Bearing Witness as a Process for Responding to Trauma Survivors: A Review

Bearing witness is a means for trauma survivors to give voice to lived experience. Bearing witness has been used in national and international commissions, inquiries, and tribunals to hear directly from survivors of abuse and trauma. This scoping review examines the documented research on the experience of survivors of trauma bearing witness. In 2021, six electronic data bases were searched-EBSCO, Informit, CINHAL, Clarivate, ProQuest, and Sage-and a search of the gray literature, revealed 1,201 references for studies between 1990 and 2021. After applying the Arksey and O'Malley framework, 21 studies that met inclusion criteria were identified. The inclusion criteria focused on studies where survivors expressed their views on bearing witness to trauma in official processes inclusive of public or private testimony, verbal or written. These studies utilized a range of methodologies and designs that represented the perspectives of 3,192 survivors of trauma who had borne witness. Analysis of the studies resulted in key findings under four themes: healing versus re-traumatization, support and safety of survivors, engaging and involving survivors, and culture and context. The literature indicates that bearing witness is a critical means to give voice to survivors of trauma and to provide them with acknowledgment; however, the literature is inconclusive regarding the impact of bearing witness on survivors. More research is required to better understand how survivors can best benefit and be supported by processes of bearing witness, and not be harmed or re-traumatized.

Novel approach to prenatal predictors of outcomes for fetuses with severe Ebstein anomaly

OBJECTIVE

Ebstein anomaly (EA) is a cardiac malformation with highly variable presentation and severity with limited perinatal management options. We present incorporation of fetal lung measurements into a multidisciplinary evaluation for counseling and predicting postnatal outcomes in patients with severe EA.

METHODS

Five fetuses with severe fetal EA were reviewed. Third trimester sonographic observed/expected total lung area (O/E TLA) and lung to head ratio (O/E LHR), fetal MRI total fetal lung volume ratio (O/E-TFLV), echocardiographic cardio-thoracic ratio (CT ratio), sonographic estimated fetal weight (EFW) by Hadlock formula and presence of hydrops, were used to guide perinatal management.

RESULTS

Three of five had appropriate fetal growth, were delivered at term in a cardiac operative suite, and underwent immediate intervention with good neonatal outcomes. Two had severe fetal growth restriction (FGR), CT ratios > 0.8 and O/E LHR and TLA < 25%. One of which delivered prematurely with neonatal demise and one suffered in utero demise at 34 weeks.

CONCLUSIONS

FGR, hydrops, increased CT ratio and reduced O/E LHR and TFLV are potential prognosticators of poor outcomes in severe EA, and should be validated in larger cohorts that would allow for a statistical analysis of the predictive utility of these measurements.

Technology-Facilitated Abuse Against Women From Culturally and Linguistically Diverse Backgrounds: A Scoping Review of the Literature

Women from culturally and linguistically diverse (CALD) backgrounds are particularly vulnerable to domestic and family violence, including technology-facilitated abuse. Often CALD women depend on technology to connect with support networks in their home country. Technology-facilitated abuse can be devastating and isolating. There is limited comprehensive knowledge of how technology-facilitated abuse is experienced by CALD women. This scoping review addresses this gap by exploring and analysing the available literature on technology-facilitated abuse amongst CALD women in the context of domestic and family violence. Employing a scoping review methodology, a total of nine studies were identified from a database search and other sources (including snowball, web search, and search verification processes). Studies were included if they contained the following three elements: (1) a focus on technology-facilitated abuse, (2) the inclusion of CALD women's experiences, and (3) a context of domestic and family violence (DFV). This review firstly maps the methodologies and characteristics of the studies. Second, the most common types of technology-facilitated abuse that disproportionally affect CALD women are identified together with culturally related help-seeking barriers. Areas for future research are discussed along with suggestions for improving practises and policies for prevention and intervention.

The Impact of Critical Life Points and Events for Survivors of Institutional Child Sexual Abuse: Understanding Trauma and the Role of Compensation in Recovery

Although the impact of child sexual abuse (CSA) is well documented in the international literature, little is known about the critical points of recovery across the life course for survivors of institutional CSA. The aim of this study was to identify critical points, or events across the life course that may increase, or decrease, a survivor's vulnerability to the complex traumatization of institutional CSA (ICSA). The sample consisted of two hundred and forty-eight witness statements extracted from the 56 publicly available case studies presented to the Australian Royal Commission into Institutional Responses to Child Sexual Abuse during 2013-2016 (Commonwealth of Australia, 2017). A content analysis and thematic coding of the statements identified seven main themes in the witness statements (Gender, Organization, Triggers, Trauma, Mental Health, Intervention and Compensation), that appeared to be critical events across the life course. The themes were transformed into variables for further analysis using SPSS. Significant Likelihood Ratios were found between associations with the organization where the abuse occurred and between triggers and breastfeeding/sensory, breast feeding/childcare, emotional and physical distress, and mental health (p < 0.01). Significant associations were also found between receiving compensation for the CSA and triggers, trauma, breast feeding-sensory and childcare (p < 0.05) and gender and breast feeding (p < 0.05). Overall, the findings showed that triggers can be random across the life course occurring mainly through indirect association, or in situations that evoke memories of the CSA, and that receiving compensation can assist survivors in their recovery journey. The findings also indicate the need for health care professionals to be aware of the critical points in a CSA survivor's recovery and how triggers may impact on their mental welling throughout the life course.

Myocardial Work in Echocardiography

Myocardial work is an emerging tool in echocardiography that incorporates left ventricular afterload into global longitudinal strain analysis. Myocardial work correlates with myocardial oxygen consumption, and work efficiency can also be assessed. Myocardial work has been evaluated in a variety of clinical conditions to assess the added value of myocardial work compared to left ventricular ejection fraction and global longitudinal strain. This review showcases the current use of myocardial work in adult echocardiography and its possible role in cardiac pathologies.

RASA2 ablation in T cells boosts antigen sensitivity and long-term function

The efficacy of adoptive T cell therapies for cancer treatment can be limited by suppressive signals from both extrinsic factors and intrinsic inhibitory checkpoints1,2. Targeted gene editing has the potential to overcome these limitations and enhance T cell therapeutic function3-10. Here we performed multiple genome-wide CRISPR knock-out screens under different immunosuppressive conditions to identify genes that can be targeted to prevent T cell dysfunction. These screens converged on RASA2, a RAS GTPase-activating protein (RasGAP) that we identify as a signalling checkpoint in human T cells, which is downregulated upon acute T cell receptor stimulation and can increase gradually with chronic antigen exposure. RASA2 ablation enhanced MAPK signalling and chimeric antigen receptor (CAR) T cell cytolytic activity in response to target antigen. Repeated tumour antigen stimulations in vitro revealed that RASA2-deficient T cells show increased activation, cytokine production and metabolic activity compared with control cells, and show a marked advantage in persistent cancer cell killing. RASA2-knockout CAR T cells had a competitive fitness advantage over control cells in the bone marrow in a mouse model of leukaemia. Ablation of RASA2 in multiple preclinical models of T cell receptor and CAR T cell therapies prolonged survival in mice xenografted with either liquid or solid tumours. Together, our findings highlight RASA2 as a promising target to enhance both persistence and effector function in T cell therapies for cancer treatment.

A protein interaction landscape of breast cancer

[Figure: see text].

The problematization of child sexual abuse in policy and law: The Indonesian example

BACKGROUND

Indonesia has a strong national child protection policy. Yet significant limitations exist in laws, policy implementation, and coordination of services, especially regarding child sexual abuse. This is related to a lack of knowledge about child sexual abuse in Indonesia and associated taboos that constrain policy development.

OBJECTIVE

To understand how child sexual abuse problems have been represented in national child protection policy.

METHOD

'What's the problem represented to be' (Bacchi, 2009) is an analytic approach that uses discourse analysis. This method was employed to examine how child sexual abuse problems in Indonesia are constructed and represented in six government documents (two laws and four national policies).

RESULTS

Three overarching problem representations of child sexual abuse were identified: (1) children are a vulnerable, at risk, and disempowered group; (2) service access is limited and services are not coordinated; and (3) there is a lack of agreement and clarity across laws and policy in child protection. For example, inconsistencies of policy and laws regarding the minimum age for marriage can result in gender discrimination and limit a child's access to justice, protection, and services.

CONCLUSION

Policy discourses play a crucial role in the construction and representation of child sexual abuse problems in Indonesia. Current inconsistencies constrain the implementation of effective intervention and prevention programs. Further work on policy harmony is needed as well as improving community understanding of child sexual abuse.

Abstract 2308: The protein interaction landscape of breast cancer

Cancers have been associated with a diverse array of genomic alterations, many of which are rare with unknown significance. To understand the cellular mechanisms impacted by such alterations in breast invasive carcinoma, we have applied affinity-purification mass spectrometry to delineate comprehensive biophysical interaction networks for 40 frequently altered breast cancer proteins across three human breast cell lines, providing a novel resource of context-specific and shared protein-protein interaction networks in breast cancer cells. These networks interconnect and enrich for common and rare cancer mutations, and are substantially rewired by mutations. Our analysis identifies novel PIK3CA-interacting proteins which repress AKT signaling, and UBE2N emerges as a BRCA1 interactor predictive of clinical response to PARP inhibition. We also show that Spinophilin interacts with and dephosphorylates BRCA1 to promote DNA double-strand break repair. Thus, cancer protein interaction landscapes provide a framework for recognizing oncogenic drivers and drug vulnerabilities.

Citation Format: Minkyu Kim, Jisoo Park, Mehdi Bouhaddou, Kyumin Kim, Ajda Rojc, Maya Modak, Margaret Soucheray, Patrick O'Leary, Denise Wolf, Dominique C. Mitchell, Fan Zheng, John D. Gordan, Jean-Philippe Coppé, Danielle L. Swaney, Laura van' t Veer, Alan Ashworth, Trey Ideker, Nevan J. Krogan. The protein interaction landscape of breast cancer [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2021; 2021 Apr 10-15 and May 17-21. Philadelphia (PA): AACR; Cancer Res 2021;81(13_Suppl):Abstract nr 2308.

Recurrent asthma exacerbations: co-existing asthma and common variable immunodeficiency

Common variable immunodeficiency is characterized by impaired B-cell differentiation and defective immunoglobulin production manifesting as recurrent respiratory tract infections. While the condition can masquerade as asthma, late diagnosis of CVID in known asthmatic is rarely reported.

We present the case of a 43-year-old lady with recurrent episodes of wheeze, cough, sinusitis and multiple lower respiratory tract infections. Transiently responsive to antibiotics and steroids. These episodes had been occurring for many years and she had a longstanding clinical diagnosis of asthma.

As part of her work up for recurrent respiratory tract infections a CT thorax was performed and demonstrated bronchiectasis. Further tests including Immunoglobulin levels revealed critically low IgG, IgM, and IgA levels. Immunoglobulin replacement therapy was commenced with a reduction in exacerbation frequency and severity, and objective improvement of asthma control. Subsequent lung function tests demonstrated reversible airflow limitation (obstructive lung function with 13% reversibility in FEV₁ post-bronchodilator) consistent with asthma.

Our case illustrates the importance of searching for alternate and co-existent diagnoses in patients diagnosed with asthma who are unresponsive to conventional therapy. We believe that serum immunoglobulin measurement should form a component of such a workup.

O64: GENOMIC PROFILING USING CIRCULATING NUCLEIC ACIDS IN STAGE IV MELANOMA PATIENTS RECEIVING IMMUNOTHERAPY REVEALS A NOVEL GENE AMPLIFICATION LANDSCAPE AND ALLOWS FOR DETECTION OF ACTIONABLE GENE MUTATIONS

Introduction

Serial monitoring for disease progression and therapeutic efficacy at the molecular level in metastatic melanoma is hampered by a lack of reliable blood borne biomarkers. Molecular profiling of melanoma tumours is almost impractical in metastatic disease due to risks of procedure related morbidity and sampling inefficiency in representing tumour heterogeneity. Cell free DNA allows monitoring of molecular changes in melanoma over the course of immunotherapy. We investigated the utility of somatic mutation and gene amplification analyses in melanoma patients receiving immunotherapy.

Method

Cell free DNA was extracted from plasma using a QIAamp Circulating Nucleic Acid Kit (Qiagen). Pathway focused profiling of somatic mutation status was performed by ARMs PCR using QBiomarker Somatic Mutation PCR Arrays (Qiagen). Gene amplification analysis was performed by Real Time Quantitative PCR (Roche) using RT2 Profiler PCR Arrays (Qiagen).

Result

A total of twenty patients with stage IV melanoma receiving immunotherapy were enrolled in this study. The BRAF p.V600E mutation was detected in the cfDNA of 80% of BRAF positive patients. Cell free DNA was also profiled for a total of 84 genes of the cancer inflammation and immunity pathway. There was a significant difference in the copy numbers of several genes (CTLA-4, CXCL12, CXCL5, IDO1, TGFB, IFNG, IL4, PTGS2, AICDA, HLA-A, CCL4, ACKR3, TP53, MYC) between patients with progressive disease and therapeutic response (n=20, p &lt; 0.05).

Conclusion

We postulate that cell free DNA pathway focused somatic mutation and gene amplification analyses may be useful in evaluating disease progression and therapeutic response.

Take-home message

Genomic analysis of circulating nucleic acids may be useful in evaluating disease progression and therapeutic response in metastatic melanoma.

Indigenous Health Workforce: exploring how roles impact experiences in Higher Education

Indigenous people have an integral role to play in improving Indigenous health outcomes by leading and being a part of the health workforce. Educating Indigenous health professionals is hence of great importance. Indigenous health students are not always acknowledged for their multiple professional and community roles and how these can affect their university education experience and success. This paper hence examines the experiences of 27 Indigenous health students and their lecturers at one Australian university around the concept of roles. The study used an Indigenous Research Methodology combined with theory driven thematic analysis. Results identified both positive and negative experiences of roles that significantly affect Indigenous health students. The study showed that students’ roles in family and community are complex and can come into conflict with student and future professional roles when students attend university. Academics interviewed for the research showed little to no understanding of Indigenous students’ complex existing roles. This research may assist universities and educators to support Indigenous health students to transition from community to university and achieve success.

Placement of Reveal LINQ Device in the Left Anterior Axillary Position

Implantable loop recorders (ILR) are utilized for long-term rhythm monitoring. Typical placement of the Medtronic Reveal LINQ along the left parasternal border may compromise the quality and/or feasibility of future imaging studies. We sought to evaluate the utility of placing an ILR in the left anterior axillary position and the impact on the quality of cardiac imaging. We reviewed patients from May 2017 to June 2018 who had placement of a Reveal LINQ device in the left anterior axillary position. Demographic, procedural, and clinical data were collected via retrospective review. Cardiac magnetic resonance imaging (MRI) studies were reviewed for image quality after ILR placement. Eight patients met inclusion criteria for this study (median age 6 years, 50% female). Six patients (75%) had an ILR placed in the operating room, while all others were placed in the electrophysiology lab. All patients demonstrated acceptable R waves for diagnostic evaluation (median = 0.85 mV, range 0.24-1.7 mV). Cardiac MRI was obtained in 7 patients following ILR placement with diagnostic image quality and no adverse events. One device was explanted 28 days after placement due to concern for possible infection. No other devices required removal or revision (median follow up duration 11 months, IQR 8-13.5). ILR placement in the left anterior axillary position can record adequate signals in pediatric patients. In addition, axillary ILR device position may allow for completion of cardiac imaging, particularly cardiac MRI, without significant artifacts which is critical for patients with congenital heart disease.

Child sexual abuse in Indonesia: A systematic review of literature, law and policy

BACKGROUND

Like many middle-income countries, knowledge about child sexual abuse (CSA) is limited in Indonesia. The national government has stated a commitment to protect children from the worst forms of abuse, yet the sensitivity of CSA along with the complexity of culture and law, present substantial challenges.

OBJECTIVE

This article reviews current knowledge about CSA in Indonesia, in the context of existing laws and policies that influence CSA prevention and intervention.

METHOD

A systematic review of this research was conducted in the following manner: a review of scholarly literature and grey literature in English (19 papers) and in Bahasa Indonesian (11 papers), and a review of CSA-related Indonesian laws (4 documents) and policies (5 documents).

RESULTS

This review finds that knowledge about CSA in Indonesia is still limited. The taboos on discussing sexual matters were identified as factors that impede reporting of CSA. Poverty also leads to increasing children's risk of sexual abuse. There was less attention to CSA occurring within family contexts and focus was more upon its occurrence outside of the family. The study identified that contradictory definitions of children within the law add to children's vulnerability to CSA; this is especially the case for girls. Current child protection strategies in prevention and intervention lack specific focus on CSA.

CONCLUSION

Further research is needed to enable the development of evidence-based approaches to better harmonize the development of law and policy with contemporary knowledge about CSA.

Abstract P6-06-01: Analyzing the physical and functional protein interaction landscape of breast cancer

A key unanswered question in cancer genetics is how different mutations, dispersed across a multitude of genes, elicit similar pathology and patient outcomes. The answer may lie in understanding the molecular networks and protein complexes (i.e. signaling pathways, chromatin architecture, etc) in cancer and mapping mutated genes into the complexes and pathways in which they function. Determining how systematic interaction networks are wired in cancer cells and how different mutations perturb these networks will guide the search for new cancer genes and provide a platform for integrating patient data to make biological and clinical predictions more accurate. The goal of this study is to uncover the comprehensive protein-protein interaction networks and pathways in various breast cancer subtypes to better understand how mutated cancer genes and genomes hijack and re-wire pathways and complexes during the course of breast tumorigenesis.

Here we catalog protein-protein interactions for 40 genes recurrently mutated in breast cancer, using affinity purification and mass spectrometry. To identify co-associated proteins, cDNA clones expressing each protein were tagged with 3xFLAG at either N or C-terminus and introduced into MCF10A (non-tumorigenic “healthy” control), MCF7 (luminal A subtype), and MDA-MB-231 (claudin-low) cells using doxycycline-inducible lentiviral vectors. For proteins with prevalent pathogenic mutations (e.g. PIK3CA-H1047R, BRCA1-C61G), mutant cDNA clones were also analyzed in parallel. Our interaction network reveals subtype and mutation-specific protein-protein interactions, many of which are not previously reported. Given that genes encoding components of a protein complex or a biological pathway often share similar phenotype upon genetic perturbation, we genetically knocked out genes interacting with DNA damage response (DDR) proteins using CRISPR/Cas9, and found multiple novel interacting genes whose knockout results in significant PARPi (olaparib) and/or cisplatin sensitivity. This result not only functionally validates the physical protein interactions, but also demonstrates that our interactome mapping approach can helps identify newdruggable vulnerabilities in cancer cells.

We anticipate the breast cancer interactome study will uncover aberrant pathways and protein complexes uniquely operating in breast cancer cells, and thus pinpoint proteins that may potentially serve as distinct biomarkers or therapeutic targets for tumors having the same or similar subtypes and/or genomic mutations.

Citation Format: Kim M, Kim K, Tutuncuoglu B, Soucheray M, Swaney D, Zheng F, Park J, O'Leary P, Coppé J-P, van 't Veer L, Ashworth A, Ideker T, Krogan N. Analyzing the physical and functional protein interaction landscape of breast cancer [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P6-06-01.

Development of acquired resistance to lapatinib may sensitise HER2-positive breast cancer cells to apoptosis induction by obatoclax and TRAIL

Background

Lapatinib has clinical efficacy in the treatment of trastuzumab-refractory HER2-positive breast cancer. However, a significant proportion of patients develop progressive disease due to acquired resistance to the drug. Induction of apoptotic cell death is a key mechanism of action of lapatinib in HER2-positive breast cancer cells.

Methods

We examined alterations in regulation of the intrinsic and extrinsic apoptosis pathways in cell line models of acquired lapatinib resistance both in vitro and in patient samples from the NCT01485926 clinical trial, and investigated potential strategies to exploit alterations in apoptosis signalling to overcome lapatinib resistance in HER2-positive breast cancer.

Results

In this study, we examined two cell lines models of acquired lapatinib resistance (SKBR3-L and HCC1954-L) and showed that lapatinib does not induce apoptosis in these cells. We identified alterations in members of the BCL-2 family of proteins, in particular MCL-1 and BAX, which may play a role in resistance to lapatinib. We tested the therapeutic inhibitor obatoclax, which targets MCL-1. Both SKBR3-L and HCC1954-L cells showed greater sensitivity to obatoclax-induced apoptosis than parental cells. Interestingly, we also found that the development of acquired resistance to lapatinib resulted in acquired sensitivity to TRAIL in SKBR3-L cells. Sensitivity to TRAIL in the SKBR3-L cells was associated with reduced phosphorylation of AKT, increased expression of FOXO3a and decreased expression of c-FLIP. In SKBR3-L cells, TRAIL treatment caused activation of caspase 8, caspase 9 and caspase 3/7. In a second resistant model, HCC1954-L cells, p-AKT levels were not decreased and these cells did not show enhanced sensitivity to TRAIL. Furthermore, combining obatoclax with TRAIL improved response in SKBR3-L cells but not in HCC1954-L cells.

Conclusions

Our findings highlight the possibility of targeting altered apoptotic signalling to overcome acquired lapatinib resistance, and identify potential novel treatment strategies, with potential biomarkers, for HER2-positive breast cancer that is resistant to HER2 targeted therapies.

Electronic supplementary material

The online version of this article (10.1186/s12885-018-4852-1) contains supplementary material, which is available to authorized users.

Violence against children in Afghanistan: Concerns and opportunities for positive change

Violence against children (VAC) in Afghanistan is a serious issue in the context of many decades of conflict and poverty. To date, limited studies have explored the extent of VAC in Afghanistan and the settings where VAC takes place. To understand (i) the extent of VAC, (ii) settings where VAC takes place, (iii) parental forms of VAC and (iv) regional differences, an interview administered cross-sectional survey was employed among a community sample of 145 children and 104 parents living within Kabul, Torkham, and Jalalabad. Demographic information was collected as well as items from the International Child Abuse Screening Tool (ICAST-CH). In this study, 71% of children reported experiencing physical violence is some form in the past year. Home was the most likely location of violence. The overwhelming majority of parents reported using physical violence as a discipline method. Parents who attained higher levels of education and had more skilled occupations used violence less as a discipline method. However, consistent with international research, children cited their parents as their preferred source of support in situations of violence. Interestingly, parents did not see violent forms of discipline as more effective than non-violent strategies. The results offer a disturbing yet 'on the ground' insight into VAC in Afghanistan from the experience of children and parents. The results have important implications for programming design and provide a focus for stopping and preventing VAC in Afghanistan and similar contexts.

Hazardous child labor in Nepal: The case of brick kilns

Hazardous child labor in Nepal is a serious concern, particularly in the brick kiln industry. Although a range of interventions have been implemented in Nepal to address hazardous child labor, there is a lack of research to both measure success and shape further development in interventions that integrate sound child protection practices to ensure the wellbeing of all children. This paper provides a review of the literature outlining interventions for children working in brick kilns in Nepal, and presents preliminary case study findings of one current intervention in the Kathmandu Valley. The paper highlights the strength of applying foundational child protection principles and advocates for the development and implementation of future programs underpinned by broad civil society principles within a child rights and protection framework.

The Effect of Child Sexual Abuse on Men: Toward a Male Sensitive Measure

Child sexual abuse (CSA) is a trauma that affects males in substantial numbers, sometimes in ways that are gender-specific (e.g., compromised masculine identity, confusion regarding sexuality). Much of the identification of the male-specific outcomes has been derived from practitioner experience and small qualitative studies. The current study explores gender-specific outcomes and describes the development of a scale to measure the effects of CSA on men. First, qualitative interviews with 20 men who were sexually abused in childhood were thematically analyzed. The emergent themes of sexuality, self-concept, psychological and emotional well-being, and social functioning were used to construct a 30-item instrument which was later completed by 147 men with histories of CSA. The dimensionality of the 30 items was then assessed for suitability as scales using confirmatory factor analysis (CFA). The final instrument, the Male Sexual Abuse Effects Scale (MSAES), combines three subscales: Negative Identity, Guilt and Self-Blame, and Psychological and Emotional Well-Being. Items concerning masculine identity were shown to be valid in the scale. MSAES scores were compared with the General Health Questionnaire-28 (GHQ-28) and found to be significantly correlated. GHQ-28 clinical thresholds were applied to differentiate clinical from nonclinical cases; an independent-samples t test showed that the clinical cases from the GHQ-28 had high scores on the MSAES. The new scale has the potential to help clinicians and researchers identify men who have been severely affected by CSA and who should be of clinical concern.

A study of the norcaradiene–cycloheptatriene equilibrium in a series of azulenones by NMR spectroscopy; the impact of substitution on the position of equilibrium

NMR investigation of the impact of substitution on the norcaradiene–cycloheptatriene equilibrium.

A new approach for the automatic evaluation of the solidification structure in steel using orientational entropy filtering

We present a new method for the automatic evaluation of the dendritic solidification structure in metallurgical micrographs of solidified steel. The evaluation of the microstructural parameters such as the primary dendrite arm spacing and the primary grain size are of high importance due to their direct relationship with the internal quality and mechanical properties of the cast product. Given the repeated geometric features in the micrographs and the regular pattern in colour intensity, we applied a filter mask to determine the local entropies within the masks in order to detect the centre coordinates of each individual dendrite. The orientation of the dendrites was determined by rotating the filter mask over each pixel to find the orientation which corresponds to the lowest entropy value. The segmentation of the microstructure was then performed via Delaunay tessellation and subsequent transformation of the triangular mesh into a rectangular grid, enabling the determination of the desired microstructural parameters.

Suicide attempts among men with histories of child sexual abuse: examining abuse severity, mental health, and masculine norms

OBJECTIVE

Men who were sexually abused during childhood are at risk for a variety of long-term mental health problems, including suicidality. However, little is known about which factors are related to recent suicide attempts for this vulnerable, under-researched population. The purpose of this study was to examine the relationship between abuse severity, mental health, masculine norms and recent suicide attempts among men with histories of child sexual abuse (CSA).

METHODS

We analyzed survey data gathered from a purposive sample of 487 men who were sexually abused during childhood. The age of the sample ranged from 19 to 84 years (μ = 50.4 years). Recent suicide attempts served as the dependent variable in the study. Self-reported measures of sexual abuse severity, child physical abuse, mental health, masculine norms, and demographic information (age, race) represented the independent variables.

RESULTS

The results from logistic regression modeling found that five variables - duration of the sexual abuse, use of force during the sexual abuse, high conformity to masculine norms, level of depressive symptoms, and suicidal ideation - increased the odds of a suicide attempt in the past 12 months.

CONCLUSION

To improve mental health services for men with histories of CSA, mental health practitioners should incorporate sexual abuse severity, current mental health, and adherence to masculine norms into assessment and treatment planning.

Credible deterrence: FDA and the Park Doctrine in the 21st century

One of FDA's most powerful enforcement tools is strict liability criminal prosecution of corporate officers under the Park Doctrine. Recent comments by high-ranking FDA officials about using this power more aggressively and recent cases apparently making good on this promise have spurred commentators to call for the doctrine's demise. Critics argue that strict liability for corporate officers violates fundamental notions of fairness and the appropriate relationship between guilt and liability in criminal law. As a response to these critics, this article argues that the Park Doctrine continues to serve a valuable purpose in deterring conduct that endangers the public health and that structural, political, and practical limitations on FDA's use of Park prosecutions have been, and will continue to be, effective protections against the abuses critics fear. This article proposes a model for understanding why and how FDA uses its prosecutorial powers and assesses a sample of recent high-profile prosecutions under this model to argue that the modern "escalation" of Park prosecutions is in fact a continuation of FDA's historical policy.

The effect of severe child sexual abuse and disclosure on mental health during adulthood

This study examined the relationship among severe child sexual abuse, disclosure, and mental health symptoms during adulthood. The sample consisted of 172 adults who were sexually abused in childhood. The multivariate model showed that respondents in their 30s and 40s who were abused by more than one abuser, who were injured by their abusers, who were abused by a biological relative, who told someone about the abuse when it occurred, and who did not discuss their abuse in depth within one year of the abuse had a greater number of mental health symptoms. Abuse severity and disclosure history should be assessed by professionals to identify clients who are at higher risk of mental health symptoms and to focus therapy.

Topoisomerase I amplification in melanoma is associated with more advanced tumours and poor prognosis

In this study, we used array-comparative genomic hybridization (aCGH) and fluorescent in situ hybridization (FISH) to examine genetic aberrations in melanoma cell lines and tissues. Array-comparative genomic hybridization revealed that the most frequent genetic changes found in melanoma cell lines were amplifications on chromosomes 7p and 20q, along with disruptions on Chr 9, 10, 11, 12, 22 and Y. Validation of the results using FISH on tissue microarrays (TMAs) identified TOP1 as being amplified in melanoma tissues. TOP1 amplification was detected in a high percentage (33%) of tumours and was associated with thicker, aggressive tumours. These results show that TOP1 amplification is associated with advanced tumours and poor prognosis in melanoma. These observations open the possibility that TOP1-targeted therapeutics may be of benefit in a particular subgroup of advanced stage melanoma patients.

Mesenteric vasculitis in adults with Henoch-Schonlein purpura: a not-so-benign condition

INTRODUCTION

The gastrointestinal manifestations of Henoch-Schonlein purpura (HSP) are well characterised, but their recognition can be difficult when they occur in isolation. Furthermore, HSP can run a more serious course in adults, compared to children, in whom the disease usually occurs.

MATERIALS AND METHODS

We describe two cases that illustrate the challenges of HSP with mesenteric vasculitis and the outcome in adults.

CONCLUSION

Although self-limiting in most patients, the outcome of HSP in adults can be far from benign and even fatal.

Australian study on public knowledge of human genetics and health

AIMS

This study was designed to obtain data on public understanding of genetic concepts in the adult population of Western Australia. It explored knowledge of genetic risk of disease, inheritance, biology, determinism, and factors that predict relatively higher genetic knowledge within the general population.

METHOD

A cross-sectional telephone survey of 1,009 respondents.

RESULTS

Most members of the Western Australian community are aware of basic genetic concepts and the link between genes, inheritance, and risk of disease. Significantly fewer understand the biological mechanisms underlying these concepts and there was some misconception around the meaning of 'increased genetic risk'. The odds of higher genetic knowledge (>19 out of 24 questions correct) were greater among those with 12 years or more education (OR = 3.0), those aged 18-44 years (OR = 2.3), women (OR = 2.0), those with annual household income of AUD 80,000 or more (OR = 1.8), and those who had talked with someone (OR = 1.7) or searched the internet (OR = 1.6) for information on genes and health.

CONCLUSIONS

This study provides evidence of an association between social location and public knowledge of human genetic concepts related to health and disease. This is consistent with previous findings and raises questions about the acquisition of textbook genetics knowledge within socio-cultural contexts. The impact of misconceptions about genetic concepts on the uptake of preventive health behaviors requires further investigation, as does the level of genetics knowledge that is required to empower informed participation in individual and societal decisions about genetics and health.

Mothers' protection of their children after discovering they have been sexually abused: an information-processing perspective

OBJECTIVE

The purpose of this study was to understand why some non-offending mothers did not protect their children consistently after they knew they were sexually abused.

METHODS

The sample included 85 mothers who were involved with child protective services: 48 mothers who protected their children consistently were compared to 37 mothers who did not.

RESULTS

Several variables explained 47% of the variance in the multivariate analysis. If the mother did not ask the abuser whether the abuse occurred, attributed responsibility to the abuser, believed consistently that the abuse occurred, and was not a victim of domestic violence, then she was more likely to protect her child consistently.

CONCLUSIONS

Some maternal characteristics believed to affect protectiveness, such as mothers' mental health and substance abuse, were not related to whether they protected their children consistently, whereas other variables, such as domestic violence, were. Researchers need to continue to examine these and other variables simultaneously, so that practitioners can better understand which children are most likely to receive inadequate protection.

PRACTICE IMPLICATIONS

Practitioners should ask mothers whether they believe the abusers' behavior was sexual and abusive. If mothers do not perceive sexual abuse, then they will not believe abuse occurred or attribute responsibility to the abusers. Helping mothers understand the nature of sexual abuse may change their beliefs and attributions. If the abuser is the mother's partner and he has physically assaulted her, practitioners need to assess her willingness and ability, with adequate services and support, to restrict his access to her child.

Economic evaluation of the familial cancer programme in Western Australia: predictive genetic testing for familial adenomatous polyposis and hereditary non-polyposis colorectal carcinoma

AIM

To evaluate costs and outcomes of genetic testing for familial colorectal cancer through services provided by Genetic Services of Western Australia (GSWA).

METHODS

Costs and outcomes of predictive DNA-based testing for inherited colorectal cancers (CRC) were assessed, specifically for familial adenomatous polyposis (FAP) and hereditary non-polyposis CRC (HNPCC) using a decision-analysis model. Costs were assigned according to standards of care in Western Australia (WA). Cancer risks and the efficacy of surveillance on long-term outcomes were derived from the published literature.

RESULTS

The cost-effectiveness of genetic testing was compared in first-degree relatives of known mutation carriers who have a 50% risk of carrying the mutated gene (intervention group) to individuals with the same risk but who do not undergo a genetic test (control subjects). Compared with control subjects undergoing the same high-level surveillance and surgery, the FAP and HNPCC intervention groups provided total savings of 13,390 US dollars and 14,783-15,460 per person (males-females), respectively. HPNCC mutation carriers also gained 1 CRC-free year. Compared to control subjects having only population surveillance, individuals in the FAP intervention group delayed the onset of CRC by 40 years for a net cost of 9,042 US dollars. Individuals in the HNPCC intervention group delayed the onset of CRC by 8 years at a net cost of 12,141 US dollars for males and 12,596 US dollars for females.

CONCLUSIONS

Genetic testing for familial CRC in WA allows targeted surveillance for mutation carriers, which ensures the efficient use of resources and reduces cancer-related morbidity, if clinical recommendations for intervention are adopted.

Right Ventricular Function in Asymptomatic Individuals with a Systemic Right Ventricle

BACKGROUND

In congenital heart defects where the morphologic right ventricle (RV) supports the systemic circulation, RV failure is common yet develops gradually. We hypothesized that patients who are asymptomatic may have unrecognized RV dysfunction.

METHODS

Conventional and Doppler tissue/strain echocardiography were performed on consecutive patients with asymptomatic systemic RV caused by congenitally corrected transposition of the great arteries (ccTGA) and on age-matched control subjects. RV index of myocardial performance was measured using conventional echocardiography. Longitudinal tissue velocities, strain rate, and strain of the basal RV free wall were measured using Doppler tissue/strain echocardiography and compared with nonsystemic RV of the control subjects.

RESULTS

Mean age was 39.5 +/- 14.6 (n = 13) and 36 +/- 24 (n = 10) years for ccTGA and control groups, respectively. Mean RV index of myocardial performance was higher in patients with ccTGA than in control subjects (0.66 +/- 0.25 vs 0.28 +/- 0.12, P < .001). Mean RV tissue displacement (10.8 +/- 4.5 vs 20.3 +/- 3.9 mm, P < .0001), peak systolic strain rate (-1.16 +/- 0.3 vs -2.23 +/- 0.9 s(-1), P = .005), and peak systolic strain (-17.3 +/- 8.0 vs -30.6 +/- 11.0%, P = .008) were significantly lower in patients with ccTGA compared with control subjects, respectively.

CONCLUSION

Patients with asymptomatic ccTGA have quantifiable RV dysfunction by echocardiography.

Response of Charité total disc replacement under physiologic loads: prosthesis component motion patterns

BACKGROUND CONTEXT

Total disc replacement (TDR) has been recommended to reduce pain of presumed discogenic origin while preserving spinal motion. The floating core of Charité TDR is professed to allow the replication of the kinematics of a healthy disc under physiologic loads. While segmental motion after Charité TDR has been measured, little is known about the effects of a physiologic compressive preload on vertebral motion and the motion of prosthesis components after TDR.

PURPOSE

(1) Does Charité TDR allow restoration of normal load-displacement behavior of a lumbar motion segment under physiologic loads? (2) How do the prosthesis components move relative to each other under physiologic loads when implanted in a lumbar motion segment?

STUDY DESIGN

A biomechanical study using human lumbar spines (L1-sacrum).

METHODS

Five lumbar spines (age: 52+/-9.3) were used. Specimens were tested under flexion (8 Nm) and extension (6 Nm) moments with compressive follower preloads of 0 N and 400 N in the following sequence: (i) intact, (ii) Charité TDR at L5-S1, (iii) simulated healed fusion at L5-S1 with Charité TDR at L4-L5. Segmental motion was measured optoelectronically. Motions between prosthesis end plates and core were visually assessed using sequential digital video-fluoroscopy over the full range of motion. Here we report on kinematics of 10 Charité TDRs: 5 at L5-S1 and 5 at L4-L5.

RESULTS

Charité TDR increased the flexion-extension range of motion of lumbar segments (p<.05). At 400 N preload, the range of motion increased from intact values of 6.8+/-4.4 to 10.0+/-2.4 degrees at L5-S1 and from 7.0+/-2.6 to 10.8+/-2.9 degrees at L4-L5. Charité TDR increased segmental lordosis by 8.1+/-6.9 degrees at L5-S1 (p<.05) and 5.4+/-3.5 degrees at L4-L5 (p<.05). Four patterns of prosthesis component motion were noted: (1) angular motion only between the upper end plate and core, with little or no visual evidence of core translation (9 of 10 TDRs at 0 N preload and 5 of 10 TDRs at 400 N preload); (2) lift-off of upper prosthesis end plate from core or of core from lower end plate (observed in extension in 9 of 10 TDRs under 0 N preload only); (3) core entrapment, resulting in a locked core over a portion of the range of motion (observed in extension in 8 of 10 TDRs under 400 N preload); (4) angular motion between both the upper and lower end plates and core, with visual evidence of core translation (1 of 10 TDRs at 0 N preload, 5 of 10 TDRs at 400 N preload). The pattern of load-displacement curves was substantially changed under a physiologic preload in 8 of 10 TDRs; instead of a relatively gradual change in angle with changing moment application as seen for an intact segment, the TDR displayed regions of both relatively small and relatively large angular changes with gradual moment application.

CONCLUSIONS

Charité TDR restored near normal quantity of flexion-extension range of motion under a constant physiologic preload; however, the quality of segmental motion differed from the intact case over the flexion-extension range. Whereas some TDRs showed visual evidence of core translation, the predominant angular motion within the prosthesis occurred between the upper end plate and the polyethylene core. Likely factors affecting the function of the Charité TDR include implant placement and orientation, intraoperative change in lordosis, and magnitude of physiologic compressive preload. Further work is needed to assess the effects of the prosthesis motion patterns identified in the study on the load sharing at the implanted level and polyethylene core wear.

Subcutaneous glucose sensor values closely parallel blood glucose during insulin-induced hypoglycaemia

AIMS

To assess the accuracy of the Minimed continuous glucose monitoring system (CGMS) in estimating blood glucose concentration during a controlled reduction in blood glucose.

RESEARCH DESIGN AND METHODS

We studied nine adolescent diabetics (age 14 +/- 1.5 years) wearing the CGMS during hyperinsulinaemic hypoglycaemic clamp studies. The glucose values obtained by the CGMS were compared with the venous blood samples taken during the studies and measured at the bedside using a glucose oxidase technique.

RESULTS

Blood glucose was lowered from euglycaemia to a mean of 2.8 mmol/l over 120 min and maintained at that level for a further 40 min. A total of 429 paired glucose measurements were available for analysis. Analysis using weighted Deming regression and t-tests revealed small differences between the methods, with blood glucose levels slightly higher than interstitial fluid levels. The mean difference across all values was 0.13 mmol/l. The observed difference was greatest at blood glucose values < 3.3 mmol/l.

CONCLUSIONS

This study suggests that during a fall in systemic glucose the subcutaneous glucose sensor provides an accurate reflection of blood glucose. However, a small difference is apparent at blood glucose values < 3.3 mmol/l.

Modeling SSI financial eligibility and simulating the effect of policy options

This article simulates eligibility for Supplemental Security Income (SSI) among the elderly, analyzes factors affecting participation, and looks at the potential effects of various options to modify financial eligibility standards for the federal SSI program. We find that in the estimated noninstitutional elderly population of 30.2 million in the United States in 1991, approximately 2 million individuals aged 65 or older were eligible for SSI (a 6.6 percent rate of eligibility). Our overall estimate of the rate of participation among eligible elderly is approximately 63 percent, suggesting that more than a third of those who are eligible do not participate in the program. The results of our analysis of factors affecting participation among the eligible elderly show that expected SSI benefits and a number of demographic and socioeconomic variables are associated with the probability of participation. We also simulate the effects of various policy options on the poverty rate, poverty gap, annual program cost, the number of participants, and the average estimated benefits among participants. The simulations consider the potential effects of five policy alternatives: Increase the general income exclusion (GIE) from $20 to $80. Increase the earned income exclusion (EIE) from $65 to $260. Increase the federal benefit rate (FBR) by $50 for individuals and $75 for couples and eliminate the GIE. Increase the asset threshold to $3,000 for individuals and $4,500 for couples. Increase the asset threshold to $6,000 for individuals and $9,000 for couples. Using 1991 microdata from the Survey of Income and Program Participation (SIPP) matched to Social Security Administration administrative records and making adjustments reflecting aggregate program statistics, we present the results of our simulations for December 1999. The results show substantial variation in the simulated effects of the five policy alternatives along the various outcome dimensions considered. The simulated effects on the poverty gap of the elderly population range from a 7.9 percent reduction ("Increase the GIE from $20 to $80") to a 0.1 percent reduction ("Increase the EIE from $65 to $260"). All simulated interventions are expected to increase the rate of SSI participation among the elderly from a high of 20.3 percent ("Increase the GIE from $20 to $80") to a low of 0.5 percent ("Increase the EIE from $65 to $260"). We also find that the interventions that have greater estimated effects in terms of increased participation and reduced poverty tend to cost more. At the high end, we estimate that increasing the GIE from $20 to $80 could raise annual federal SSI cash benefit outlays by about 46 percent, compared with only 0.9 percent for increasing the EIE from $65 to $260. Similar to the EIE intervention, raising the resource thresholds by 50 percent would reduce the overall poverty gap of the elderly by only 0.2 percent, would increase SSI participation only modestly (by 1.3 percent), but would entail slightly higher program costs (by 1.4 percent). Increasing the asset threshold by 200 percent would have higher estimated effects on all three outcomes, but it would still be associated with relatively low increases in both costs and benefits. Finally, the simulated effects on the three key outcomes of increasing the FBR by $50 for individuals and $75 for couples, combined with eliminating the GIE, are relatively large but are clearly less substantial than increasing the GIE from $20 to $80. This work relies on data from the SIPP matched to administrative data on federal SSI benefits that provide a more accurate picture of SSI participation than has been feasible for previous studies. We simulate eligibility for federal SSI benefits by applying the program rules to detailed information on the characteristics of individuals and couples based on the rich array of demographic and socioeconomic data in the SIPP, particularly the comprehensive information SIPP provides on assets and monthly income. A probit model is estimated to analyze factors affecting participation among the eligible elderly. Finally, we conduct the policy simulations using altered program rules represented by the policy alternatives and predicted participation probabilities to estimate outcomes under simulated program rules. We compare those simulated outcomes to observed outcomes under current program rules. The results of our simulations are conditional on the characteristics of participants and eligibles in 1991, but they also reflect aggregate adjustments capturing substantial changes in overall participation and program benefit levels between 1991 and 1999.

Origins of skeletal pain: sensory and sympathetic innervation of the mouse femur

Although skeletal pain plays a major role in reducing the quality of life in patients suffering from osteoarthritis, Paget's disease, sickle cell anemia and bone cancer, little is known about the mechanisms that generate and maintain this pain. To define the peripheral fibers involved in transmitting and modulating skeletal pain, we used immunohistochemistry with antigen retrieval, confocal microscopy and three-dimensional image reconstruction of the bone to examine the sensory and sympathetic innervation of mineralized bone, bone marrow and periosteum of the normal mouse femur. Thinly myelinated and unmyelinated peptidergic sensory fibers were labeled with antibodies raised against calcitonin gene-related peptide (CGRP) and the unmyelinated, non-peptidergic sensory fibers were labeled with the isolectin B4 (Bandeira simplicifolia). Myelinated sensory fibers were labeled with an antibody raised against 200-kDa neurofilament H (clone RT-97). Sympathetic fibers were labeled with an antibody raised against tyrosine hydroxylase. CGRP, RT-97, and tyrosine hydroxylase immunoreactive fibers, but not isolectin B4 positive fibers, were present throughout the bone marrow, mineralized bone and the periosteum. While the periosteum is the most densely innervated tissue, when the total volume of each tissue is considered, the bone marrow receives the greatest total number of sensory and sympathetic fibers followed by mineralized bone and then periosteum. Understanding the sensory and sympathetic innervation of bone should provide a better understanding of the mechanisms that drive bone pain and aid in developing therapeutic strategies for treating skeletal pain.

Miniaturized transesophageal echocardiography in newborn infants

BACKGROUND AND METHODS

A miniaturized 5.5 to 10 MHz, phased-array, single longitudinal plane transducer mounted on a 3.3-mm diameter catheter (miniaturized transesophageal echocardiography [TEE]) may overcome mechanical limitations of standard pediatric transesophageal probes. We evaluated whether the miniaturized TEE probe could define clinically relevant anatomy in 17 infants who weighed less than 6 kg.

RESULTS

Twenty-two studies were performed in 17 infants without complication, weighing 2.1 to 5.6 kg. Twenty of twenty-two studies were diagnostic. Pediatric biplane TEE was not possible in 13 studies. Lack of horizontal plane imaging with miniaturized TEE made evaluation difficult in patients with atrioventricular septal defect.

CONCLUSION

Miniaturized TEE provided diagnostic intraoperative TEE in the majority of infants studied and may allow broader and safer application of TEE to neonates and small infants.

Dynamic equilibria in the products of intramolecular Buchner additions of diazoketones to aryl rings bearing methoxy substituents

Rhodium carboxylate catalyzed aromatic addition reactions of a range of diazoketones bearing methoxy-substituted aryl rings have been explored. While the existence of norcaradiene-cycloheptatriene equilibria in related compounds is well established, the aromatic addition products in this study display more complex dynamic equilibria due to conjugation with the methoxy group; the experimental evidence for this is discussed in detail. In the azulenone products 21-26 derived from p-methoxy-substituted diazoketones 14-16, the diastereomers interconvert via a spiro intermediate 39. A related mechanistic process in the azulenones 43-46 derived from the o-methoxy-substituted diazoketones 17, 18 interconverts regioisomers, explaining the conflicting reports for the regioselectivity of the cyclization of diazoketone 1. With the m-methoxy-substituted diazoketone 19, involvement of the methoxy group through a different pathway results in fragmentation of the azulenone to form the tetralone 47. With the azulenones 21-26 exclusive trapping of the norcaradiene associated with the less thermodynamically stable diastereomers in a cycloadduct with N-phenylmaleimide is observed. Due to the presence of the activating methoxy substituent on the aromatic ring, the aromatic addition reactions of the diazoketones studied were not very sensitive to the nature of the rhodium catalyst.