Novel Service Delivery Approach to Address Reproductive Health Disparities within Immigrant Latino Communities in Geographic Hot Spots: An Implementation Study.

Latinx youths continue to have the highest rates of teenage births in the United States and are at increased risk of acquiring sexually transmitted infections, including HIV/AIDS. A community-based research partnership piloted Families Talking Together, a brief, parent-based sexual risk reduction program using a novel and culturally relevant approach. This mixed-methods study examined the feasibility and acceptability of Spanish-speaking promotoras de salud (that is, community health workers) as implementers of an evidence-based intervention (EBI) to reach underserved immigrant communities. Findings suggest that promotoras are capable of implementing the EBI with positive organizational, client, and implementation outcomes. Furthermore, promotoras hold particular promise for addressing reproductive health disparities as they are indigenous and trusted members of the community who can reach members of marginalized Latino populations.

Parent, Teacher, and School Stakeholder Perspectives on Adolescent Pregnancy Prevention Programming for Latino Youth.

Teen pregnancy remains a public health concern particularly among Latinos, whose pregnancy rate of 83.5 per 1000 girls constitutes one of the highest rates of teen pregnancy among all ethnic and racial groups in the United States. To enhance the effectiveness of interventions for diverse Latino populations in the US, it is crucial to assess the community's understanding of the etiology of the problem of adolescent pregnancy and to implement programs that reflect the local community's beliefs and preferences. We present findings from six focus groups held with parents (n = 18), teachers (n = 23) and school stakeholders (n = 8) regarding teen pregnancy prevention among Latino youth at a high school located in a large, Midwestern city. Two investigators analyzed data iteratively using a template organizing approach. A consensus emerged across the groups regarding content that emphasized respect for oneself and one's family, a focus on personal and shared responsibility in reproductive health behavior, information about the "realities" or consequences associated with engaging in sexual activity, and information about contraceptives. The strong request from participants to include a parental education component reflects the community's belief that parents play a crucial, protective role in the socialization and development of adolescent sexual behavior, a view that is supported by empirical research. Findings highlight the importance of involving local school communities in identifying adolescent pregnancy prevention strategies that are responsive to the community's cultural values, beliefs, and preferences, as well as the school's capacity and teacher preferences.

Determining spectral response of the National Ignition Facility particle time of flight diagnostic to x rays.

The Particle Time of Flight (PTOF) diagnostic is a chemical vapor deposition diamond detector used for measuring multiple nuclear bang times at the National Ignition Facility. Due to the non-trivial, polycrystalline structure of these detectors, individual characterization and measurement are required to interrogate the sensitivity and behavior of charge carriers. In this paper, a process is developed for determining the x-ray sensitivity of PTOF detectors and relating it to the intrinsic properties of the detector. We demonstrate that the diamond sample measured has a significant non-homogeneity in its properties, with the charge collection well described by a linear model ax + b, where a = 0.63 ± 0.16 V-1 mm-1 and b = 0.00 ± 0.04 V-1. We also use this method to confirm an electron to hole mobility ratio of 1.5 ± 1.0 and an effective bandgap of 1.8 eV rather than the theoretical 5.5 eV, leading to a large sensitivity increase.

[Rehabilitation in lymphedema surgery]. / Tratamiento rehabilitador en la cirugía del linfedema.

Conservative treatment of lymphedema usually includes complex decongestive therapy in order to reduce the volume of the lymphedema, and compression garments in the maintenance phase. Follow-up is carried out in the Rehabilitation Services. Surgical treatment of lymphedema is a therapeutic option, the interest of which has increased in recent years, although there is no current evidence that it can cure lymphedema and it is always accompanied by conservative treatment. Most studies focus on results according to the type of surgery and there is no standardized protocol for conservative treatment before or after surgery. The objective of this work is to prepare a compendium about the most frequent lymphedema surgeries and their indications, focusing on the rehabilitation treatment for each surgery.

A 2-4 keV multilayer mirrored channel for the NIF Dante system.

During inertial confinement fusion experiments at the National Ignition Facility (NIF), a capsule filled with deuterium and tritium (DT) gas, surrounded by a DT ice layer and a high-density carbon ablator, is driven to the temperature and densities required to initiate fusion. In the indirect method, 2 MJ of NIF laser light heats the inside of a gold hohlraum to a radiation temperature of 300 eV; thermal x rays from the hohlraum interior couple to the capsule and create a central hotspot at tens of millions degrees Kelvin and a density of 100-200 g/cm3. During the laser interaction with the gold wall, m-band x rays are produced at ∼2.5 keV; these can penetrate into the capsule and preheat the ablator and DT fuel. Preheat can impact instability growth rates in the ablation front and at the fuel-ablator interface. Monitoring the hohlraum x-ray spectrum throughout the implosion is, therefore, critical; for this purpose, a Multilayer Mirror (MLM) with flat response in the 2-4 keV range has been installed in the NIF 37° Dante calorimeter. Precision engineering and x-ray calibration of components mean the channel will report 2-4 keV spectral power with an uncertainty of ±8.7%.

Next Steps in Untangling the Web of Violence: A Research Agenda.

In this commentary, we outline four key trends in violence and trauma research and describe needed research to advance our ability to understand, prevent, and respond these problems. The trends are the move toward evidence-based policy, the recognition of the importance of trauma dosage, the shift to strengths-based approaches, and increased attention to race, gender, and other personality and community characteristics regarding health disparities and culturally appropriate interventions. For each trend, we have identified needed research areas, taking care to identify low-resource and high-resource studies that can help us reduce the burden of trauma.

Child Protective Services Guidelines for Substantiating Exposure to Domestic Violence as Maltreatment and Assigning Caregiver Responsibility: Policy Analysis and Recommendations.

The purpose of this study was to examine the range of policy approaches used by child welfare systems in the United States to guide workers in classifying and substantiating child exposure to domestic violence (CEDV) as an actionable form of maltreatment. To that end, we conducted a qualitative document analysis of child protective services (CPS) policy manuals from all state-administered child welfare systems in the U.S. (N = 41). Our findings indicate that a majority of state-administered systems (71%) have adopted policy requiring workers to demonstrate that children have endured harm or the threat of harm before substantiating CEDV-related maltreatment. Many state systems (51%) also include policy directives that require workers to identify a primary aggressor during CPS investigations involving CEDV, while far fewer (37%) provide language that potentially exonerates survivors of domestic violence from being held accountable for failure to protect on the basis of their own victimization. Based on our findings and identification of policy exemplars, we offer a recommended set of quality policy indicators for states to consider in the formulation of their policy guidelines for substantiating children's exposure to domestic violence that promotes the safety and wellbeing of both children and adult survivors of domestic violence.

Using administrative data to uncover how often and why supervisory neglect happens: Implications for child maltreatment prevention.

BACKGROUND: Despite supervisory neglect being the most prevalent and fatal neglect sub-type, the most common reasons why caregivers are substantiated for this type of maltreatment remains unknown. OBJECTIVE: Our study describes cases substantiated for supervisory neglect in a Midwestern state in an effort to inform prevention strategies against supervisory neglect. PARTICIPANTS AND SETTING: This study utilized state administrative data from substantiated child maltreatment investigations conducted between May 1st and October 31st, 2019 (N = 11,208). METHODS: We first identified the substantiated investigations where supervisory neglect was present and established investigation-level correlates for these cases. We then selected a random sample of investigations with a substantiated allegation of supervisory neglect (n = 150) for a qualitative review of written investigative narratives to uncover the contextual factors of supervisory neglect and identify which factors frequently co-occur. RESULTS: Supervisory neglect was the most common maltreatment type, present in 71% (n = 7945) of substantiated child welfare investigations. Our qualitative review of 150 randomly selected cases identified ten distinct, non-mutually exclusive contextual factors of supervisory neglect. Child exposure to domestic violence was the most prevalent contextual factor (45%), followed by caregiver's substance-related problems (42%). Childhood exposure to domestic violence and caregiver's substance-related problems was the most common co-occurrence of factors, present in 18% of cases. CONCLUSIONS: Supervisory neglect accounts for the vast majority of child maltreatment incidents. To prevent the largest share of supervisory neglect cases, policy and programs are needed to address domestic violence and substance-related problems among caregivers.

Proof-of-concept of a neutron time-of-flight ellipsoidal detector.

The time-resolved measurement of neutrons emitted from nuclear implosions at inertial confinement fusion facilities is used to characterize the fusing plasma. Several significant quantities are routinely measured by neutron time-of-flight (nToF) detectors in these experiments. Current nToF detectors use scintillators as well as solid-state Cherenkov radiators. The latter has an inherently faster time response and can provide a co-registered γ-ray measurement as well as improved precision in the bulk hot-spot velocity. This work discusses a nToF ellipsoidal detector that also utilizes a solid-state Cherenkov radiator. The detector has the potential to achieve a fast instrument response function allowing for characterization of the γ-ray burn history as well as the ability to field the detector closer to the fusion source. Proof-of-concept testing of the nToF ellipsoidal detector has been conducted at the National Ignition Facility using commercial optics. A time-resolved neutron signal has been measured from the diagnostic. Preliminary simulations corroborate the results.

The five line-of-sight neutron time-of-flight (nToF) suite on the National Ignition Facility (NIF).

Measurement of the neutron spectrum from inertial confinement fusion implosions is one of the primary diagnostics of implosion performance. Analysis of the spectrum gives access to quantities such as neutron yield, hot-spot velocity, apparent ion temperature, and compressed fuel ρr through measurement of the down-scatter ratio. On the National Ignition Facility, the neutron time-of-flight suite has been upgraded to include five independent, collimated lines of sight, each comprising a high dynamic range bibenzyl/diphenylacetylene-stilbene scintillator [R. Hatarik et al., Plasma Fusion Res. 9, 4404104 (2014)] and high-speed fused silica Cherenkov detectors [A. S. Moore et al., Rev. Sci. Instrum. 89, 10I120 (2018)].

[Analysis to determine optimal age for surgical management of equinus foot in patients with childhood cerebral palsy]. / Análisis para determinar la edad óptima para el manejo quirúrgico del pie equino en pacientes con parálisis cerebral infantil.

INTRODUCTION: Childhood cerebral palsy, a non-progressive brain injury, occurs before, during or after delivery, with variable neurological damage from mild to disabling. The deformity in equine is treated conservatively at an early age, but when is surgical management indicated? OBJECTIVE: Our goal was to determine the optimal age for surgical management of the equine foot in CCP patients. MATERIAL AND METHODS: Retrospective study, in patients diagnosed with CCP (all types), treated surgically with open or percutaneous Achilles tendon elongation, assessed with external consultation notes, in patients aged 1-16 years, and average follow-up of 6 years, evaluating progress with relapse of deformity and gait with plantigrade support. RESULTS: 55 patients, 74 equinus feet (29 in girls, 45 in boys) were analyzed with surgical treatment. Those treated before six years old presented relapses, with vulnerable period in 4-6 years. Monoplegia presented 100% relapses, and triplegia presented 0%. Open surgery presented 50% recurrence and percutaneous technique only 19%. CONCLUSION: In our institution, the optimal age is suggested in 6-12 years. Percutaneous technique over the open, should be preferred, and greater attention should be paid to monitoring monoplexy.

INTRODUCCIÓN: La parálisis cerebral infantil es una lesión cerebral no progresiva que ocurre antes, durante o después del parto y provoca daño neurológico variable que oscila de leve hasta discapacitante. La deformidad en el pie equino se trata conservadoramente en edades tempranas, pero ¿cuándo está indicado el manejo quirúrgico? OBJETIVO: Determinar la edad óptima para el manejo quirúrgico del pie equino en pacientes con PCI. MATERIAL Y MÉTODOS: Estudio retrospectivo realizado en pacientes con diagnóstico de PCI (todos los tipos), tratados quirúrgicamente con alargamiento del tendón de Aquiles abierto o percutáneo y valorados con notas de la consulta externa; los pacientes tuvieron de 1-16 años y un seguimiento promedio de seis años, valorándose la marcha con recidiva de deformidad y la marcha plantígrada. RESULTADOS: Se analizaron 55 pacientes, 74 con pie equino (29 niñas y 45 niños); de éstos, presentaron más recidivas los operados antes de los seis años de edad, con un período vulnerable entre los cuatro y seis años. La monoplejía registró 100% de recidivas, mientras que la triplejía 0%. La cirugía abierta se asoció con recurrencia en 50% y la cirugía percutánea sólo en 19%. CONCLUSIONES: En nuestra institución, se sugiere que la edad óptima de la cirugía esté entre los 6-12 años. Es preferible la técnica percutánea sobre la abierta, debiendo poner mayor atención en el seguimiento de la monoplejía.

Tratamiento rehabilitador en la cirugía del linfedema / Rehabilitation in lymphedema surgery

El tratamiento conservador de los pacientes con linfedema habitualmente comprende la terapia descongestiva compleja con objetivo de reducir el volumen y las prendas de compresión en fase de mantenimiento, realizando un seguimiento en los servicios de Rehabilitación. El tratamiento quirúrgico del linfedema es una opción terapéutica cuyo interés ha aumentado en los últimos años, aunque no existe evidencia actual de que pueda curar el linfedema y siempre se acompaña de tratamiento conservador. La mayoría de los estudios se centran en los resultados según el tipo de cirugía y no existe un protocolo estandarizado sobre el tratamiento conservador antes o después de la cirugía. Con este trabajo se pretende realizar un compendio sobre las cirugías de linfedema más frecuentes y sus indicaciones, centrándose en el tratamiento rehabilitador que implica cada cirugía.(AU)

Conservative treatment of lymphedema usually includes complex decongestive therapy in order to reduce the volume of the lymphedema, and compression garments in the maintenance phase. Follow-up is carried out in the Rehabilitation Services. Surgical treatment of lymphedema is a therapeutic option, the interest of which has increased in recent years, although there is no current evidence that it can cure lymphedema and it is always accompanied by conservative treatment. Most studies focus on results according to the type of surgery and there is no standardized protocol for conservative treatment before or after surgery. The objective of this work is to prepare a compendium about the most frequent lymphedema surgeries and their indications, focusing on the rehabilitation treatment for each surgery.(AU)

Development, CAPTA Part C Referral and Services Among Young Children in the U.S. Child Welfare System: Implications for Latino Children.

Amendments made to the Child Abuse Prevention and Treatment Act in 2003 and the Individuals with Disabilities Education Improvement Act in 2004 opened the door to a promising partnership between child welfare services and early intervention (EI) agencies by requiring a referral to EI services for all children under age 3 involved in a substantiated case of child abuse, neglect, or illegal drug exposure. However, little research has been conducted to assess the implications of these policies. Using data drawn from a nationally representative study conducted in 2008-2009, we observed less than a fifth of all children in substantiated cases to receive a referral to developmental services (18.2%) approximately 5 years after the passage of the amendments. Of children in contact with the U.S. child welfare system, Hispanic children of immigrants demonstrated the greatest developmental need yet were among the least likely to receive EI services by the end of the study period. Implications for policy and practice are discussed.

Análisis para determinar la edad óptima para el manejo quirúrgico del pie equino en pacientes con parálisis cerebral infantil / Analysis to determine optimal age for surgical management of equinus foot in patients with childhood cerebral palsy

Resumen: Introducción: La parálisis cerebral infantil es una lesión cerebral no progresiva que ocurre antes, durante o después del parto y provoca daño neurológico variable que oscila de leve hasta discapacitante. La deformidad en el pie equino se trata conservadoramente en edades tempranas, pero ¿cuándo está indicado el manejo quirúrgico? Objetivo: Determinar la edad óptima para el manejo quirúrgico del pie equino en pacientes con PCI. Material y métodos: Estudio retrospectivo realizado en pacientes con diagnóstico de PCI (todos los tipos), tratados quirúrgicamente con alargamiento del tendón de Aquiles abierto o percutáneo y valorados con notas de la consulta externa; los pacientes tuvieron de 1-16 años y un seguimiento promedio de seis años, valorándose la marcha con recidiva de deformidad y la marcha plantígrada. Resultados: Se analizaron 55 pacientes, 74 con pie equino (29 niñas y 45 niños); de éstos, presentaron más recidivas los operados antes de los seis años de edad, con un período vulnerable entre los cuatro y seis años. La monoplejía registró 100% de recidivas, mientras que la triplejía 0%. La cirugía abierta se asoció con recurrencia en 50% y la cirugía percutánea sólo en 19%. Conclusiones: En nuestra institución, se sugiere que la edad óptima de la cirugía esté entre los 6-12 años. Es preferible la técnica percutánea sobre la abierta, debiendo poner mayor atención en el seguimiento de la monoplejía.

Abstract: Introduction: Childhood cerebral palsy, a non-progressive brain injury, occurs before, during or after delivery, with variable neurological damage from mild to disabling. The deformity in equine is treated conservatively at an early age, but when is surgical management indicated? Objective: Our goal was to determine the optimal age for surgical management of the equine foot in CCP patients. Material and methods: Retrospective study, in patients diagnosed with CCP (all types), treated surgically with open or percutaneous Achilles tendon elongation, assessed with external consultation notes, in patients aged 1-16 years, and average follow-up of 6 years, evaluating progress with relapse of deformity and gait with plantigrade support. Results: 55 patients, 74 equinus feet (29 in girls, 45 in boys) were analyzed with surgical treatment. Those treated before six years old presented relapses, with vulnerable period in 4-6 years. Monoplegia presented 100% relapses, and triplegia presented 0%. Open surgery presented 50% recurrence and percutaneous technique only 19%. Conclusion: In our institution, the optimal age is suggested in 6-12 years. Percutaneous technique over the open, should be preferred, and greater attention should be paid to monitoring monoplexy.

[Miliary tuberculosis and cerebral tuberculomas. Apropos a case]. / Tuberculosis miliar y tuberculomas cerebrales. A propósito de un caso.

We present a case of a 45-year-old patient with miliary tuberculosis (MI), whose initial clinical symptomatology was uncertain. A few weeks after the beginning of chemotherapy, and in the face a Jacksonian crisis, cerebral tuberculomas were detected with CAT. The interesting thing in this case is to highlight that the diagnosis of MT anatomopathologic after pulmonary biopsy with mini-thoracotomy and that the cerebral complication could be classified within the so-called "paradoxical worsening" as it has been documented in the literature.