"If you don't send me five other pictures I am going to post the photo online": A qualitative analysis of experiences of survivors of sextortion.

In this study, we explored survivors' experience with sextortion (threats to expose sexual images to coerce victims to provide additional pictures, sex, or other favors). We conducted in-depth telephone interviews with 48 adults aged 18 to 25 who had been targets of sextortion. Nearly half of participants were minors at the time of the sextortion incident. Data were analyzed using thematic analysis, which resulted in four major dimensions. The dimensions identified were the emotional connections between victims and perpetrators, the nature of the threats, societal responses, and integrating the sextortion into their life stories. The findings emphasized the multidimensional nature of this phenomenon. There was a wide range of emotional connections, from brief connections to close intimate relationships or strong friendships. Some threats remained unfulfilled, while other were carried out. Some threats were one-time and some lasted for years. Societal responses were central in participants' narratives, with most participants actually turning to their peers and parents for support. Many expressed thankfulness for the opportunity to tell their story during the interviews. For the majority of participants sextortion was perceived as a central event in their lives, one that changed them forever. Listening to the voices of survivors helps professionals understand these harmful situations.

Possible Factors Supporting Cross-Agency Collaboration in Child Abuse Cases: A Scoping Review.

Cross-agency collaboration for responding to child abuse cases is critical for the safety and wellbeing of children. However, working effectively across organizational boundaries can be difficult, especially where there are considerable disciplinary differences. Accordingly, many jurisdictions have put in place policies and processes to support cross-agency collaboration across groups responding to severe child abuse. The aim of this scoping review was to highlight key factors that may influence the quality of cross-agency collaboration in severe child abuse cases. A systematic search comprising 57 empirical studies examining the facilitators and/or barriers to cross-agency collaboration in child abuse cases was undertaken identifying eleven factors. This review found the most commonly cited factor was the need to reconcile the different roles/mandates of workers with their roles in a cross-agency response. A clear cross-agency protocol that establishes agreed procedures was also a commonly cited factor, along with cross-agency training, and communication and information sharing practices. This scoping review highlighted the lack of high-quality evidence that could be used to assess the effectiveness of policies and processes to support cross-agency collaboration for child abuse cases, and targeted areas for future research to enhance the quality of evidence for this common type of program/intervention.

Investigating Public Perception of Occupational Therapy: An Environmental Scan of Three Media Outlets.

Using a phenomenological approach, this study investigated visibility and perception of the profession of occupational therapy in three media outlets. Content analysis occurred on LexisNexis Academic (LNA), Google Images, and Twitter platforms. Analysis of LNA identified the prevalence of articles about occupational therapy in domestic newspapers and similar media avenues, MaxQDA qualitative software coded Google Images from a search on occupational therapy, and AnalyzeWords evaluated Twitter feeds of four health care professions for presence and tone in a social media context. Results indicate that although occupational therapy is 100 years old, its presence in news and online platforms could be stronger. This study suggests that a clear professional identity for occupational therapy practitioners must be strategically communicated through academic and social platforms. Such advocacy promotes the profession, meets the next iteration of occupational therapy's professional vision, and allows occupational therapy to remain a prominent and formidable stakeholder in today's health care marketplace.

Length of Time to Resolve Criminal Charges of Child Sexual Abuse: A Three-County Case Study.

The present study sought to examine the court culture of three Oregon counties and their timelines for resolving felony child sexual abuse cases. Specifically, we examined (a) case outcomes, churning (i.e., the extent to which four court events were rescheduled), the length of time to reach a criminal case resolution, and how this length of time compared to that for felonies generally; (b) whether mandatory minimum sentences affected resolution timeliness; and (c) key stakeholders' perceptions about their local court culture. Data included retrospective case-file abstraction (N = 532) on all felony child sex crimes for a 2-year period and interviews with legal professionals (N = 23). Across all three counties, a minority of child sexual abuse cases (18% to 47%) were resolved within the target timeframe of 4 months. In contrast, most felonies (65% to 77%) were resolved within this timeframe. The rescheduling of trials and the requirement of mandatory minimum sentences for some felony child sexual abuse crimes increased the time until case resolution. Results suggest that court cultures that are hierarchical and cooperative may lead to longer case resolution times than court cultures that are self-managing or autonomous. Implications of these results and other results are discussed.

Using child advocacy center tracking data to examine criminal disposition times.

Given the difficulty of obtaining criminal justice data on child abuse cases, information from child advocacy centers could be an important resource for answering questions about criminal justice outcomes for child abuse cases. In this exploratory study, we use data from one child advocacy center (N = 632) to examine the feasibility of using NCAtrak, a national computerized, Web-based case tracking system, to examine criminal disposition timeframes in child abuse cases. The system data indicated that the time frame for the cases to be criminally resolved varied widely. About one in four child physical and sexual abuse cases with adult offenders took more than one year to reach a final disposition. About 11% of child sexual abuse cases with juvenile offenders took more than one year to reach a criminal disposition. We encourage child advocacy centers using computer-based data systems to think of additional ways they might use this potentially rich source of data.

"It all depends on the guy and the girl": a qualitative study of youth experiences with statutory victimization relationships.

The purpose of this exploratory study was to examine youths' perceptions of statutory victimization relationships and youths' experience interacting with professionals. In-person qualitative interviews were conducted with 22 youths identified as statutory rape victims by two child advocacy centers. Using grounded theory, interviews were coded thematically using constant comparison analysis. The discussion of the relationship dynamics suggested a great deal of variation. Some youths described the relationships in exploitive terms. However, more typically, the interviewed youth described the relationship as reciprocal, even some time after it had ended. The professional intervention often resulted in feelings of helplessness for the youth. The results suggest creative and flexible protocols are needed for handling these cases that recognize adolescents' developing autonomy.

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.

Emergency Nurses' Experience Providing Care and Perceptions About Using Telemedicine for Sexual Assault Patients.

Most emergency medical clinicians are not trained to conduct forensic sexual assault exams yet are often the first to care for survivors of recent sexual assault. Before the implementation of live sexual assault nurse examiner (SANE) consultation provided via telemedicine ("teleSANE") in one state, results of an online survey of emergency nurses (N = 116) found only 13% felt extremely confident providing quality forensic sexual assault examinations. Two-thirds of emergency nurses felt using teleSANE during sexual assault care would support their clinical decision-making skills. Findings suggest that teleSANE may be a promising strategy to improve access to specialized sexual assault care.

Clinical and toxicity predictors of response and progression to temsirolimus in women with recurrent or metastatic endometrial cancer.

OBJECTIVE: Temsirolimus (TEM) has recently shown activity (NCIC CTG phase II trial) in endometrial cancer (EC). Despite EC having a high rate of PTEN mutation, in this trial activity was independent of PTEN and other molecular markers. We explored whether treatment related toxicity occurring in cycle one was predictive of outcomes. METHODS: Patients were those enrolled on two sequential phase II studies of the NCIC CTG that evaluated single agent TEM in women with recurrent or metastatic chemotherapy naïve or treated EC. An exploratory landmark analysis examined the relationship between early treatment related toxicities as well as prior chemotherapy and efficacy outcomes (response, progression, and tumor size shrinkage) in univariate and multivariate analyses. The relationship between molecular markers and outcomes was also reexamined in patients. RESULTS: Mucositis, diarrhea, decreased absolute neutrophil count, as well as elevated glucose, or cholesterol were not independent predictors of response or progression. Highest fasting triglyceride predicted for a 3.5% tumor shrinkage from baseline. Women previously treated with chemotherapy were at 7.37 times greater risk of progression and experienced 20.9% increased tumor growth compared to chemotherapy naïve women. Molecular markers were not predictors of response or progression. CONCLUSIONS: Except for elevation in fasting triglyceride being associated with minimal tumor shrinkage, no other relationship between efficacy and TEM induced adverse events was found. mTOR inhibition activity in EC seems greatest in chemo-naïve patients. Future studies of mTOR inhibitors in EC should focus on women without prior chemotherapy while continuing to explore molecular mechanisms of benefit.

Including Patient Voices in Continuing Medical Education: One Provider's Experience.

In 2021, UpToDate began offering continuing medical education (CME) planned and delivered by patients. The patient-authored medical topic reviews focus on lessons learned from interactions with the healthcare system and emphasise quality of life for those living with specific conditions. Having access to the patient voice at the point of care provides clinicians with a perspective that can improve patient-provider communication and promote shared decision-making. Participants who viewed the patient-authored topics were emailed a survey about the content; several responses indicated that the new topics were useful in clinical practice. While positive responses demonstrate that clinicians value the patient perspective, we also received replies from participants and from the patient authors themselves indicating there is more work to be done in developing patient-led CME. As more patients are invited to join the conversation, their expertise will be increasingly recognised as integral to CME.

Factors Affecting Telemedicine Implementation in Emergency Departments and Nurses' Perceptions of Virtual Sexual Assault Nurse Examiner Consultation for Sexual Assault Survivors.

INTRODUCTION: Emergency department (ED) nurses play a critical role in caring for sexual assault patients, but many have not received training on how to conduct a proper sexual assault forensic medical examination. Live or real-time sexual assault nurse examiner (SANE) consultation provided via telemedicine (known as "teleSANE") during sexual assault examinations is a promising new practice to address this issue. PURPOSE: The purpose of this study was to assess ED nurses' perceptions of influences on telemedicine use, as well as the utility and feasibility of teleSANE, and identify potential influences on teleSANE implementation in EDs. METHODS: Guided by the Consolidated Framework for Implementation Research, this developmental evaluation involved semistructured qualitative interviews with 15 ED nurses from 13 EDs. RESULTS: Interviews revealed facilitators and barriers to current telemedicine use across Consolidated Framework for Implementation Research levels. Facilitators included state-level grant funding and technical assistance. Barriers included clinician discomfort being on video and access to ongoing training. Participants believed teleSANE consultation would improve patient care and forensic evidence collection but had concerns for patient privacy and acceptability. Most participants worked in EDs that have the information technology support and telemedicine equipment needed to support teleSANE implementation, although many requested ongoing education and trainings on teleSANE and sexual assault care to improve clinician confidence and account for high staff turnover. DISCUSSION: Findings highlight the unique needs of sexual assault survivors receiving telemedicine services in EDs, particularly those in rural communities with heightened privacy concerns and limited access to specialty care.

Reducing Falls in Older Women with Urinary Incontinence.

Urinary incontinence is common in older women and doubles the risk of falls in this population. The association between urinary incontinence, especially urgency urinary incontinence, and falls is multifactorial and likely the result of a complex interaction between physical, mental, social, and environmental factors. As a result of this multifactorial etiology and based on existing evidence, the integration of different fall prevention strategies including strength and resistance exercises, bladder training, and home hazard reduction have the potential to decrease the risk of falls in older women with urinary incontinence. Given the prevalence of urinary incontinence and the significant morbidity associated with falls, effective interventions to reduce fall risk in older women with urinary incontinence is of high public health significance.

A phase I/II study of the Src inhibitor saracatinib (AZD0530) in combination with gemcitabine in advanced pancreatic cancer.

AIM: This phase I/II study of saracatinib in combination with gemcitabine in patients with advanced pancreatic cancer was conducted by the NCIC Clinical Trials Group. The aims were to define the recommended phase II dose (RP2D) of saracatinib when combined with gemcitabine, and assess the efficacy of this combination in advanced pancreatic cancer. PATIENTS AND METHODS: Eligibility criteria included locally advanced or metastatic pancreatic adenocarcinoma and no prior chemotherapy. In phase I saracatinib was escalated in combination with gemcitabine (1000 mg/m(2)) to determine the recommended phase II dose (RP2D). The study was then expanded to a single arm phase II trial using a Simon 2-stage design. The primary endpoint was objective tumor response (OR) plus stable disease ≥ 4 months (SD4) rate; if ≥ 8 patients had OR+SD4, the study would proceed to stage 2. RESULTS: Thirteen patients were enrolled into the phase I portion of this study. Saracatinib 175 mg PO daily was chosen as the RP2D in combination with gemcitabine. Twenty-one additional patients were then enrolled at the RP2D (phase II). Of the 22 response evaluable patients treated at the RP2D, 9 patients (40.9%) had progressive disease, 6 patients (27.3%) had stable disease for less than 4 months, 5 patients (22.7%) had SD4, and 2 patients (9.1%) had a partial response to treatment. Objective criteria for continuing to stage 2 were thus not met and the trial was closed following the accrual of 34 patients. CONCLUSION: Saracatinib 175 mg daily in combination with gemcitabine is well tolerated but the combination did not improve efficacy over what would be expected from gemcitabine alone.

Mental health professionals in children's advocacy centers: is there role conflict?

Two recent chapters in professional books have criticized children's advocacy centers for creating role conflict for mental health professionals because of their work with criminal justice and child protection professionals in children's advocacy centers as part of a coordinated response to child abuse. This article argues that these critiques misunderstand children's advocacy center practice and overestimate the risk of role conflict. Children's advocacy center standards set a boundary between forensic interviewing and therapy, which in most children's advocacy centers are done by separate professionals and never by the same professional for a given child. Many mental health professionals serve children's advocacy centers as consultants with no treatment role. Children's advocacy center therapists are rarely involved in investigation, and their participation in multidisciplinary teams focuses on children's interests and well-being.

Statutory Rape: Case Characteristics When Offenders are Younger Than 21 Years of Age Versus Older.

Statutory rape laws are intended to protect adolescents from harm as a result of sexual activity with older individuals. In this pursuit, many, but far from all, states' statutory rape laws differentiate younger and older offenders. In effect, many of these states differentiate offenders who are 21 and older from those who are under 21. It is unknown, however, whether and how the dynamics of statutory rape vary depending on the age of the offender. To explore the contribution of offender age to the dynamics of statutory rape, data were collected from the records of 105 statutory rape cases referred to a child abuse assessment center over a 63-month period. Records included detailed reports on case history and victims' family history, mental health and health-risking behaviors, medical examination results, and forensic interview summaries. Cases of offenders11.Because these cases are under investigation, "offenders" here refers to "suspects." For ease of reading, we use "offenders" to be consistent with prior research terminology. under 21 were compared to the cases of offenders 21 years and older. Compared to cases of younger offenders, cases of offenders 21 years and older more often involved slightly older adolescent victims. Independent of age, victims with offenders 21 and over compared with offenders under 21 were over six times as likely to have a prior history of a high, versus low, number of psychosocial problems and were seven times more likely to experience multiple forms of coercion versus no coercion by the offender. Findings suggest that statutory rape prevention, policy and response strategies should consider the critical ways that case characteristics and victims differ according to this key offender attribute.

Phase II trial of OGX-011 in combination with docetaxel in metastatic breast cancer.

PURPOSE: Clusterin is an antiapoptotic protein activated in response to cellular stress. OGX-011 is a second-generation antisense oligonucleotide that inhibits clusterin expression. The primary objective of this phase II trial was to assess the safety and efficacy of the combination of OGX-011 and docetaxel for metastatic breast cancer. EXPERIMENTAL DESIGN: Women with measurable metastatic breast cancer and or=55%. Objective response in >or=6 of the first 14 patients was required for the trial to continue to the second stage. RESULTS: Fifteen patients were enrolled. A median of six cycles were delivered (range, 2-10). Five partial responses were confirmed for a 33% response rate (95% confidence interval, 11.8-61.6%) with a further 9 (60%) patients showing stable disease. The median duration of stable disease was 9.3 months. The median time to progression was 8 months (95% confidence interval, 5.62-9.43 months). Toxic effects were similar to those with single agent docetaxel. Although serum clusterin decreased on treatment, there was no relationship observed between the magnitude of decrease and response. CONCLUSION: The combination of OGX-011 and docetaxel at 75 mg/m(2) is well tolerated and clinical activity was seen in these patients with metastatic breast cancer, but there was an insufficient number of responses to meet the criteria for proceeding to the second stage of accrual.

Disclosure and service use on a college campus after an unwanted sexual experience.

In order to continue to facilitate the disclosure of sexual assault to professional support services, the current study examined the extent to which survivors report using campus services and whether friends who had disclosed to participants used the services. We also compared knowledge of a campus sexual assault center and likelihood of using the center among college men and women. Surveys were completed by 1,230 students, including victims of unwanted contact (n = 127), victims of unwanted intercourse (n = 26), and friends of victims (n = 253). Students who reported being victims of unwanted sexual experiences were reluctant to use services, expressing concerns that they would not be believed and that they would be blamed for what had happened to them. College men were significantly less likely to know where the sexual assault center was located, to report that they would use the center, and to report that unwanted sexual experiences were a problem on campus. Results indicate that much needs to be done to educate the campus community about the value of using professional support services after a sexual assault.

CME in the Time of COVID-19: Educating Healthcare Professionals at the Point-of-care and Improving Performance Outcomes.

UpToDate® is a point-of-care clinical resource used by nearly 2 million clinicians worldwide. Users in the USA and other regions can obtain continuing education credits after researching clinical questions at the point-of-care. As part of the CME credit redemption process, participants provide feedback on the information researched during the UpToDate® learning activity. We examined the impact of UpToDate® searches on clinical decision-making related to COVID-19. Between January 1 and 31 August 2020, UpToDate® added more than 40 topic reviews on various aspects of COVID-19 diagnosis and management, and developed new methods for delivering COVID-19 content to our learners. During the observation period, participants accessed COVID-19-related topic reviews over 7.5 million times. Data collected from CME activity evaluations and user feedback suggested that the learning activity had a significant impact on clinical decision-making. Over 94% reported that they modified their management strategies as a result of using UpToDate®, and 97% reported that use of UpToDate® led to improvement in care. These findings support the benefit of self-directed, point-of-care learning activities on the clinical management of patients during a global pandemic.

Storytelling-Plots of resilience, learning, and discovery in emergency management.

Almost everyone can relate to the experience of telling a story. This article explores how storytelling is being used to identify risks and create hazard mitigation strategies, as well as how it can promote learning within the field of emergency management. Storytelling is both a pedagogical tool and an invaluable resource for practicing emergency managers. This article illustrates the ways in which the process of telling a story enables participates to talk about stressful concerns, internalize complex concepts, and even have fun. The article explores how storytelling drove the public process leading to the adoption of hazard mitigation plans, and how eight types of stories, as defined by the American humorist Kurt Vonnegut, can strengthen emergency management education. This article also explores how research suggests that storytelling can provide an effective way for both the tellers of story and their listeners to find meaning in events, provide context to what is being taught, transmit emotion along with information, develop a professional identity, build empathy and compassion, and help with remembering events and lessons learned. The authors have a long history of utilizing storytelling and present this article in order to share and explore storytelling as applied to the discipline of emergency management.

Using Telehealth for Pediatric, Adolescent, and Adult Sexual Assault Forensic Medical Examinations: An Integrative Review.

OBJECTIVE: Improved access to qualified nurse examiners to perform sexual assault forensic examinations is needed. This integrative review examines the current research literature on synchronous "real-time or live" telehealth support and guidance during pediatric, adolescent, and adult sexual abuse/assault forensic examinations. METHODS: Informational databases (CINAHL, Health Source: Nursing/Academic Edition, Medline, PsychInfo, and Violence & Abuse Abstracts) were searched, and research articles including live telehealth for sexual assault survivors were reviewed (n = 98). RESULTS: Review of the articles resulted in the inclusion of seven studies that utilized live video telehealth during the sexual assault forensic examination. CONCLUSION: The current research literature supports the premise that synchronous telehealth is a promising modality for this patient population. However, the lack of large comprehensive studies warrants additional research to understand outcomes and develop best practices. Additional research studies are needed to evaluate the effectiveness, cost, and criminal justice impact of this intervention.