Evaluation and management of intimate partner violence in the emergency department.

Intimate partner violence (IPV) and emergency medicine intersect when individuals experiencing IPV present to emergency departments for medical care, either on their own or when brought in by law enforcement authorities for medical evaluation and social services. Coordination of care is required, with particular attention paid to the sensitive nature of the patient's presentation and with an emphasis on trauma-informed care. Emergent medical needs must be balanced with concerns for the patient's emotional well-being and the need for advocacy and social services. This supplement reviews best practices and evidence-based recommendations for the evaluation and management of patients who have experienced IPV, with a focus on the considerations for traumatic injuries in these patients.

Patient, medical and legal perspectives on reentry: the need for a low-barrier, collaborative, patient-centered approach.

BACKGROUND: Worldwide, the United States has the highest incarceration rate per capita. Thousands of people are released from US correctional facilities each year, including many who are impacted by HIV infection and substance use disorder (SUD), two frequently comorbid conditions that present multiple challenges upon reentry. Reentry and care engagement research involving justice-involved people with HIV (PWH) with comorbid SUD has been largely limited to the perspective of those released. To formulate effective interventions for this population aimed at maintaining health and reducing recidivism, it is crucial to collect data from formerly incarcerated individuals with firsthand experience of the reentry process as well as other actors within the reentry framework. Insights from medical and legal service providers working in reentry systems have the potential to address key implementation concerns. To inform an intervention aimed at helping recently-released individuals PWH and SUD, we conducted a qualitative study to assess barriers and facilitators to community reentry from the perspectives of diverse consumers and providers of medical, legal, and reentry services. RESULTS: Fifteen stakeholders within XXX County participated in in-person interviews. Results indicated that 1) Patients/clients emphasized psychosocial support and individual attitude more than medical and legal participants, who chiefly focused on logistical factors such as finances, housing, and transportation; 2) Patients/clients expressed both medical and legal needs during the reentry period, though medical providers and participants from legal entities mainly expressed concerns limited to their respective scopes of work; 3) All three participant groups underscored the need for a low-barrier, collaborative, patient-centered approach to reentry with the goal of achieving self-sufficiency. CONCLUSIONS: Findings support and extend existing literature detailing the barriers and facilitators to successful reentry. Our findings underscore the notion that an effective reentry intervention addresses both medical and legal needs, includes an individualized approach that incorporates psychosocial needs, and focuses on establishing self-sufficiency.

Phosphoinositide 3-Kinase Is Integral for the Acute Activity of Leptin and Insulin in Male Arcuate NPY/AgRP Neurons.

Neuropeptide Y (NPY)/Agouti-related protein (AgRP) neurons in the arcuate nucleus of the hypothalamus are part of a neuroendocrine feedback loop that regulates feeding behavior and glucose homeostasis. NPY/AgRP neurons sense peripheral signals (including the hormones leptin, insulin, and ghrelin) and integrate those signals with inputs from other brain regions. These inputs modify both long-term changes in gene transcription and acute changes in the electrical activity of these neurons, leading to a coordinated response to maintain energy and glucose homeostasis. However, the mechanisms by which the hormones insulin and leptin acutely modify the electrical activity of these neurons remain unclear. In this study, we show that loss of the phosphoinositide 3-kinase catalytic subunits p110α and p110ß in AgRP neurons abrogates the leptin- and insulin-induced inhibition of AgRP neurons. Moreover, continual disruption of p110α and p110ß in AgRP neurons results in increased weight gain. The increased adiposity was concomitant with a hypometabolic phenotype: decreased energy expenditure independent of changes in food intake. Deficiency of p110α and p110ß in AgRP neurons also impaired glucose homeostasis and insulin sensitivity. In summary, these data highlight the requirement of both p110α and p110ß in AgRP neurons for the proper regulation of energy balance and glucose homeostasis.

Comparative clinical study of two tooth bleaching protocols with 6% hydrogen peroxide.

Objective. The objective was to compare the clinical efficacy of two different tooth bleaching protocols after 1 and 2 weeks of treatment with an over-the-counter paint-on gel containing 6% hydrogen peroxide. Material and methods. Sixteen volunteer patients (minimum shade A2 or darker on maxillary teeth) were selected to participate in this randomized, single-blind (examiner-blinded), single-center, 2-group clinical trial using a divided mouth model. The product was applied in our clinic to one hemi-arch (Group I) in each patient at two sessions one week apart, making five applications at each session (separated by 10 min intervals). The patients themselves applied the product once a day for 10 days in the other hemiarch (Group II). Efficacy was measured according to the Vita Classical shade guide at baseline and at one and two weeks. Differences between groups (office-treated vs. home-treated hemiarches) were tested by repeated-measures analysis of variance. Results. Significant (P < .05) differences in shade values were detected between pre- and post-bleaching in both groups. The two groups did not significantly differ in tooth shade at the end of the treatment. Conclusions. Treatment with 6% hydrogen peroxide gel using the paint-on system shows significant clinical efficacy whether applied by clinicians or by the patients themselves.