Identification and Incidence of Child Maltreatment During the COVID-19 Pandemic.

The coronavirus disease 2019 (COVID-19) pandemic has raised serious concerns about child maltreatment, which is known to increase in frequency and severity during times of high stress. The present study used diverse datasets to concurrently examine changes in identification and medical evaluation of maltreatment allegations from before to during COVID-19. Four sources of data were collected from two counties for the months of March-December in 2019 and 2020, including reports to social services and child maltreatment evaluation clinic medical evaluations (CMECs). The number of reports, number of children reported, and rate of children reported were used to evaluate identification. Incidence was estimated based on the number of medical evaluations conducted at the CMECs. Maltreatment type, reporter type, and child demographics were also considered. Across both counties, there were significantly fewer reports and reported children in 2020 compared to 2019, signifying decreased identification of suspected maltreatment cases. This was especially true in spring and fall when children are typically in school. Across both counties, the proportion of children reported to the county that received medical evaluations was higher in 2020 compared to 2019. This suggests that the pandemic was related to an increase in the occurrence maltreatment serious enough to warrant medical evaluations, or perhaps in the relative number of serious cases identified. Findings show divergent trends in reporting and evaluation of suspected maltreatment cases from before to during COVID-19. Identification and service delivery methods need creative solutions to adapt to changing environments. Medical, social, and legal systems need to prepare for increases in families seeking services as pandemic-related restrictions are lifted.

STRIDER NZAus: a multicentre randomised controlled trial of sildenafil therapy in early-onset fetal growth restriction.

OBJECTIVE: To assess the effect of maternal sildenafil therapy on fetal growth in pregnancies with early-onset fetal growth restriction. DESIGN: A randomised placebo-controlled trial. SETTING: Thirteen maternal-fetal medicine units across New Zealand and Australia. POPULATION: Women with singleton pregnancies affected by fetal growth restriction at 22+0 to 29+6 weeks. METHODS: Women were randomised to oral administration of 25 mg sildenafil citrate or visually matching placebo three times daily until 32+0 weeks, birth or fetal death (whichever occurred first). MAIN OUTCOME MEASURES: The primary outcome was the proportion of pregnancies with an increase in fetal growth velocity. Secondary outcomes included live birth, survival to hospital discharge free of major neonatal morbidity and pre-eclampsia. RESULTS: Sildenafil did not affect the proportion of pregnancies with an increase in fetal growth velocity; 32/61 (52.5%) sildenafil-treated, 39/57 (68.4%) placebo-treated [adjusted odds ratio (OR) 0.49, 95% CI 0.23-1.05] and had no effect on abdominal circumference Z-scores (P = 0.61). Sildenafil use was associated with a lower mean uterine artery pulsatility index after 48 hours of treatment (1.56 versus 1.81; P = 0.02). The live birth rate was 56/63 (88.9%) for sildenafil-treated and 47/59 (79.7%) for placebo-treated (adjusted OR 2.50, 95% CI 0.80-7.79); survival to hospital discharge free of major neonatal morbidity was 42/63 (66.7%) for sildenafil-treated and 33/59 (55.9%) for placebo-treated (adjusted OR 1.93, 95% CI 0.84-4.45); and new-onset pre-eclampsia was 9/51 (17.7%) for sildenafil-treated and 14/55 (25.5%) for placebo-treated (OR 0.67, 95% CI 0.26-1.75). CONCLUSIONS: Maternal sildenafil use had no effect on fetal growth velocity. Prospectively planned meta-analyses will determine whether sildenafil exerts other effects on maternal and fetal/neonatal wellbeing. TWEETABLE ABSTRACT: Maternal sildenafil use has no beneficial effect on growth in early-onset FGR, but also no evidence of harm.

Upwelling intensification as part of the Pliocene-Pleistocene climate transition.

A deep-sea sediment core underlying the Benguela upwelling system off southwest Africa provides a continuous time series of sea surface temperature (SST) for the past 4.5 million years. Our results indicate that temperatures in the region have declined by about 10 degrees C since 3.2 million years ago. Records of paleoproductivity suggest that this cooling was associated with an increase in wind-driven upwelling tied to a shift from relatively stable global warmth during the mid-Pliocene to the high-amplitude glacial-interglacial cycles of the late Quaternary. These observations imply that Atlantic Ocean surface water circulation was radically different during the mid-Pliocene.

Paleo-Rock-Hosted Life on Earth and the Search on Mars: A Review and Strategy for Exploration.

Here we review published studies on the abundance and diversity of terrestrial rock-hosted life, the environments it inhabits, the evolution of its metabolisms, and its fossil biomarkers to provide guidance in the search for life on Mars. Key findings are (1) much terrestrial deep subsurface metabolic activity relies on abiotic energy-yielding fluxes and in situ abiotic and biotic recycling of metabolic waste products rather than on buried organic products of photosynthesis; (2) subsurface microbial cell concentrations are highest at interfaces with pronounced chemical redox gradients or permeability variations and do not correlate with bulk host rock organic carbon; (3) metabolic pathways for chemolithoautotrophic microorganisms evolved earlier in Earth's history than those of surface-dwelling phototrophic microorganisms; (4) the emergence of the former occurred at a time when Mars was habitable, whereas the emergence of the latter occurred at a time when the martian surface was not continually habitable; (5) the terrestrial rock record has biomarkers of subsurface life at least back hundreds of millions of years and likely to 3.45 Ga with several examples of excellent preservation in rock types that are quite different from those preserving the photosphere-supported biosphere. These findings suggest that rock-hosted life would have been more likely to emerge and be preserved in a martian context. Consequently, we outline a Mars exploration strategy that targets subsurface life and scales spatially, focusing initially on identifying rocks with evidence for groundwater flow and low-temperature mineralization, then identifying redox and permeability interfaces preserved within rock outcrops, and finally focusing on finding minerals associated with redox reactions and associated traces of carbon and diagnostic chemical and isotopic biosignatures. Using this strategy on Earth yields ancient rock-hosted life, preserved in the fossil record and confirmable via a suite of morphologic, organic, mineralogical, and isotopic fingerprints at micrometer scale. We expect an emphasis on rock-hosted life and this scale-dependent strategy to be crucial in the search for life on Mars.

Methane seep carbonates yield clumped isotope signatures out of equilibrium with formation temperatures.

Methane cold seep systems typically exhibit extensive buildups of authigenic carbonate minerals, resulting from local increases in alkalinity driven by methane oxidation. Here, we demonstrate that modern seep authigenic carbonates exhibit anomalously low clumped isotope values (Δ47), as much as ∼0.2‰ lower than expected values. In modern seeps, this range of disequilibrium translates into apparent temperatures that are always warmer than ambient temperatures, by up to 50 °C. We examine various mechanisms that may induce disequilibrium behaviour in modern seep carbonates, and suggest that the observed values result from several factors including kinetic isotopic effects during methane oxidation, mixing of inorganic carbon pools, pH effects and rapid precipitation. Ancient seep carbonates studied here also exhibit potential disequilibrium signals. Ultimately, these findings indicate the predominance of disequilibrium clumped isotope behaviour in modern cold seep carbonates that must be considered when characterizing environmental conditions in both modern and ancient cold seep settings.

Media and delivery systems.

Distention media are necessary for panoramic and operative hysteroscopy. The ability to see the uterine cavity and perform operative procedures under direct vision are the major advantages of hysteroscopy. The hysteroscopic surgeons' operative capacity is enhanced or restricted by the choice and effective use of distending media and their delivery systems.

Team triage improves emergency department efficiency.

OBJECTIVE: To see whether three hours of combined doctor and nurse triage would lead to earlier medical assessment and treatment and whether this benefit would carry on for the rest of the day when normal triage had resumed. METHOD: Eight days were randomly selected; four for team triage and four for the normal nurse led triage. Team triage was coordinated by a middle grade or consultant from 9 am to 12 noon. Times to triage, to see a doctor, radiology, admission, and discharge were recorded. No additional medical or nursing staff were used and staffing levels were similar each day. All patients including blue light emergencies and minor injuries were included. RESULTS: Median times were significantly reduced (p<0.05) during the intervention to triage (2 min v 7 min, p = 0. 029), to see a doctor (2 min v 32 min, p = 0.029), and to radiology (11.5 min v 44.5 min, p = 0.029). Waiting times at midday were longer for patients in the non-intervention group. More patients were seen and discharged within 20 minutes in the intervention group (18 of 95 (19%) v 2 of 69 (3%) p = 0.0043). No significant knock on effect was demonstrable for the remaining 21 hours after the intervention ceased. CONCLUSION: Three hours of combined doctor and nurse triage significantly reduces the time to medical assessment, radiology, and to discharge during the intervention period. Waiting times at midday were shorter in the triage group. There was no significant knock on effect the rest of the day.

Evaluation of patients for microsurgery.

PIP: Prior to undergoing conservative pelvic surgery for improvement of fertility, there must be meticulous preoperative evaluation. This evaluation involves a history, all previous records and operative reports, psychologic evaluation, physical examination, hysterosalpingogram, laparoscopy, and tests for male factor and ovulation. In history taking, the physician is most interested in past evidence of infection. The emotional status of the patient must be considered, especially for those individuals who are seeking sterilization reversal. Often, with a history of previous pelvic surgery the rate of success is lowered. Physical examination is usually not useful in predicting final outcome of microsurgery; however, it does determine the patient's general preoperative status. Hysterosalpingography and laparoscopy are complementary procedures which are the cornerstone of the preoperative evaluation. The 1st gives evidence of the status of the uterus and the tube proximal to the block, if 1 exists. If the block is in the isthmic portion, the hysterosalpingogram will indicate how much of the tube is patent next to the corpus. Preoperative laparoscopy is necessary for proper and complete evaluation of pelvic status; it allows the operator to visualize the distal segment of the tube. Laparoscopy indicates the extent of pelvic adhesion, ovary and tube involvement, mobility of the tube, extent of fimbrial involvement, and presence of disease. When all factors are taken are into consideration, the surgeon must determine whether the benefits of surgery will outweigh the risks. Patient age, emotional needs, other parameters of fertility, status of tubes and ovaries, etc. must all be taken into consideration.^ieng

Fluid mechanical stress and the platelet.

Platelet thrombi in suspensions stirred in an aggregometer or subjected to shear flow in a Couette viscometer or circular tube can only form as a result of collisions between the cells. In whole blood, the presence of the red cells results in pronounced lateral displacements of the paths of the platelets through the vessel, which in turn increases the frequency of collisions between platelets and also makes possible platelet-wall interactions. In addition, blood cells in a suspension undergoing shear flow are subjected to fluid stresses which can result in their deformation. Such stresses may locally attain high values in the arterial circulation at bifurcations, sharp bends and stenoses where the flow is disturbed. Since platelet thrombi have been found downstream of sites of such geometry, the effects of high and variable shear stress on the platelet release reaction and aggregation were investigated. Washed platelets containing C14-serotonin in Tyrodes-albumin solution were subjected to oscillatory flow at 37 degrees C and provided the time average wall velocity gradient was above 2,000 sec-1, the thrombin-induced release of serotonin was appreciably greater than in the corresponding controls incubated at rest. No measurable serotonin was released as a result of flow alone. This synergistic effect of oscillatory shear flow was also noted in the presence of inhibitors of the release reaction.

Interdisciplinary health care and female victims of domestic violence.

Female victims of domestic violence often face uncertainty in hospital emergency rooms. Victims may encounter physicians, nurses, social workers, and other health care providers who do not work collaboratively, have limited knowledge of domestic violence, and express negative attitudes. Hence, treatment outcomes may be negative. A retrospective case study of 153 medical records of female victims at two Midwestern hospital emergency medicine departments was completed. Findings suggest positive treatment outcome where interdisciplinary collaboration was evident. Included were more accurate assessments in terms of past history, more descriptive emotional symptoms displayed by victims, and written documentation of recommendations concerning intervention and linkage to community resources. Implications for policy and interdisciplinary training are discussed.

Temporal associations of human papillomavirus infection with cervical cytologic abnormalities.

The relationship between infection with different human papillomavirus types and cervical intraepithelial neoplasia was studied in a group of 398 women seen in a private gynecology practice in Washington, D.C. Each woman was assessed for human papillomavirus infection by Southern blot hybridization analysis of cervical cells obtained by swab. The human papillomavirus results were correlated with the results of Papanicolaou smears taken the same day and with data abstracted from medical records regarding past cervical disease. Subjects with normal cytologic findings at the time of human papillomavirus testing were followed up for an average of 2 to 3 years with additional Papanicolaou smears. At the time of human papillomavirus testing, 58% (19/33) of women with cervical intraepithelial neoplasia had detectable human papillomavirus deoxyribonucleic acid in contrast to 10% (28/289) of women with normal cytologic findings (p less than 0.001). This association persisted after statistical adjustment for age and current use of oral contraceptives, a factor that appeared to increase the detection of human papillomavirus. Among women with no current cytologic evidence of neoplasia, human papillomavirus detection was more likely in those with a history of past genital neoplasia (p = 0.05). In the follow-up study, 15% (3 of 20) of cytologically normal women who were human papillomavirus-positive at baseline subsequently exhibited cervical cells suggestive of cervical intraepithelial neoplasia compared with only 5% (9 of 195) of human papillomavirus-negative women. However, this difference reflected recurrent and not incident neoplasia.