Trauma-Informed Care.

Most children will experience some type of trauma during childhood, and many children suffer from significant adversities. Research in genetics, neuroscience, and epidemiology all provide evidence that these experiences have effects at the molecular, cellular, and organ level, with consequences on physical, emotional, developmental, and behavioral health across the life span. Trauma-informed care translates that science to inform and improve pediatric care and outcomes. To practically address trauma and promote resilience, pediatric clinicians need tools to assess childhood trauma and adversity experiences as well as practical guidance, resources, and interventions. In this clinical report, we summarize current, practical advice for rendering trauma-informed care across varied medical settings.

Resolving two Haploembia (Embioptera: Oligotomidae) cryptic species: molecular data confirms parthenogenetic females can be distinguished by their antisocial behavior.

The names of two cryptic species of Haploembia found in California are resolved and methods for identification are summarized. Molecular data of the Histone III subunit was used to evaluate color and behavior as species identifiers, confirming that antisocial behavior is a good identifier for the parthenogenetic species (Haploembia tarsalis), whereas the more variable coloration patterns were helpful, but less so. A genome size ratio of 1.44 between the parthenogenetic H. tarsalis and the sexually reproducing H. solieri was observed, along with higher genetic variation within the asexual lineage. This, and the identification of what appears to be a putative hybrid, contributes to current work examining mutation rates and selective pressures on genome size in parthenogenetic populations.

Perceptions of medical malpractice and medical malpractice reform among first- and fourth-year medical students.

OBJECTIVES: Comparison of first- and fourth-year medical student perceptions of the U.S. medical malpractice system and their disposition toward reform, and examination of the relationship between school year and other potential correlates of these perceptions. METHODS: Data derived from 109 students at Brown Medical School who responded to a 2006 web-based survey of attitudes and background characteristics. We report student perceptions stratified by medical school year. We use Mann-Whitney U and chi2 tests to examine the correlates of perceptions and linear regression to examine these in a multivariate context. RESULTS: There were no significant differences in the dispositions of first- and fourth-year students toward the current system (p> or =0.05). However, fourth-year students were more likely to favor screening panels for malpractice cases (82.2% vs. 70.4%) and capping pain and suffering damages (68.9% vs. 55.2%) (both p<0.05). Multivariate results reveal greater concern about malpractice among students intending to specialize in high-risk areas (both p<0.001). Bivariate results reveal greater concern among students with lawyer relatives (p<0.05). CONCLUSIONS: First- and fourth-year students had overwhelmingly negative perceptions of the medical malpractice system. This implies attitudes toward malpractice are formed before medical school, with intended specialty and other background characteristics more negatively influencing students' views.

Compliance in Rhode Island emergency departments with American Academy of Pediatrics recommendations for adolescent sexual assaults.

OBJECTIVES: We assessed the offering of American Academy of Pediatrics-recommended tests and prophylaxes after sexual assault to adolescents who presented to Rhode Island emergency departments for 3 categories of sexual exposures: sexual assault, consensual sex, and suspected sexual abuse. PATIENTS AND METHODS: This study entailed a retrospective review of visits for adolescent sexual exposures across 11 Rhode Island emergency departments between January 1995 and June 2001. Cases were identified through billing codes. Offering of each test and prophylaxis was compared by gender, category of sexual exposure, and type of sexual assault. Multivariable linear regression models were used to identify factors associated with the offering of a greater number of tests and prophylaxes after sexual assault. RESULTS: The vast majority of emergency department visits for adolescent sexual exposures were by sexually assaulted girls (82.5%). Across the 3 sexual exposure categories, girls were offered tests and prophylaxes more often than boys (eg, chlamydia or gonorrhea testing and prophylaxis). Among sexually assaulted adolescents, 32.8% of girls and no boys were offered all recommended tests and prophylaxes. The multivariable linear regression found that vaginally and/or anally assaulted girls were offered, on average, 2.5 more tests and prophylaxes than patients with other types of sexual assaults. Girls presenting for care at the state's women's health care specialty hospital emergency departments were offered 1.7 more tests and prophylaxes than those evaluated in general hospital emergency departments. CONCLUSIONS: Many adolescents did not receive American Academy of Pediatrics-recommended tests and prophylaxes after sexual assault. Boys received fewer tests than girls. Testing and prophylaxis varied by type of emergency department. Efforts are needed to improve and standardize emergency department medical management of adolescent sexual exposures.