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Abstract Human trafficking is a public health issue affecting homeless young adults across the United States; however, screening tools for trafficking specifically for this population are lengthy and onerous. The aim of this study was to develop a sensitive, brief, and user-friendly trafficking screening tool for homeless young adults. Five candidate items for the screening tool were identified from the Vera Institute's Trafficking Victim Identification Tool (TVIT). Study participants were asked the five candidate items, and then received a trafficking assessment using the Human Trafficking Identification and Measurement (HTIAM-14), which is validated for the homeless youth population. A multivariable logistic model was used to analyze the five candidate items in relation to a trafficking experience on the longer HTIAM-14. Homeless people, aged 18 to 22 years old, receiving support from Covenant House New Jersey were eligible to participate in the study. Over 15 months in 2015–2017, 340 trafficking assessments were performed for 307 participants; 8.8% (30) of the assessments revealed a human trafficking experience. Of assessments identifying a trafficking experience, 66.7% (20) found sex trafficking and 46.7% (14) labor trafficking, with 16.7% (5) demonstrating both forms of trafficking. We validated a new screening tool, Quick Youth Indicators for Trafficking (QYIT). QYIT allows providers to screen for trafficking among homeless young adults; an affirmative answer to at least one QYIT question is 86.7% sensitive and 76.5% specific in identifying a trafficking experience. QYIT is the first highly sensitive, comprehensive trafficking screening tool that is truly brief and does not require a trafficking expert to administer. Use of QYIT at appropriate agencies will enable social service providers to systematically detect and serve homeless young adults who have labor and/or sex trafficking experiences. Highlights • QYIT is a validated screening tool for identification of labor and/or sex trafficking among homeless young adults in service provision settings. • Labor trafficking is an important and significant form of trafficking experienced by homeless young adults. • Homeless young adults who have survived trafficking may have different needs from other, non-trafficked homeless young adults. [ABSTRACT FROM AUTHOR]

Purpose To explore the factors that differentiate trafficked homeless youth from not-trafficked homeless youth. Methods From November 2015–February 2017, homeless youth served by Covenant House New Jersey, aged 18–22, received a trafficking assessment. Youth were stratified based upon trafficking experience, and their responses to demographic and social history questions were examined for association with trafficking occurrence. Results Of 344 participants, 9.6% had a trafficking experience. Having an Individualized Education Program/504 plan was, for the first time in anti-trafficking literature, associated with a trafficking experience in bivariable analysis. IEP/504 plans are developed for school-aged children whose ability to succeed in traditional educational formats is challenged by learning, social, or functional problems. In the multivariable analysis, a history of arrest was associated with being trafficked while the presence of a supportive adult was associated with not being trafficked. Gender was not associated with a trafficking experience. Conclusions This study is the largest to specifically assess homeless youth's demographic and social variables for association with trafficking experience. Homeless youth who are and are not trafficked share similar life experiences, but those with a supportive adult in their life had lower odds of being trafficked. Building upon our research, future investigations exploring order of occurrence will elucidate the risk factors for and protective factors against trafficking among homeless youth, contributing to evidence-based prevention efforts. [ABSTRACT FROM AUTHOR]

BACKGROUND: Gastrointestinal hemorrhage (GIH) is a common complaint seen in the emergency department (ED) and carries a small but significant mortality rate. The principal purpose of this investigation was to determine whether an ED venous lactate as part of initial laboratory studies is predictive of mortality in patients admitted to the hospital for GIH. METHODS: Retrospective cohort study for 6 years at an urban tertiary referral hospital included all ED patients with the charted diagnosis of acute GIH. Serum lactate was drawn at the bedside as part of patient care after arrival to the ED at the discretion of the clinical team. Clinical parameters and inpatient mortality were collected from the medical record. Optimal cut points for lactate were derived using receiver operating characteristics curves and imputed into a multivariable logistic regression model. RESULTS: Of the 2834 medical records that had GIH diagnoses, 1644 had an ED lactate recorded. A lactate greater than 4 mmol/L conferred a 6.4-fold increased odds of in-hospital mortality (94% specificity, P < .001). Controlling for age, initial hematocrit, and heart rate, every 1-point increase in lactate conferred a 1.4-fold increase in the odds of mortality. CONCLUSIONS: Elevated initial lactate drawn in the ED can be associated with in-hospital mortality for ED patients with acute GIH. Prospective validation studies are warranted. [ABSTRACT FROM AUTHOR]

Pediatricians are uniquely and well positioned to recognize risk factors for and experiences of labor and sex trafficking in children. While clinical and social interventions are well discussed in the literature, the underlying mechanisms that cause and contribute to trafficking are poorly addressed among healthcare professionals. A "colorblind" or otherwise "apolitical" approach to trafficking prevention is ineffective and may be detrimental to the patient-practitioner relationship. Pediatricians must be historico-socially aware of the contexts in which they practice to improve the health of pediatric populations. This article addresses the relevant trafficking legal terminology that may be unfamiliar to most pediatricians and focuses on a few "ism"-schisms (capitalism, racism, sexism, cis-heteronormativity, nativism, and classism) that create vulnerability to trafficking in pediatric populations. The article closes with some intervention recommendations and many more prevention-measure recommendations. [ABSTRACT FROM AUTHOR]

Abstract: Background: Undifferentiated altered mental status and hemodynamic instability are common presenting complaints in the Emergency Department (ED). Emergency practitioners do not have the luxury of time to perform sequential examination, history, testing, diagnosis, and treatment. Rather, we do all of these things at once to save lives and decrease morbidity. An important diagnosis to consider and upon which we can easily intervene is that of thiamine deficiency. Objectives: We present a case of an altered and unstable woman who presented to our busy ED and had rapid improvement after the administration of vitamin B1. We discuss the presentation, pathophysiology, consequences of missed diagnosis, and management of this disease process. Case Report: A middle-aged woman presented to our ED with unstable vital signs and an alteration in her mental status. She was unable to provide a history. Empiric treatment with thiamine resulted in the resolution of her hemodynamic instability and improvement in her mental status. Conclusion: Our patient benefited from the swift administration of thiamine and illustrates the importance of thiamine administration in the altered or hemodynamically unstable emergency patient with an elevated lactate. [Copyright &y& Elsevier]

Study Objective: We explore self-reported knowledge, attitudes, and behaviors of emergency physicians in regard to the care of transgender and gender-nonconforming patients to identify opportunities to improve care of this population.Methods: From July to August 2016, we electronically surveyed the American College of Emergency Physicians' Emergency Medicine Practice-Based Research Network of 654 active emergency physician participants. We performed frequency tabulations to analyze the closed-ended response items.Results: Of the 399 respondents (61% response rate), 88.0% reported caring for transgender and gender-nonconforming patients in the emergency department (ED), although 82.5% had no formal training about this population. The majority of physicians (86.0%) were comfortable asking about personal pronouns. Only 26.1% of respondents knew the most common gender-affirming surgery for female-to-male patients; 9.8% knew the most common nonhormone gender-affirming medication that male-to-female patients use. Almost no respondents (<3%) were aware of emergency medicine practitioners' performing inappropriate examinations on transgender and gender-nonconforming patients.Conclusion: Although transgender and gender-nonconforming people represent a minority of ED patients nationwide, the majority of respondents reported personally providing care to members of this population. Most respondents lacked basic clinical knowledge about transgender and gender-nonconforming care. [ABSTRACT FROM AUTHOR]

Human trafficking is a significant human rights problem that is often associated with psychological and physical violence. There is no demographic that is spared from human trafficking. Traffickers maintain control of victims through physical, sexual, and emotional violence and manipulation. Because victims of trafficking seek medical attention for the medical and psychological consequences of assault and neglected health conditions, emergency clinicians are in a unique position to recognize victims and intervene. Evaluation of possible trafficking victims is challenging because patients who have been exploited rarely self-identify. This article outlines the clinical approach to the identification and treatment of a potential victim of human trafficking in the emergency department. Emergency practitioners should maintain a high index of suspicion when evaluating patients who appear to be at risk for abuse and violence, and assess for specific indicators of trafficking. Potential victims should be evaluated with a multidisciplinary and patient-centered technique. Furthermore, emergency practitioners should be aware of national and local resources to guide the approach to helping identified victims. Having established protocols for victim identification, care, and referrals can greatly facilitate health care providers' assisting this population. [ABSTRACT FROM AUTHOR]

Children who are separated from their families and usual caregivers in emergencies face a multitude of risks to their health and wellbeing. This study presents findings from the first known population-based estimation of separation in an emergency setting. Point prevalence and basic characteristics were measured to inform programming, policies and funding for affected populations. A household survey was carried out in the Democratic Republic of the Congo to estimate separation subsequent to an attack by the M23 militia group. Separation was tracked in terms of children arriving into the household after the M23 attacks and children who had departed from the household after the recall event without their parent or usual caregiver. Five hundred and twenty-two households were surveyed. In the sample of 2,197 children living in the respondents’ homes at the time of data collection, 8.47% ( n = 186) were separated children who had newly arrived in the household since the M23 attack. In the sample of 2,034 children living in the respondents’ homes prior to the M23 attack, 5.31% ( n = 108) children had since departed from the household, resulting in separation from their parents or usual caregivers. Characteristics of children who arrived and children who departed diverged in terms of age, reasons for separation and frequency of unaccompaniment. The findings indicate the potential for population-based estimation of separation to be replicated in emergency settings to inform funding appeals and programmatic response. [ABSTRACT FROM AUTHOR]