Institutional Betrayal in the Criminal and Civil Legal Systems: Exploratory Factor Analysis with a Sample of Black and Hispanic Survivors of Intimate Partner Violence.

Institutional betrayal (IB) is well-documented among survivors of gender-based violence seeking help and/or reporting incidents of violence in various settings, including college campuses and health care settings. Two of the most common institutions from which survivors seek help are the criminal and civil legal systems; however, less is known about the experiences of IB among survivors interfacing with those systems. Previous studies exploring IB have implemented the Institutional Betrayal Questionnaire (IBQ) and its various adaptations, but this scale has not yet been analyzed in the criminal or civil legal context, nor has it been analyzed among racially marginalized survivors. This paper explores the potential for utilizing the IBQ-Health among a sample of 199 Black and Hispanic survivors of intimate partner violence (IPV) who sought help from the criminal and/or civil legal system(s). An exploratory factor analysis was conducted to explore the fit of the measure to the data. Results suggest that the measure as it has previously been used does not demonstrate strong reliability or fit with this population or institution. Possible explanations and future directions are explored, including support for developing and piloting a new measure to assess IB among Black and Hispanic survivors of interpersonal violence who are seeking help from criminal and civil legal institutions.

Cardiorespiratory physiology and swimming capacity of Atlantic salmon (Salmo salar) at cold temperatures.

We investigated how acclimation to 8, 4 and 1°C, and acute cooling from 8  to 1°C, affected the Atlantic salmon's aerobic and anaerobic metabolism, and cardiac function, during a critical swim speed (Ucrit) test. This study revealed several interesting temperature-dependent effects. First, while differences in resting heart rate (fH) between groups were predictable based on previous research (range ∼28-65 beats  min-1), with values for 1°C-acclimated fish slightly higher than those of acutely exposed conspecifics, the resting cardiac output () of 1°C-acclimated fish was much lower and compensated for by a higher resting blood oxygen extraction (MO2/). In contrast, the acutely exposed fish had a ∼2-fold greater resting stroke volume (VS) compared with that of the other groups. Second, increases in fH (1.2- to 1.4-fold) contributed little to during the Ucrit test, and the contributions of (VS) versus MO2/ to aerobic scope (AS) were very different in the two groups tested at 1°C (1°C-acclimated and 8-1°C fish). Finally, Ucrit was 2.08 and 1.69 body lengths (BL) s-1 in the 8 and 4°C-acclimated groups, but only 1.27 and 1.44 BL s-1 in the 1°C-acclimated and 8-1°C fish, respectively - this lower value in 1°C versus 8-1°C fish despite higher values for maximum metabolic rate and AS. These data: support recent studies which suggest that the capacity to increase fH is constrained at low temperatures; show that cardiorespiratory function at cold temperatures, and its response to increased demands, depends on exposure duration; and suggest that AS does not constrain swimming capacity in salmon when chronically exposed to temperatures approaching their lower limit.

Crying Wolf: A Qualitative Review of Misinformation and Conspiracy Theories in Lupus Erythematosus.

BACKGROUND: Lupus comprises a complex group of inflammatory disorders including cutaneous lupus erythematosus (CLE) and systemic lupus erythematosus (SLE). The issue of health misinformation is increasingly problematic, although the content of misinformation related to lupus available online has not been deeply explored. This study aimed to qualitatively assess the type of misinformation related to lupus available online. METHODS: A literature search on PubMed was conducted, using search terms "cutaneous lupus" OR "discoid lupus" OR "lupus" AND "misinformation" OR "conspiracy" OR "disinformation." Further searches were also performed on Google, YouTube, Twitter, Facebook, Instagram, and TikTok. RESULTS: Published literature describing lupus-related misinformation was minimal, with only three manuscripts identified. Conversely, a variety of points of misinformation were identified online and on social media. Key themes identified in online content included suggestion of incorrect causes such as infection or aspartame consumption, false risk assessments such as lupus never developing in males, false claims about conventional treatments, and promotion of alternative treatments or "cures" without evidence. CONCLUSION: Dermatologists, rheumatologists, and all clinicians treating patients with lupus play an essential role in dispelling the pervasive misinformation surrounding the disease and its treatments, encouraging patients to seek reliable sources of information, and advocating for evidence-based guidance.

Think zinc: Transient nutritional deficiency related to novel maternal SLC30A2 mutation potentially precipitated by antenatal proton pump inhibitor exposure.

A second-born breastfed infant presented with zinc deficiency. His mother had a novel heterozygous mutation in SLC30A2. A previous baby did not have zinc deficiency but the mother had taken a proton pump inhibitor (PPI) during the second pregnancy. Antenatal PPI exposure may plausibly contribute to transient infantile zinc deficiency.

Dermatology mycology diagnostics in Ireland: National deficits identified in 2022 that are relevant internationally.

BACKGROUND: Conventional testing methods for dermatophytes are time-consuming, and resource limitations in our institution have prompted curtailed access to these diagnostics. OBJECTIVES: Evaluation of our hospital's dermatological mycology diagnostic services and similar services nationally. METHODS: This was a retrospective observational study on skin, hair and nail mycology samples in our institution comparing twenty five-year periods (2011-2015 and 2016-2021), including analysis of dermatology clinic data and correspondence related to fungal infection. A survey of national public hospitals' laboratories was conducted to evaluate their mycology testing capabilities. RESULTS: The total 5 year test count prior to curtailment was 4851 specimens comprising 90% (n = 4344) from general practice and 6% (n = 290) from dermatology clinics. For the 5 years post curtailment, 64.5% (582/903) of specimens were from dermatology clinics. Dermatology clinic data demonstrated doubling of attendances (for all conditions) and of correspondence related to fungal infection. During this time also, national dermatological antifungal purchasing increased 11%. Ten of 28 Irish public hospital laboratories reported the provision of in-house dermatological mycology testing, and none had routine availability of susceptibility or molecular testing of dermatophytes. CONCLUSION: This study is the first to report an appraisal of dermatological fungal diagnostic services in Ireland. Insufficient testing capacity implies that patients are either being treated for fungal infection without appropriate diagnostic confirmation, or being left untreated because of the lack of access to diagnostics. The introduction of molecular detection methods and susceptibility systems would enhance testing capabilities and reduce the requirement for the external referral.

Cot-side imaging of functional connectivity in the developing brain during sleep using wearable high-density diffuse optical tomography.

Studies of cortical function in newborn infants in clinical settings are extremely challenging to undertake with traditional neuroimaging approaches. Partly in response to this challenge, functional near-infrared spectroscopy (fNIRS) has become an increasingly common clinical research tool but has significant limitations including a low spatial resolution and poor depth specificity. Moreover, the bulky optical fibres required in traditional fNIRS approaches present significant mechanical challenges, particularly for the study of vulnerable newborn infants. A new generation of wearable, modular, high-density diffuse optical tomography (HD-DOT) technologies has recently emerged that overcomes many of the limitations of traditional, fibre-based and low-density fNIRS measurements. Driven by the development of this new technology, we have undertaken the first cot-side study of newborn infants using wearable HD-DOT in a clinical setting. We use this technology to study functional brain connectivity (FC) in newborn infants during sleep and assess the effect of neonatal sleep states, active sleep (AS) and quiet sleep (QS), on resting state FC. Our results demonstrate that it is now possible to obtain high-quality functional images of the neonatal brain in the clinical setting with few constraints. Our results also suggest that sleep states differentially affect FC in the neonatal brain, consistent with prior reports.

Epidemiology of dermatomycoses and onychomycoses in Ireland (2001-2020): A single-institution review.

BACKGROUND: Fungal skin infections are recognised as one of the most common health disorders globally, and dermatophyte infections of the skin, hair and nails are the most common fungal infections. Dermatophytes can be classified as anthropophilic, zoophilic or geophilic species based on their primary habitat association, and this classification makes epidemiological analysis useful for the prevention and control of these infections. The Irish contribution to the epidemiology of these infections has been scant, with just two papers (both reporting paediatric tinea capitis only) published in the last 20 years, and none in the last seven. OBJECTIVES: To perform a comprehensive retrospective epidemiological analysis of all dermatological mycology tests performed in University Hospital Limerick over a 20-year period. METHODS: All mycology laboratory test results were extracted from the Laboratory Information Management System (LIMS, iLab, DXC Technologies) from 2001 to 2020 inclusive for analysis. Specimen types were categorised according to the site of sampling. The data were analysed using Microsoft Excel. RESULTS: About 12,951 specimens of skin, hair and nails were studied. Median patient age was 42 years (IQR 26-57) with a slight female preponderance (57.2%). Two thirds of samples (67%, n = 8633) were nail, 32% were skin scrapings (n = 4118) and 200 hair samples (1.5%) were received. Zoophilic dermatophytes were more commonly present in females (38% F, 23% M, proportion of dermatophytes) and in those under 10 years of age or from 45 to 70 years (36% and 34% zoophiles, respectively, proportion of dermatophytes), although anthropophiles predominated every age and gender category. Anthropophiles had their highest prevalence in the 10-20 years age category (80% anthropophiles, proportion of dermatophytes), and yeast infections were more prevalent in older patients (29% of >60 year olds vs. 17% of <60 year olds, proportion of all fungal positives). Trichophyton rubrum was the most prevalent pathogen detected, accounting for 53% of all dermatophytes detected, 61% of those detected from nail samples and 34% from skin and hair samples. Trichophyton tonsurans was the most prevalent dermatophyte in tinea capitis, accounting for 37% of dermatophytes detected. Both of these organisms are anthropophilic, and this group showed consistently increased prevalence in proportion to all fungal isolates. The proportion of this dermatophyte class (anthropophiles) increased among both nail samples and skin/hair samples during the study period, from 55% of samples in the first 5 years of the study (2001-2005) to 88% (proportion of dermatophytes) in the final 5 years. Conversely, yeast detection decreased. CONCLUSIONS: This study provides a detailed overview of the epidemiology of the fungal cultures of skin, nail and hair samples in the Mid-West of Ireland over a 20-year period. Monitoring this changing landscape is important in identifying likely sources of infections, to identifying potential outbreaks, and may help guide empiric treatment. To the best of our knowledge, this study provides the first detailed analysis from Ireland of fungal detections from skin, hair and nail samples, and is the first epidemiological fungal report of any kind in over 7 years.

A blistering eruption of the head and neck in an 18-year-old.

An 18-year-old presented with an atypical blistering eruption. Direct immunofluorescence microscopy of perilesional skin showed strong linear deposition of IgG and C3 at the dermoepidermal junction. Her presentation was unusual and posed a diagnostic challenge, as this condition is very rare in this age group.

Tinea capitis with multiple isolates: The interaction of nature, animal and child.

Tinea capitis is an infection of the scalp and hair commonly seen in the pediatric population. Detection of multiple dermatophytes is unusual, and true mixed infections have been rarely reported. Herein, we describe an 8-year-old girl with tinea capitis revealing three different dermatophyte isolates that highlight the clinical challenge posed by this phenomenon.

Mapping the prevalence of severe acute malnutrition in Papua, Indonesia by using geostatistical models.

BACKGROUND: Severe acute malnutrition (SAM) is the most life-threatening form of malnutrition, and in 2019, approximately 14.3 million children under the age of 5 were considered to have SAM. The prevalence of child malnutrition is recorded through large-scale household surveys run at multi-year intervals. However, these surveys are expensive, yield estimates with high levels of aggregation, are run over large time intervals, and may show gaps in area coverage. Geospatial modelling approaches could address some of these challenges by combining geo-located survey data with geospatial data to produce mapped estimates that predict malnutrition risk in both surveyed and non-surveyed areas. METHODS: A secondary analysis of cluster-level program evaluation data (n = 123 primary sampling units) was performed to map severe acute malnutrition (SAM) in Papuan children under 2 years (0-23 months) of age with a spatial resolution of 1 × 1 km in Papua, Indonesia. The approach used Bayesian geostatistical modelling techniques and publicly available geospatial data layers. RESULTS: In Papua, Indonesia, SAM was predicted in geostatistical models by using six geospatial covariates related primarily to conditions of remoteness and inaccessibility. The predicted 1-km spatial resolution maps of SAM showed substantial spatial variation across the province. By combining the predicted rates of SAM with estimates of the population under 2 years of age, the prevalence of SAM in late 2018 was estimated to be around 15,000 children (95% CI 10,209-26,252). Further tests of the predicted levels suggested that in most areas of Papua, more than 5% of Papuan children under 2 years of age had SAM, while three districts likely had more than 15% of children with SAM. CONCLUSIONS: Eradication of hunger and malnutrition remains a key development goal, and more spatially detailed data can guide efficient intervention strategies. The application of additional household survey datasets in geostatistical models is one way to improve the monitoring and timely estimation of populations at risk of malnutrition. Importantly, geospatial mapping can yield insights for both surveyed and non-surveyed areas and can be applied in low-income country contexts where data is scarce and data collection is expensive or regions are inaccessible.

Systemic evaluation of cutaneous sarcoidosis: 15-year dermatology experience at University Hospital Limerick.

Sarcoidosis is a multisystem granulomatous disease that can affect almost any organ including the skin, liver, ocular, cardiac, renal, nervous, musculoskeletal and endocrine systems. Systemic evaluation is indicated in all patients diagnosed with cutaneous sarcoidosis, as it is associated with asymptomatic systemic disease in 30%-40% of patients. Guidelines recommend that patients diagnosed with sarcoidosis undergo baseline and surveillance investigations including full blood count (FBC), renal and liver profile, Vitamin D, serum calcium, electrocardiography (ECG), chest radiography, pulmonary function tests (PFTs) and ophthalmology examination to assess for systemic involvement. Recommendations for surveillance monitoring vary on interval duration but include regular FBC, biochemistry, chest radiography and PFTs, with additional investigations and prompt referral to respective specialties as indicated.. We conducted a retrospective analysis to evaluate extracutaneous involvement and systemic evaluation of patients diagnosed with cutaneous sarcoidosis during the period 2004-2020, and compared our findings with international guidelines. Cutaneous manifestation was the primary presentation for 67% of the patients (12 of 18), an extracutaneous disease subsequently developed in 67% (8 of 12) of these patients. Baseline investigations included chest radiography (94%; 17 of 18), PFTs (39%; 7 of 18), FBC (94% (17 of 18), renal profile (89%; 16 of 18), liver function tests (83%; 15 of 18) and serum calcium (89%; 16 of 18); ECG was performed for 4 (25%) of 16 patients. No Vitamin D levels were recorded. Specialist referral was required for 89% (16 of 18); of these 16 patients, 94% (15 of 16) required referral to the Respiratory Medicine department, 69% (11 of 16) to Ophthalmology and 19% (3 of 16) to Nephrology. The results highlight the importance of a structured protocol for the systemic evaluation of patients diagnosed with cutaneous sarcoidosis. We subsequently developed a baseline and surveillance protocol for the assessment of extracutaneous disease in patients at University Hospital Limerick.

Metastatic melanoma in the Mid-West of Ireland: a retrospective review.

BACKGROUND: Melanoma is the fifth most common invasive cancer in Ireland, and incidence is increasing. Metastatic melanoma has been associated with poor overall survival historically. New systemic anti-cancer treatment (SACT) options for advanced melanoma have emerged in the last decade, and outcomes are improving. AIMS: The aim of our study was to assess the incidence and clinicopathological features of metastatic melanoma in our centre, and subsequent treatment with SACT. METHODS: We analysed retrospectively patients with metastatic melanoma in the Mid-West of Ireland, over a 6-year period (2014-2019). RESULTS: In 6 years, a total of 620 patients were diagnosed with melanoma, 28 (5%) had metastatic or unresectable disease at diagnosis. Mean age at primary diagnosis was 64.5 years (range 24-90 years) and 20 (71%) were male. Median Breslow depth was 4.3 mm (mean 5.5 mm, SD ± 4.4 mm). Thirteen patients (46%) had metastases at initial presentation. Fifteen (53%) received systemic treatment in the regional cancer centre. Of 13 who did not have systemic treatment, 8 had radiological and clinical surveillance, 3 declined further treatment or surveillance and 2 were lost to follow-up. Eleven patients died from the disease with median overall survival of 1.5 years (SD ± 1.3 years). CONCLUSION: Patients with metastatic melanoma commonly had metastases at the time of first presentation. Just over half of patients with metastatic melanoma received SACT. Early detection of melanoma is key. Further research on factors involved in late presentation, and those precluding systemic treatment, may contribute to improved outcomes in advanced melanoma.

Patient experience and satisfaction with remote memory assessment: Responding to clinical need in times of COVID-19 restrictions.

BACKGROUND: The suspension of memory services during the COVID-19 pandemic delayed dementia diagnosis and access to early intervention. Some services responded to the challenge by developing a remote memory assessment pathway to comply with reduced social contact measures to protect vulnerable patients. The aim of the study was to establish whether remote model is considered a satisfactory experience within the context of the COVID-19 pandemic and to understand the factors associated with patient and carer satisfaction of remote pathway. METHOD: 73 participants recruited from patients referred to memory clinic in West Sussex, who were assessed over a video or telephone. Participants completed an 11-item questionnaire capturing satisfaction across a range of elements, contextual items (the impact of the pandemic, loneliness, previous experience of using teleconference technology and diagnosis), as well as 3 dimensions from Patient Experience Questionnaire. Descriptive statistics are reported at a whole sample level, separated by patient and carer status. A hypothesis driven set of bivariate analyses (Spearman's rank) was used to understand the association between overall satisfaction and key independent factors across the whole sample. RESULTS: 73 participants were typically older adults (M=68.5, SD=13.3) and female (n=40, 54.8%). The patient was more likely to be older, feel lonely within the past week and to have used video call software when compared to the carer (p> 0.05). Participants were generally satisfied with the remote pathway with 95.8% (n=69) agreeing or strongly agreeing with the statement "Overall, I was satisfied with the assessment". Patients and carers did not significantly differ on any satisfaction response, apart from the ease of use of technology, in which carers were more likely to find the technology easy to use (U= 432.5; p=0.01). Worry about contracting COVID and communication experience was positively associated with overall satisfaction, whilst perceived communication barriers were significantly negatively associated with overall satisfaction. CONCLUSIONS: Remote memory assessment was a positive and satisfactory experience for most patient and carers. The remote pathway should be considered as an option available during and beyond the pandemic to improve access and patient choice of assessment modality.

Attending to the intersectionality and saliency of clients' identities: A further investigation of therapists' multicultural orientation.

Psychotherapy clients often hold multiple and varied cultural identities, and it is important for therapists to attend to the intersectionality of clients' cultural identities, as well as the saliency of these identities. However, to date, few studies have considered the saliency of clients' multiple identities and how this may impact clients' perceptions of cultural processes in therapy. Therefore, this study utilized polynomial regression and response surface analysis to operationalize and examine congruent and discrepant effects between the saliency of clients' multiple identities and their perceptions of their therapists' cultural humility and cultural missed opportunities. Data for this study consisted of 87 clients who received individual counseling services at either a university counseling center or training clinic at two large universities in the United States. As hypothesized, results indicated significant discrepant effects between the saliency of clients' first and second most important cultural identities and perceptions of their therapists' cultural humility and cultural missed opportunities. Specifically, clients' ratings of their therapist's cultural missed opportunities were lowest when they reported either a) high saliency of cultural identity one and low saliency of cultural identity two, or b) low saliency of cultural identity one and high saliency of cultural identity two. Similarly, clients' ratings of their therapist's cultural humility were highest when they reported either a) high saliency of cultural identity one and low saliency of cultural identity two, or b) low saliency of cultural identity one and high saliency of cultural identity two. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Virtue, flourishing, and positive psychology in psychotherapy: An overview and research prospectus.

Researchers have increasingly called for the examination of both mental health symptoms and well-being when providing and evaluating psychotherapy, and although symptoms and well-being are typically inversely related, these appear to be distinct constructs that may require distinct intervention strategies. Positive psychology interventions, virtue-based treatments, and psychotherapies explicitly focused on promoting well-being have emerged in response to, or perhaps in concert with, the calls for attention to symptoms and well-being. Our review of the relevant and vast research pockets revealed that these treatments demonstrated relative efficacy in promoting well-being, whereas evidence for relative efficacy when reducing symptoms was largely inconclusive, particularly in psychotherapy contexts. We organized our review around the virtue-ethics notion that growth in virtuousness fosters flourishing, with flourishing consisting of more than the absence of symptoms, and specifically, that flourishing also involves increased well-being. The lack of evidence for relative efficacy among active alternative treatment conditions in promoting flourishing may suggest equal effectiveness, and yet, this also suggests that there are yet-to-be-identified moderators and mechanisms of change and/or insufficient use of research designs and/or statistical procedures that could more clearly test this major tenet of the virtue-ethics tradition. Nevertheless, we know that evidence-based problem-focused psychotherapies are effective at reducing symptoms, and our review showed that positive psychology interventions, virtue-based treatments, and psychotherapies explicitly focused on well-being promote well-being and/or virtue development. We encourage researchers and psychotherapists to continue to integrate symptom reduction and well-being promotion into psychotherapy approaches aimed at fostering client flourishing. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Tractography of the corticospinal tracts in infants with focal perinatal injury: comparison with normal controls and to motor development.

INTRODUCTION: Our aims were to (1) assess the corticospinal tracts (CSTs) in infants with focal injury and healthy term controls using probabilistic tractography and (2) to correlate the conventional magnetic resonance imaging (MRI) and tractography findings in infants with focal injury with their later motor function. METHODS: We studied 20 infants with focal lesions and 23 controls using MRI and diffusion tensor imaging. Tract volume, fractional anisotropy (FA), apparent diffusion coefficient (ADC) values, axial diffusivity and radial diffusivity (RD) of the CSTs were determined. Asymmetry indices (AIs) were calculated by comparing ipsilateral to contralateral CSTs. Motor outcome was assessed using a standardized neurological examination. RESULTS: Conventional MRI was able to predict normal motor development (n = 9) or hemiplegia (n = 6). In children who developed a mild motor asymmetry (n = 5), conventional MRI predicted a hemiplegia in two and normal motor development in three infants. The AIs for tract volume, FA, ADC and RD showed a significant difference between controls and infants who developed a hemiplegia, and RD also showed a significant difference in AI between controls and infants who developed a mild asymmetry. CONCLUSION: Conventional MRI was able to predict subsequent normal motor development or hemiplegia following focal injury in newborn infants. Measures of RD obtained from diffusion tractography may offer additional information for predicting a subsequent asymmetry in motor function.

Tract-based spatial statistics of magnetic resonance images to assess disease and treatment effects in perinatal asphyxial encephalopathy.

Biomarkers are required for efficient trials of neuroprotective interventions after perinatal asphyxia. This study aimed to determine whether diffusion tensor imaging (DTI) analyzed by tract-based spatial statistics (TBSS) may be a suitable biomarker of disease and treatment effects after perinatal asphyxia in small groups of patients. We performed TBSS from DTI obtained at 3 T from eight healthy control infants, 10 untreated and 10 hypothermia-treated infants with neonatal encephalopathy. Median (range) postnatal age at scan was 1 d (1-21) in the healthy infants, 6 d (4-20) in the cooled, and 7 d (4-18) in noncooled infants. Compared with the control group, fractional anisotropy (FA) was significantly reduced not only in several white matter tracts in the noncooled infants but also in the internal capsule in the cooled group. Noncooled infants had significantly lower FA than the cooled treated infants, indicating more extensive damage, in the anterior and posterior limbs of the internal capsule, the corpus callosum, and optic radiations. We conclude that perinatal hypoxic ischemic encephalopathy is associated with widespread white matter abnormalities that are reduced by moderate hypothermia. DTI analyzed by TBSS detects this treatment effect and is therefore a qualified biomarker for the early evaluation of neuroprotective interventions.