Intimate Partner Violence and Human Trafficking: Trauma We May Not Identify.

Intimate partner violence and human trafficking commonly affect patients presenting to the emergency department including the trauma bay. Although these forms of violence and exploitation are not always the underlying cause of that particular emergency department encounter, screening is important regardless of the presenting condition because this presentation may be the only opportunity to receive help and ultimately plants the seed for future access to help regardless of what a patient chooses to do following this first encounter. There are important medical care considerations in these patients beyond trauma bay procedures that can make the difference in saving a life.

Preparing residents to deal with human trafficking.

BACKGROUND: Victims of human trafficking (HT) are predisposed to numerous health concerns. Many encounter health care practitioners during captivity, but awareness and knowledge among front-line physicians is low. Limited data exist on attempts to address this within residency training programmes. Formal curriculum time in residency is limited and online modules may be a useful educational option. METHODS: Residents in family medicine, emergency medicine and general paediatrics at the University of Alberta were invited to participate. They completed short surveys to assess knowledge both before and after completing an online learning module either individually (n = 15) or in a facilitated session (n = 17). Baseline and post-intervention changes in self-reported and tested knowledge were assessed. RESULTS: Thirty-two residents completed the pre-intervention survey: only 6% self-identified as somewhat knowledgeable on HT and 16% knew the red flags used to identify victims. Eighty-one percent wanted this topic incorporated into residency training, but only 6% and 25% had received education previously in residency or medical school, respectively. Thirteen percent were comfortable supporting victims, and 6% reported knowing how to provide support. Twenty residents completed the post-intervention survey, with improvements in both self-reported (p < 0.001) and tested (p = 0.005) knowledge of HT. Residents also reported being more prepared to identify victims (p < 0.001), more comfortable supporting victims (p < 0.001) and more confident in knowing how to support victims (p < 0.001). DISCUSSION: Baseline HT knowledge in residents providing first-contact care appears limited. Residency programmes should consider providing more HT education in order to improve competency in care. Although an online module was shown to be effective, protected time might be necessary for the widespread adoption of online education delivery.

Teleost leukocyte immune-type receptors activate distinct phagocytic modes for target acquisition and engulfment.

Channel catfish (Ictalurus punctatus) IpLITRs belong to the Ig superfamily and regulate innate immune cell effector responses. This study tested the hypothesis that ITAM-dependent and ITAM-independent phagocytic pathways are engaged by different subtypes of the IpLITR family. When stably expressed in RBL-2H3 cells, the ITAM-containing fusion-construct IpLITR 2.6b/IpFcRγ-L stimulated phagocytic responses that were abrogated at suboptimal incubation temperatures and by pharmacological inhibitors of the classic signaling components of the mammalian FcR-dependent phagocytic pathway. Interestingly, the ITIM-containing receptor IpLITR 1.1b also induced phagocytosis through an actin-dependent mechanism, but this process was insensitive to the pharmacological inhibitors tested and remained functional at temperatures as low as 22°C. The IpLITR 1.1b also displayed a unique target-acquisition phenotype that consisted of complex, membranous protrusions, which captured targets in phagocytic cup-like structures but often failed to completely engulf targets. Taken together, these findings suggest that teleost immunoregulatory receptors that associate with ITAM-containing adaptors can engage conserved components of the phagocytic machinery to engulf extracellular targets akin to the classic FcR-mediated response in mammals. Alternatively, IpLITR 1.1b displays a stalled phagocytic phenotype that is likely dependent on the selective recruitment of the minimal molecular machinery required for target capture but results in incomplete target engulfment. Overall, this study demonstrates that IpLITRs can selectively engage distinct components of the phagocytic process and provides important new information regarding the target acquisition as well as internalization mechanisms involved in controlling phagocytic responses across vertebrates.