized by both a sibling and peer reported the greatest mental distress. This work establishes that for some children and adolescents, victimization at the hands of other juveniles happens both at home and school. Programs should consider the role of siblings and target parents and siblings to encourage the development and maintenance of constructive sibling interactions.

Family dynamics and young children's sibling victimization

This research examines how family dynamics like interparental conflict, family violence, and quality of parenting are associated with young children's experiences of sibling victimization. We use nationally representative data from interviews with caregivers of 1,726 children aged 2 to 9 years of age. We hypothesized different family dynamics predictors for a composite of common types of sibling victimization (property, psychological, and mild physical aggression) in comparison to severe physical sibling victimization (victimization that includes physical aggression with a weapon and/or injury). Multinomial regression results showed that sibling victimization in general was associated with negative family dynamics but that children in the severe group had even less parental warmth, poor parental supervision, and greater exposure to interparental conflict and family violence than children in the common types victimization group. Different aspects of family dynamics contribute to sibling victimization, but possibly in different ways and with different consequences. The findings underscore the importance of a family systems theory approach to clinical and intervention work.

Child maltreatment rates assessed in a national household survey of caregivers and youth

This paper reports on national estimates for past year child maltreatment from a national household survey conducted in 2011. It also discusses the validity of such estimates in light of other available epidemiology. The Second National Survey of Children Exposed to Violence obtained rates based on 4,503 children and youth from interviews with caregivers about the children ages 0-9 and with the youth themselves for ages 10-17. The past year rates for physical abuse by caregivers were 4.0% for all sample children, emotional abuse by caregivers 5.6%, sexual abuse by caregivers 0.1%, sexual abuse by caregivers and non-caregivers 2.2%, neglect 4.7% and custodial interference 1.2%. Overall, 12.1% of the sample experienced at least one of these forms of maltreatment. Twenty-three percent of the maltreated children or 2.8% of the full sample experienced 2 or more forms of maltreatment. Some authority (teacher, police, medical personnel or counselor) was aware of considerable portions of most maltreatment, which suggests the potential for intervention. Many of the study's estimates were reasonable in light of other child maltreatment epidemiological studies, but comparisons about emotional abuse and neglect were problematic because of ambiguity about definitions.

Age-related neurochemical changes in the rhesus macaque inferior colliculus

Age-related hearing loss (ARHL) is marked by audiometric hearing deficits that propagate along the auditory pathway. Neurochemical changes as a function of aging have also been identified in neurons along the auditory pathway in both rodents and carnivores, however, very little is known about how these neurochemicals change in the non-human primate. To examine how these compensatory neurochemical changes relate to normal aging and audiometric sensitivity along the auditory pathway, we collected auditory brainstem responses (ABRs) and brain specimens from seven rhesus monkeys spanning in age from 15 to 35 years old, and examined the relationship between click evoked ABR thresholds and the ABR evoked pure tone average (PTA) and changes in the number of parvalbumin and NADPH-diaphorase positive cells in the auditory midbrain. We found that the number of parvalbumin positive cells in the central nucleus and the surrounding cortex regions of the inferior colliculus were strongly correlated with advancing age and ABR PTA. We also found that the numbers of NADPHd positive cells in these same regions were not associated with normal aging or changes in the ABR thresholds. These findings suggest that the auditory midbrain undergoes an up-regulation of parvalbumin expressing neurons with aging that is related to changes in the processing of frequencies across the audiometric range.

Youth exposure to violence prevention programs in a national sample

This paper assesses how many children and youth have had exposure to programs aimed at preventing various kinds of violence perpetration and victimization. Based on a national sample of children 5-17, 65% had ever been exposed to a violence prevention program, 55% in the past year. Most respondents (71%) rated the programs as very or somewhat helpful. Younger children (5-9) who had been exposed to higher quality prevention programs had lower levels of peer victimization and perpetration. But the association did not apply to older youth or youth exposed to lower quality programs. Disclosure to authorities was also more common for children with higher quality program exposure who had experienced peer victimizations or conventional crime victimizations. The findings are consistent with possible benefits from violence prevention education programs. However, they also suggest that too few programs currently include efficacious components.

Upset among youth in response to questions about exposure to violence, sexual assault and family maltreatment

To assess whether youth are upset by being asked questions about sensitive kinds of abuse, victimization, family maltreatment, and sexual victimization in the course of standard epidemiological surveys. A national sample of youth aged 10-17 were interviewed on the telephone by experienced interviewers as part of the National Survey of Children Exposed to Violence. At the end they were asked whether answering questions had upset them. Of the youth interviewed, 4.5% reported being at all upset and 0.8% reported being pretty or a lot upset. However, only a minority of those upset, .3% of the total sample, said they would not participate again had they known about the content. But even in this group, the regret about participation was mostly due to the length of the survey, not the types of questions being asked. Thus, asking about exposure to abuse and sensitive kinds of victimization in standard interview surveys is associated with low levels of respondent upset due to the nature of the questions.

Association of sibling aggression with child and adolescent mental health

OBJECTIVE

Sibling aggression is common but often dismissed as benign. We examine whether being a victim of various forms of sibling aggression is associated with children's and adolescents' mental health distress. We also contrast the consequences of sibling versus peer aggression for children's and adolescents' mental health.

METHODS

We analyzed a national probability sample (n = 3599) that included telephone interviews about past year victimizations conducted with youth aged 10 to 17 or an adult caregiver concerning children aged 0 to 9.

RESULTS

Children ages 0 to 9 and youth ages 10 to 17 who experienced sibling aggression in the past year (ie, psychological, property, mild or severe physical assault), reported greater mental health distress. Children ages 0 to 9 showed greater mental health distress than did youth aged 10 to 17 in the case of mild physical assault, but they did not differ for the other types of sibling aggression. Comparison of sibling versus peer aggression generally showed that sibling and peer aggression independently and uniquely predicted worsened mental health.

CONCLUSIONS

The possible importance of sibling aggression for children's and adolescents' mental health should not be dismissed. The mobilization to prevent and stop peer victimization and bullying should expand to encompass sibling aggression as well.