A Rare Case of Postmenopausal Hirsutism Associated With a Serous Cystadenofibroma of the Ovary.

Hirsutism in females is most commonly associated with polycystic ovarian syndrome, but can also result from congenital adrenal hyperplasia and ovarian tumors like granulosa cell tumors, Sertoli-Leydig cell tumors, and hilus cell tumors. We present a case of a 54-year-old female with hirsutism, diagnosed with ovarian cystadenofibroma. She had a history of premature ovarian failure at the age of 35 and presented with new onset chin and upper lip hair, and scalp hair loss. Labs showed elevated total testosterone, normal dehydroepiandrosterone (DHEA) and sex hormone-binding globulin (SHBG), low estradiol, and postmenopausal range anti-Mullerian hormone (AMH), follicle-stimulating hormone (FSH), luteinizing hormone (LH), and prolactin. Cytogenetic testing showed a normal XX karyotype. Initial transvaginal ultrasound revealed a thickened endometrial stripe and unremarkable ovaries. Repeat ultrasound and MRI noted persistent endometrial thickening and a solid-cystic structure in the left ovary. The patient underwent total hysterectomy, bilateral salpingo-oophorectomy, and sentinel lymph node dissection. Endometrial biopsy showed FIGO grade 1 endometrioid carcinoma, and the left ovary biopsy revealed benign serous cystadenofibroma and endometriosis. Postoperatively, hirsutism resolved and testosterone levels normalized. Hirsutism in postmenopausal women should prompt evaluation for adrenal or ovarian sources, including tumors. Ovarian tumors cause about 1% of hirsutism cases. Our case highlights the need for thorough evaluation, as benign ovarian tumors can also cause androgen excess and associated conditions like endometrial cancer.

ChatGPT-generated help produces learning gains equivalent to human tutor-authored help on mathematics skills.

Authoring of help content within educational technologies is labor intensive, requiring many iterations of content creation, refining, and proofreading. In this paper, we conduct an efficacy evaluation of ChatGPT-generated help using a 3 x 4 study design (N = 274) to compare the learning gains of ChatGPT to human tutor-authored help across four mathematics problem subject areas. Participants are randomly assigned to one of three hint conditions (control, human tutor, or ChatGPT) paired with one of four randomly assigned subject areas (Elementary Algebra, Intermediate Algebra, College Algebra, or Statistics). We find that only the ChatGPT condition produces statistically significant learning gains compared to a no-help control, with no statistically significant differences in gains or time-on-task observed between learners receiving ChatGPT vs human tutor help. Notably, ChatGPT-generated help failed quality checks on 32% of problems. This was, however, reducible to nearly 0% for algebra problems and 13% for statistics problems after applying self-consistency, a "hallucination" mitigation technique for Large Language Models.

Exploring Intervention with South Asian Women in the United States Experiencing Domestic Violence.

PURPOSE: The current study reports intervention from the perspective of abused South Asian women in the United States (U.S.) aligning with the Center for Disease Control (CDC's) ecological model. MATERIAL AND METHODS: In-depth telephonic interviews were conducted with a convenience sample of 20 South Asian women in the U.S. The interviews were analyzed using thematic analysis. RESULTS: Utilizing the CDC's ecological model, the following themes emerged for prevention at the individual level: walk away the first-time abuse occurred; at the relationship level: pre-marital counseling and at the societal level: act on the red flags before the wedding, address the stringent gender roles, socialization, and blame. For protection, the following themes emerged at the individual level: self-determination and strength, protection of children, and financial independence. At the relationship level, the theme of marital counseling emerged and at the community level, the theme of community resources emerged. DISCUSSION: The South Asian natal family or family members in positions of power can recognize red flags, raise their voice, take constructive action to address misogyny, rigid patriarchal attitudes, and prevent abuse before it occurs. CONCLUSION: There is an urgent need to recognize and work at both preventative and protective levels to address the abuse among South Asian women in the U.S.

Feasibility of Telementoring as an Intraoperative Time-out Tool during Laparoscopic Cholecystectomy for Prevention of Biliovascular Injuries.

Laparoscopic cholecystectomy is commonly performed procedure for gallbladder diseases. Biliovascular injuries are well known complications and various standard and safe strategies have been developed for safe cholecystectomy. Intraoperative time out is one of the strategies where two or more surgeons stop during surgery before dividing any structure in Calot's triangle. COVID-19 pandemic has expanded the horizon of telesurgery, teleconsultation, use of artificial intelligence and robotics in surgical training and execution. Easily available mobile applications like Facebook messenger, WhatsApp and Viber can be used for intraoperative time-out during difficult cholecystectomy with expert surgeon outside the vicinity of theatre. Such tools are cost effective and definitely boost the confidence of surgeons during surgery in case of any complexity, or help in stopping the procedure and in timely referral. Keywords: Cholecystectomy; laparoscopy; telementoring.

Effectiveness of low-dose radiation therapy in COVID-19 patients globally: A systematic review.

Background: Novel Corona Virus Disease 2019 (COVID-19) can affect multiple organs, including the lungs, resulting in pneumonia. Apart from steroids, other anti-COVID drugs that have been studied appear to have little or no effect on COVID-19 pneumonia. There is a well-known history of inflammatory disease, including pneumonia, treated with low-dose radiation therapy (LDRT). It reduces the production of proinflammatory cytokines, Interleukin-1a (IL-1a), and leukocyte recruitment.   Methods: A comprehensive literature search was conducted using PubMed, Scopus, Embase, CINAHL, and Google Scholar, with keywords such as "radiotherapy," "low-dose radiation therapy," "low-dose irradiation," "covid-19 pneumonia," "SARS-CoV-2 pneumonia," and "covid pneumonia." with additional filters for human studies and customized articles in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. We reviewed randomized controlled trials, quasi-experimental studies, cohort, case-control, and cross-sectional studies with a clearly defined intervention, including low-dose radiotherapy alone or in combination with any therapy to treat COVID-19 pneumonia from December 2019 to May 2021. Patients receiving standard or high-dose radiotherapy, including for other diseases, were excluded. Zotero software was used to collect and organize research from various databases, remove duplicates, extract relevant data, and record decisions. Participants' demographics and baseline status were obtained from the full-text articles along with the intervention's outcome/effect on patient status.  Results: Four studies with 61 participants that met the inclusion criteria were included. One was a double-blind randomized controlled trial, one a non-randomized trial, while the other two were single-arm clinical trials. Low-dose radiation therapy did not show any significant improvement in COVID-19 patients.  Conclusion: Only two studies included in this review demonstrated an improvement in inflammatory markers; however, patients were also given steroids or other drugs. Therefore, the confounding effects must be considered before drawing conclusions. This systematic review does not support mortality benefit, clinical course improvement, or imaging changes with LDRT.

Acute effects of the food preservative propionic acid on glucose metabolism in humans.

INTRODUCTION: Propionic acid (PA) is a common food preservative generally recognized as safe by the US Food and Drug Administration; however, exogenous PA has effects on glucose metabolism that are not fully understood. Our preclinical studies demonstrated exogenous PA increases glucagon, norepinephrine, and endogenous glucose production (EGP). RESEARCH DESIGN AND METHODS: We performed a randomized, placebo-controlled, crossover study in 28 healthy men and women to determine the effect of PA (1500 mg calcium propionate) on these factors. Subjects had two study visits, each preceded by a 1 week, PA-free diet. During each visit, glucose, insulin, glucagon, norepinephrine, epinephrine, and EGP were assessed for 2 hours after oral administration of PA/placebo under resting conditions (protocol 1) and during either a euglycemic (~85-90 mg/dL) or hypoglycemic (~65-70 mg/dL) hyperinsulinemic clamp (protocol 2). RESULTS: PA, as compared with placebo, significantly increased: (1) glucagon and norepinephrine during protocol 1; (2) glucagon, norepinephrine, and epinephrine under euglycemic conditions in protocol 2; and (3) norepinephrine, epinephrine, and EGP under hypoglycemic conditions in protocol 2. CONCLUSION: Oral consumption of PA leads to inappropriate activation of the insulin counterregulatory hormonal network. This inappropriate stimulation highlights PA as a potential metabolic disruptor.

Feasibility and Safety of Distal Radial Artery Access in Anatomical Snuffbox for Coronary Angiography and Coronary Intervention.

BACKGROUND: There is limited data on feasibility and safety of coronary interventions performed using radial artery at anatomical snuffbox as vascular access point in South Asian region. Our study attempts to evaluate the feasibility and safety of coronary angiography and percutaneous coronary intervention using transradial access at anatomical snuffbox. METHODS: Transradial access at anatomical snuffbox was attempted in 128 consecutive patients, who were planned for coronary angiography and/or percutaneous coronary intervention. Success in vascular access, completion of planned procedure and complications encountered, including patency of radial artery after the procedure, were investigated. RESULTS: A total of 128 patients (76 males [59.4%]; 52 females [40.6%]) between 44-78 years of age (mean age, 59.0 +/- 10.2 years) were included in the study. Distal radial artery puncture and sheath placement was successful in all patients however planned procedure was completed in 126 (98.4%) patients. Total 90 coronary angiographies and 36 percutaneous coronary interventions were performed of which five were primary percutaneous coronary intervention. We encountered brachial artery spasm among two patient (1.5%) and significant pain and swelling among three patients (2.3%). No bleeding complication, numbness or parasthesia were observed on follow-up. Patients had average pain rating of 2.4+/- 1.1 in visual analogue pain rating scale. There were no instances of radial artery occlusion after the procedure. CONCLUSIONS: Distal radial artery, at anatomical snuffbox, is a safe and feasible alternative vascular access site for coronary angiography and percutaneous coronary intervention.

Small Molecule Inhibitor Adjuvant Surfactant Therapy Attenuates Ventilator- and Hyperoxia-Induced Lung Injury in Preterm Rabbits.

BACKGROUND: Invasive mechanical ventilation (IMV) has become one of the mainstays of therapy in NICUs worldwide, as a result of which premature babies with extremely low birth weight have been able to survive. Although lifesaving, IMV can result in lung inflammation and injury. Surfactant therapy is considered a standard of care in preterm infants with immature lungs. Recently, small molecule inhibitors like siRNAs and miRNAs have been used for therapeutic purposes. Ddit3 (CHOP), Ang2 and miR34a are known to be upregulated in experimental lung injury. We wanted to test whether inhibitors for these molecules (CHOP siRNA, Ang2 siRNA, and miR34a antagomir) if used alone or with a combination with surfactant (Curosurf®) would help in reducing ventilation and hyperoxia-induced injury in an experimental lung injury model. METHODS: Preterm rabbits born by cesarean section were intratracheally instilled with the three small molecule inhibitors with or without Curosurf® prior to IMV and hyperoxia exposure. Prior to testing the inhibitors in rabbits, these small molecule inhibitors were transfected in mouse lung epithelial cells (MLE12 and AECII) and delivered to neonatal mouse pups intranasally as a proof of concept that surfactant (Curosurf®) could be used as an effective vehicle for administration of such drugs. Survival, pulmonary function tests, histopathology, immunostaining, quantitative PCR and western blotting were done to see the adjuvant effect of surfactant with these three small molecule inhibitors. RESULTS: Our data shows that Curosurf® can facilitate transfection of small molecules in MLE12 cells with the same and/or increased efficiency as Lipofectamine. Surfactant given alone or as an adjuvant with small molecule inhibitors increases survival, decreases IMV and hyperoxia-induced inflammation, improves pulmonary function and lung injury scores in preterm rabbit kits. CONCLUSION: Our study shows that Curosurf® can be used successfully as an adjuvant therapy with small molecule inhibitors for CHOP/Ang2/miR34a. In this study, of the three inhibitors used, miR34a inhibitor seemed to be the most promising compound to combat IMV and hyperoxia-induced lung injury in preterm rabbits.

Identification of abuse experiences of South Asian women in the US and women in Mumbai, India.

The authors describe the experiences of abuse drawn from in-depth interviews conducted with 20 South Asian women in the United States and a sample of 21 abused women in Mumbai, India. We describe five major themes that identify the nature of domestic violence experienced in these two contexts, barriers to help-seeking and exiting abuse, and the process of ending the abusive relationship. The research sheds light on the similarities and differences in the two contexts. We outlined the similarities in the following themes (a) type of abuse, (b) treatment of children (c) abandonment. We found differences in the following themes (d) joint meeting, (e) back and forth between natal and marital home.

Patterns of abuse among South Asian women experiencing domestic violence in the United States.

This qualitative study was conducted with a convenience sample of 20 South Asian women experiencing domestic violence in the United States. The results explore the patterns of abuse and factors and circumstances (i.e. turning points) that motivated South Asian women to change in the context of the stage that they were in as per the Landenburger's model (binding, enduring, disengaging, and recovery). The four themes that emerged from the interviews and analysis are (1) 'Timing and Frequency of abuse', (2) 'Methods of control - financial, isolation and suspicion', (3) 'Cycle of Abuse', and (4)' Turning Points - motivation to change'. Implications for practice and policy-level changes for abused South Asian women in the United States are discussed.

Dangerous Abusive Relationships and Sources of Resilience for South Asian Immigrant Women Survivors of Intimate Partner Violence.

This study explored South Asian immigrant women survivors' perspectives on intimate partner relationships that could lead to severe violence or a homicide and sources of resilience for South Asian immigrant survivors in the United States. The study recruited 16 South Asian immigrant survivors for in-depth interviews and focus groups. Data were analyzed using thematic analysis. Survivors shared some characteristics of dangerous partner such as controlling behavior, anger issues, infidelity, alcohol and drug problems, and history of childhood abuse. Incidents of severe physical abuse, threats to kill, possession of a weapon, and suspicious behavior led survivors to feel fearful for their lives. Sources of resilience in the community (e.g., support from formal sources of help) and at the individual level (e.g., education) were discussed. The needs for culturally informed services and to generate awareness of services among South Asian immigrants were highlighted.

South Asian women's coping strategies in the face of domestic violence in the United States.

We conducted in-depth telephone interviews with a convenience sample of 20 South Asian women experiencing domestic violence in the United States. Utilizing the emotion-focused and problem-focused coping framework, the researchers analyzed the narratives of abused South Asian women. Emotion-focused coping strategies include (a) spirituality and/or religion and (b) the role of children. Problem-focused coping strategies include (c) informal and formal support and (d) strategies of resisting, pacifying, safety planning. Implications for practice and future research in the United States and internationally are discussed.

Effect of follow-up by a hospital diabetes care team on diabetes control at one year after discharge from the hospital.

AIM: This study was conducted to evaluate the effect of continued follow-up by a hospital diabetes team on HbA1c at 1-year after discharge. METHODS: Adults with HbA1c ≥8% (64mmol/mol), undergoing an elective surgery, were treated in the perioperative period and randomized to continued care (CC) or the usual care (UC) after discharge. Patients in the CC group received weekly to monthly phone calls from a diabetes specialist nurse practitioner (NP) to review their home blood glucose values, diet, exercise, and medications. Patients in the UC group followed with their diabetes care providers. RESULTS: Out of 151 patients, 77 were randomized to the CC group and 74 to the UC group. HbA1c (%) at 1-year was 8.2±1.4 in the CC group and 8.5±1.5 in the UC group (p=NS). Change in HbA1c from baseline was similar between the groups; -0.7±1.4 in the CC versus -0.7±1.5 in the UC group (p=NS). A higher number of calls was not associated with lower HbA1c or reduction in HbA1c. There were 41 insulin-treated patients in the CC group and 53 in the UC group and among them, HbA1c reduction was 0.5±1.5 and 0.6±1.3 respectively (p=NS). CONCLUSIONS: Optimal perioperative treatment of diabetes is associated with an improvement in HbA1c but continued follow-up by a hospital diabetes team after discharge does not have an additional impact on long-term glycemic control. ClinicalTrials.gov identifier NCT02065050.

Safety and efficacy of saxagliptin for glycemic control in non-critically ill hospitalized patients.

OBJECTIVE: To evaluate whether saxagliptin is non-inferior to basal-bolus insulin therapy for glycemic control in patients with controlled type 2 diabetes mellitus (T2DM) admitted to hospital with non-critical illnesses. RESEARCH DESIGN AND METHODS: This was an open-label, randomized controlled clinical trial. Patients received either saxagliptin or basal-bolus insulin, both with correctional insulin doses. The main study outcome was the mean daily blood glucose (BG) after the first day of randomization. RESULTS: Of 66 patients completing the study, 33 (age 69±10 years, 40% men) were randomized to saxagliptin and 33 (age 67±10 years, 52% men) to basal-bolus insulin therapy. The mean daily BG was 149.8±22.0 mg/dL in the saxagliptin group and 146.9±30.5 mg/dL in the insulin group (p=0.59). With an observed group difference of 2.9 mg/dL and an a priori margin of 20 mg/dL, inferiority of saxagliptin was rejected in favor of non-inferiority (p=0.007). There was no significant difference in the percentage of high or low BG values. The insulin group received a higher number of insulin injections (2.3±1.7/day vs 1.2±1.9/day; p<0.001) as well as a higher daily insulin dose (13.3±12.9 units/day vs 2.4±3.3 units/day; p<0.001) than did the saxagliptin group. Continuous BG monitoring showed that glycemic variability was lower in the saxagliptin group as compared to the insulin group. Patient satisfaction scores were similar in the two groups. CONCLUSIONS: We conclude that saxagliptin use is non-inferior to basal-bolus insulin in non-critically ill hospitalized patients with T2DM controlled on 0-2 oral agents without insulin. Saxagliptin use may decrease glycemic variability in these patients. TRIAL REGISTRATION NUMBER: NCT02182895.

Frequent Episodes of Detectable Viremia in HIV Treatment-Experienced Children is Associated with a Decline in CD4+ T-cells Over Time.

BACKGROUND: The clinical consequences of the magnitude and the duration of detectable viremia in HIV-infected children have not been well characterized. We examined the predictors and immunologic consequences over time of frequent episodes of detectable viremia in HIV-infected children followed at Yale-New Haven Hospital. METHODS: We analyzed the CD4+ T-cell and HIV viral load over a 19-year period (1996 to 2013) of 104 HIV-infected children enrolled in the Yale Prospective Longitudinal Pediatric HIV Cohort. Both CD4+ T-lymphocytes and HIV viral load were measured at clinic visits every 3 to 4 months. Longitudinal data analyses using polynomial random coefficients models were conducted to examine overtime changes in CD4+ T-cell counts by frequency of episodes of detectable viremia. Moreover, regression analyses using logistic regression models were used to assess the predictors of frequent episodes of detectable viremia. RESULTS: One hundred and four (104) HIV-infected children with more than one HIV viral load measurement between 1996 and November 2013 were included in the analysis. Over 80% (N=86) of the children had detectable viral load (HIV RNA viral load ≥50 copies/ml) during more than 50% of their clinic visits. Children with infrequent episodes of detectable viremia had significantly higher CD4+ T-cell counts overtime compared to those with frequent episodes of detectable viremia (P<0.0001). CONCLUSIONS: Both frequency and magnitude of episodes of detectable viremia had effect on CD4+ T-cells. Strict adherence to a treatment goal of undetectable HIV viremia in children is likely to be beneficial.

The DNA Polymerase Gamma R953C Mutant Is Associated with Antiretroviral Therapy-Induced Mitochondrial Toxicity.

We found a heterozygous C2857T mutation (R953C) in polymerase gamma (Pol-γ) in an HIV-infected patient with mitochondrial toxicity. The R953C Pol-γ mutant binding affinity for dCTP is 8-fold less than that of the wild type. The R953C mutant shows a 4-fold decrease in discrimination of analog nucleotides relative to the wild type. R953 is located on the "O-helix" that forms the substrate deoxynucleoside triphosphate (dNTP) binding site; the interactions of R953 with E1056 and Y986 may stabilize the O-helix and affect polymerase activity.

Domestic Violence Enhanced Perinatal Home Visits: The DOVE Randomized Clinical Trial.

BACKGROUND: Perinatal intimate partner violence (IPV) is common and has significant negative health outcomes for mothers and infants. This study evaluated the effectiveness of an IPV intervention in reducing violence among abused women in perinatal home visiting programs. MATERIALS AND METHODS: This assessor-blinded multisite randomized control trial of 239 women experiencing perinatal IPV was conducted from 2006 to 2012 in U.S. urban and rural settings. The Domestic Violence Enhanced Home Visitation Program (DOVE) intervention group (n = 124) received a structured abuse assessment and six home visitor-delivered empowerment sessions integrated into home visits. All participants were screened for IPV and referred appropriately. IPV was measured by the Conflicts Tactics Scale2 at baseline through 24 months postpartum. RESULTS: There was a significant decrease in IPV over time (F = 114.23; p < 0.001) from baseline to 1, 3, 6, 12, 18, and 24 months postpartum (all p < 0.001). Additional models examining change in IPV from baseline indicated a significant treatment effect (F = 6.45; p < 0.01). Women in the DOVE treatment group reported a larger mean decrease in IPV scores from baseline compared to women in the usual care group (mean decline 40.82 vs. 35.87). All models accounted for age and maternal depression as covariates. CONCLUSIONS: The DOVE intervention was effective in decreasing IPV and is brief, thereby facilitating its incorporation within well-woman and well-child care visits, as well as home visiting programs, while satisfying recommendations set forth in the Affordable Care Act for IPV screening and brief counseling.

Comparison of abuse experiences of rural and urban African American women during perinatal period.

A subsample of 12 African American women (6 urban and 6 rural) were selected from a larger longitudinal, randomized control trial, Domestic Violence Enhanced Home Visitation (DOVE-R01 900903 National Institute of Nursing Research [NINR]/National Institutes of Health [NIH]). All African American women were chosen to control for any racial- and/or race-related cultural differences that may exist among women across geographical areas. The experiences of abuse during the perinatal period are drawn from in-depth interviews conducted at five points in time during pregnancy and the post-partum period. The analysis describes three major themes that highlight the similarities and differences among rural and urban women. The main themes found were (1) types of abuse, (2) location of abuse, and (3) response to abuse. In addition, two sub-themes (a) defiance and compliance and (b) role of children were also identified. Implications for universal screening for women of reproductive age, safer gun laws, and the need for further research are discussed.

Factors associated with disease severity in children with bronchiolitis.

OBJECTIVE: Bronchiolitis is one of the top causes of hospitalization of infants in the United States. Several clinical factors have been associated with hospitalization; however, few studies have examined factors related to severe disease. Our goal was to describe the clinical characteristics and hospital course of children admitted with bronchiolitis and to identify factors related to intensive care unit (ICU) admission in this population. METHODS: We conducted a retrospective review of all children less than 2 years of age admitted to a children's hospital with bronchiolitis between July 2008 and July 2011. Demographic and clinical data were collected including information regarding hospital course, treatments received and respiratory pathogens. RESULTS: During the study period, 734 children were admitted to the hospital with bronchiolitis, 22% of whom were admitted to the ICU and 10% of whom were intubated and mechanically ventilated. Admission to the ICU was associated with younger age [110 (45-210) days versus 69 (35-149) days, p < 0.001] and history of premature birth (OR 1.7, 95% CI 1.1-2.4, p = 0.01), but not with race or ethnicity. The use of respiratory treatments was common in the children admitted to the ICU but was not associated with shortened durations of hospitalization. In addition, neither prematurity nor young age were associated with either increased duration of hospitalization or with increased likelihood of mechanical ventilation. CONCLUSIONS: During acute bronchiolitis infections, younger children and those with a history of prematurity were more likely to be admitted to the ICU with severe disease.

Engaging and retaining abused women in perinatal home visitation programs.

OBJECTIVES: Intimate partner violence (IPV) during pregnancy affects 0.9% to 17% of women and affects maternal health significantly. The impact of IPV extends to the health of children, including an increased risk of complications during pregnancy and the neonatal period, mental health problems, and cognitive delays. Despite substantial sequelae, there is limited research substantiating best practices for engaging and retaining high-risk families in perinatal home visiting (HV) programs, which have been shown to improve infant development and reduce maltreatment. METHODS: The Domestic Violence Enhanced Home Visitation Program (DOVE) is a multistate longitudinal study testing the effectiveness of a structured IPV intervention integrated into health department perinatal HV programs. The DOVE intervention, based on an empowerment model, combined 2 evidence-based interventions: a 10-minute brochure-based IPV intervention and nurse home visitation. RESULTS: Across all sites, 689 referrals were received from participating health departments. A total of 339 abused pregnant women were eligible for randomization; 42 women refused, and 239 women were randomly assigned (124 DOVE; 115 usual care), resulting in a 71% recruitment rate. Retention rates from baseline included 93% at delivery, 80% at 3 months, 76% at 6 months, and 72% at 12 months. CONCLUSIONS: Challenges for HV programs include identifying and retaining abused pregnant women in their programs. DOVE strategies for engaging and retaining abused pregnant women should be integrated into HV programs' federal government mandates for the appropriate identification and intervention of women and children exposed to IPV.