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Objectives To explore expert perspectives on risks associated with the pediatric electronic health record (EHR) for intimate partner violence (IPV) survivors and their children and to identify strategies that may mitigate these risks. Methods We conducted semistructured interviews with multidisciplinary pediatric IPV experts (nursing, physicians, social workers, hospital security, IPV advocates) recruited via snowball sampling. We coded interview transcripts using thematic analysis, then consolidated codes into themes. Results Twenty-eight participants completed interviews. Participants identified the primary source of risk as an abuser's potential access to a child's EHR by legal and illegal means. They noted that abuser's access to multiple pediatric EHR components (eg, online health portals, clinical notes, contact information) may result in escalated violence, stalking, and manipulation of IPV survivors. Suggested risk mitigation strategies included limited and coded documentation, limiting EHR access, and discussing documentation with the IPV survivor. Challenges to using these strategies included healthcare providers’ usual practice of detailed documentation and that information documented may confer both risk and benefit concurrently. Reported potential benefits of the pediatric EHR for IPV survivors included ensuring continuity of care, decreasing need to repeatedly talk about trauma histories, and communication of safety plans. Conclusions Our findings suggest the pediatric EHR may confer both risks and benefits for IPV survivors and their children. Further work is needed to develop best practices to address IPV risks related to the pediatric EHR, to ensure consistent use of these practices, and to include these practices as standard functionalities of the pediatric EHR.

Relatively few studies have considered the impact of the COVID-19 pandemic on intimate partner violence (IPV) advocates or the agencies where they work. In this study, based on United States IPV advocates' experiences working with survivors during the COVID-19 pandemic, we conducted interviews to explore: 1) personal challenges and resilience working as IPV advocates during the COVID-19 pandemic; 2) how agencies adapted to the pandemic to support IPV survivors and advocates; and 3) specific needs and challenges of culturally-specific agencies. We conducted semi-structured interviews with 53 IPV advocates from June to November 2020. Participants were included if they worked directly with survivors, identified as an IPV advocate, worked at a US-based agency, and spoke and understood English. We created a sampling matrix to ensure adequate representation from IPV advocates serving survivors from communities which have been marginalized. Interviews were conducted through a virtual platform by a trained member of the research team. We used an inductive thematic analysis approach, with weekly coding meetings to resolve discrepancies in coding. Five themes emerged from the data: 1) IPV advocates described how working as an IPV advocate during the COVID-19 pandemic impacted them personally; 2) agencies developed new methods of addressing IPV advocates' needs; 3) agencies developed new solutions to address pandemic-related client needs; 4) transitioning advocacy work to virtual formats created challenges but also opportunities and; 5) pandemic limitations and impacts compounded pre-pandemic challenges for culturally specific agencies. IPV advocates are frontline workers who have played essential roles in adjusting services to meet survivor needs during the COVID-19 pandemic while simultaneously coping with pandemic impacts on themselves and their agencies. Developing inter-agency collaborations and promoting advocates' safety and wellbeing during future public health crises will help support IPV survivors.

Objective Childhood exposure to intimate partner violence (IPV) is a pervasive public health epidemic with profound impact on child health. While past work has demonstrated how abusive partners exert control over IPV survivors in a variety of settings (eg workplace, courts, home), scant research has examined how IPV power and control behaviors manifest themselves in pediatric healthcare settings. In this study, we explore the perspectives of pediatric IPV experts about: (1) behaviors used by abusive partners to control IPV survivors in pediatric healthcare settings; (2) how controlling behaviors impact healthcare access and quality; and (3) recommendations for the pediatric healthcare team. Methods Individual semi-structured interviews were conducted with pediatric IPV experts recruited through snowball sampling. Interviews were individually coded by two research team members and analyzed using thematic analysis. Results Twenty-eight pediatric IPV experts participated. Participants described several types of controlling behaviors including limiting healthcare access, dominating conversations during medical visits, controlling medical decision making, and manipulating perceptions of the healthcare team. Participants acknowledged the challenges of recognizing controlling behaviors and provided several recommendations to addressing behaviors such as leveraging the expertise of multidisciplinary teams. Conclusions Participants described how abusive partners may attempt to control or discredit their partners in pediatric healthcare settings, using subtle behaviors that may be easily missed by the healthcare team. These results set the stage for further research and clinical practice innovation including triangulating the findings with IPV survivors, examining how frequently these behaviors occur, and developing multidisciplinary IPV training for the pediatric healthcare team.

* Abbreviations: AAP — : American Academy of Pediatrics SDOH — : social determinant of health Social determinants of health (SDOHs), defined as the social circumstances in which people are born, grow, live, work, and play, profoundly affect children’s health and drive health disparities.1 SDOHs are shaped by the distribution of money, power, and resources at global, national, and local levels. The list of potential SDOHs is expansive and includes food insecurity, housing instability, violence exposure, structural racism, poverty, and immigration-related stressors. Addressing SDOHs within the pediatric medical home has garnered considerable interest lately as a potential solution to both improving health across the life course and mitigating health care costs.1 However, one critical determinant is missing from the pediatric community’s definition of SDOHs: climate change. Climate change (also called global warming) is arguably one of the greatest public health threats of our time. Climate change is caused by rising greenhouse gas emissions from human activity, resulting in higher global average temperatures and changes to environmental and human systems. The American Academy of Pediatrics (AAP) issued a policy statement in 2007 (revised in 2015) encouraging pediatricians to reduce carbon emissions and support families experiencing the effects of climate change.2 We agree with this call to action. However, given the current national focus of policymakers, funders, and health care systems on addressing SDOHs, along with the ubiquitous impact of the changing climate on the social and environmental circumstances in which children live, we recommend climate … Address correspondence to Maya I. Ragavan, MD, MPH, MS, Division of General Academic Pediatrics, University of Pittsburgh, 3414 Fifth Ave, Pittsburgh, PA 15213. E-mail: ragavanm{at}chp.edu

Researchers often describe use of "bilingual/bicultural" research teams, especially for research being conducted with marginalized communities. In this perspectives article, we argue that while increasing the diversity of research teams is imperative, using the term "bilingual/bicultural" without further explanation is problematic. We first review the nuances of the terms bilingual and bicultural individually. Next, we describe how the terms bilingual and bicultural cannot be conflated. Finally, we provide recommendations for researchers, journals, and funding agencies.

OBJECTIVE: Incorporating culturally sensitive care into well-child visits may help address pediatric preventive care disparities faced by racial and ethnic minorities, families with limited English proficiency, and immigrants. We explored parents’ perspectives about the extent to which their children’s pediatric care is culturally sensitive and potential associations between culturally sensitive care and well-child visit quality. METHODS: We conducted cross-sectional surveys with parents attending a well-child visit for a child ages 3 to 48 months. To measure culturally sensitive care, we created a composite score by averaging 8 subscales from an adapted version of the Clinicians’ Cultural Sensitivity Survey. We assessed well-child visit quality through the Promoting Healthy Development Survey. Multivariate linear regression was used to understand associations between demographic characteristics and parent-reported culturally sensitive care. We used multivariate logistic regression to examine associations between culturally sensitive care and well-child visit quality. RESULTS: Two hundred twelve parents (71% of those approached) completed the survey. Parents born abroad, compared with those born in the United States, reported significantly higher culturally sensitive care scores (+0.21; confidence interval [CI]: 0.004, 0.43). Haitian parents reported significantly lower culturally sensitive care scores compared with non-Hispanic white parents (−0.49; CI: −0.89, −0.09). Parent-reported culturally sensitive care was significantly associated with higher odds of well-child visit quality including receipt of anticipatory guidance (adjusted odds ratio: 2.68; CI: 1.62, 4.62) and overall well-child visit quality (adjusted odds ratio: 2.54; CI: 1.59, 4.22). CONCLUSIONS: Consistent with prior research of adult patients, this study demonstrates an association between parent-reported culturally sensitive care and well-child visit quality. Future research should explore best practices to integrating culturally sensitive care in pediatric preventive health care settings.

Background Langerhans cell histiocytosis (LCH) is a rare disorder in which Langerhans cells (LC) accumulate in the skin or other organs and cause tumor formation or organ damage. Cutaneous lesions can vary widely and do not predict extent of systemic disease or prognosis. Case We present a premature infant with skin findings, multisystem involvement, and immunohistochemical markers consistent with multisystem LCH. Conclusion Limited data from preterm neonates with LCH suggest that prognosis is particularly poor, with even limited cutaneous disease often rapidly progressing to become fatal, although diagnosis is not always prompt. Early diagnosis and treatment may affect prognosis.

BACKGROUND AND OBJECTIVES Vaping has gained popularity among adolescents despite negative health consequences. Few studies have focused on factors that may protect against vaping. We sought to determine if future orientation, parental monitoring, school connectedness, and social support are associated with decreased risk of vaping and other forms of tobacco use. METHODS Data were obtained via anonymous school-based health behavior surveys among ninth- through 12th-graders in Pittsburgh, PA (n = 2487). Protective factors were assessed through validated Likert scale instruments. The primary outcome was recent (past 30-day) vaping. Additional outcomes included other forms of tobacco use and intention to quit tobacco products. Poisson regression models examined associations between protective factors and vaping and tobacco use outcomes. RESULTS Mean age was 15.7 years, 1446 (58.1%) respondents were female, and 671 youth (27.0%) reported recent vaping. Positive future orientation and high parental monitoring were associated with significantly lower prevalence of recent vaping (adjusted prevalence ratio: 0.84 [95% confidence interval: 0.73–0.97] and adjusted prevalence ratio: 0.73 [95% confidence interval: 0.62–0.85], respectively). There were no significant relationships between social support or school connectedness and vaping. All 4 protective factors were inversely associated with other forms of tobacco use. No factors were significantly associated with intent to quit tobacco products. CONCLUSIONS Findings reveal significant inverse associations between future orientation, parental monitoring, and vaping but no relationship between protective factors and intent to quit tobacco products. Developing interventions to foster protective factors in youth and their parental supports may inform primary prevention efforts to reduce vaping and other tobacco use.

Objective We aimed to identify differences in morbidity and mortality between inborn versus outborn extremely low birth weight (ELBW) infants admitted to the Texas Children's Hospital neonatal intensive care unit (NICU). Study design Vermont Oxford Network data were analyzed between January 2014 and December 2017. Inborn versus outborn outcomes were compared. Result Of 533 ELBW infants, 402 were inborn, and 131 were outborn. Gestational age and birth weight (BW) were similar. After adjusting outcomes to control for maternal steroids, maternal hypertension, maternal prenatal care, and temperature below 36 °C at admission, no outcomes were significantly different except inborn patients had decreased odds of late onset sepsis (adjusted odds ratio = 0.606, 95% confidence interval: 0.377-0.973, p = 0.038). Conclusion In this study, outborn ELBW patients had increased odds of late onset sepsis compared with inborn ELBW patients after controlling for covariates that differed significantly between these two cohorts.

Using an asynchronous motor with a frequency converter makes it possible to provide desired operating factors of electric drive. At the same time, using known types of frequency converters of domestic and import manufacture for low-power electric drives in most cases is inadvisable due to their high cost and complicated control system, as they use pulse-width modulation (PWM). In such cases, it is possible to use converters of vector-algorithmic type, which have a low cost due to a simplified control system and a special method of arrangements of the power part and the control system of the device. When developing and testing these converters, there is an acute problem of reducing the cost for manufacturing test samples. For this reason, at the initial stage of development, it is necessary to carry out simulation using computer simulation tools. The original circuit of vector-algorithmic converter is considered in this work, and the simulation results of characteristics of the developed electric drive in the MATLAB Simulink software environment are presented. General conclusions and recommendations on using the developed vector-algorithmic converter are presented.

Among 9th-to 12th-grade students who completed an anonymous health risk and protective behavior survey (n = 2346), positive future orientation was significantly and inversely associated with multiple forms of interpersonal violence including youth, community, and sexual/relationship violence. Designing interventions to promote future orientation holds promise as a cross-cutting violence prevention strategy.

* Abbreviation: GH — : global health On my first day in the NICU in Malawi, I helped care for an infant who suffered from severe lack of oxygen and trauma due to a difficult birthing process. Before this experience, I had felt ready to work at a Malawian hospital as a pediatric resident. I had taken a tropical medicine course, and my home institution mentor had run simulations and led discussions addressing the practicalities and ethics of practicing medicine within resource-limited settings. But that afternoon, when the infant became apneic, personally experiencing what had only been simulated felt much harder. The 1 available nurse and I performed compressions and manual breaths, but he never recovered spontaneous respirations. My host institution mentor arrived soon after we discontinued resuscitative efforts. With his guidance, I spoke to our patient’s family and witnessed the Malawian expression of grief in the form of wailing songs and prayers. Afterward, he and I discussed questions with which I was struggling, namely, at what point would I be causing more harm than good by continuing to resuscitate this child, knowing the limited long-term care resources available in Malawi? Both home and host institution mentors helped me navigate this clinical situation and process my patient’s death, ultimately enriching my global health (GH) experience and … Address correspondence to Maya I. Brasher, MD, Division of Neonatal-Perinatal Medicine, Department of Pediatrics, McGovern Medical School, UT Health Science Center at Houston, 6431 Fannin St, Suite MSB 3.244, Houston, TX 77030. E-mail: maya.i.brasher{at}uth.tmc.edu

Necrotizing enterocolitis (NEC) is a gastrointestinal emergency most commonly seen in premature infants, but equally important to recognize in term infants. Early diagnosis and management is critical to achieving optimal patient outcomes. This report outlines a simulation of the challenging scenario of a term infant presenting to the emergency center with NEC as a result of bacteremia and sepsis due to a urinary tract infection (UTI). This simulation can be used for teaching different levels of learners including novice, intermediate, and advanced. It focuses on the presentation, diagnosis, and emergent management of NEC, and additionally incorporates Pediatric Advanced Life Support (PALS) for more advanced learners.

Objectives Well-child visits are a critical component of pediatric health care; however, disparities in attendance and quality of care exist for Asian children. Limited research has explored Asian immigrant parents' perspectives about their well-child visit experience. Methods Qualitative interviews were conducted with Chinese, Vietnamese, and Asian Indian immigrant parents. Participants were recruited from community-based organizations in the Boston area. Interviews focused on parents' perceptions about well-child visits, including individual attitudes, social and cultural factors affecting their opinions, perceived behavioral control, and improving visits for Asian immigrant families. Data were coded and analyzed using thematic analysis. Results Fifty-one parents participated. Although participants reported attending well-child visits, they thought language barriers and unfamiliarity with US preventive health care may limit attendance for other Asian immigrant families. Some reported high-quality visits, while others described them as "too simple," recollecting health care experiences from their countries of origin where more tests were completed. Participants described seeking advice about their children's preventive care from elder family members. Many expressed the importance of culturally concordant health care providers and culturally sensitive care, while others thought that culture was less relevant. Differences emerged among the 3 subgroups around culturally concordant care and traditional medicine. Conclusions Querying parents about their past health care experiences and providing information about well-child visits may be useful when caring for immigrant families. Social influences on children's health outside of the parent–provider–child triad may also be important. Further work should explore how to deliver culturally sensitive care that considers not only a family's language preferences but also their unique cultural identity.

Providing patients, parents, and families high-quality healthcare in the language of their choice is a fundamental component of patient-centered care in pediatric settings. However, language needs may be complex and dynamic, creating clinical and ethical challenges in cases of provider–parent discordance regarding the need for an interpreter. In this perspectives article, we use a clinical encounter as a foundation to discuss the intricacies of addressing language needs in pediatrics. We also describe the urgent need for further innovation and improvement in linguistic supports available to diverse patients and families.

Psoriasis patients experience chronic systemic skin inflammation and develop cardiovascular comorbidities that shorten their lifespan. Whether cardiovascular disease is improved by treatment with current biologics that target disease-specific pathways is unclear. KC-Tie2 mice develop psoriasiform skin inflammation with increases in IL-23 and IL-17A and proinflammatory monocytosis and neutrophilia that precedes development of carotid artery thrombus formation. To examine whether targeted blockade of IL-23 or IL-17A in KC-Tie2 pso- riasis mice improves cardiovascular outcomes, mice were treated systemically for 6 weeks with antibodies targeting IL-17A, IL-17RA, IL-12/23p40, or IL-23p19. Skin inflammation; thrombosis clotting times; and percentage of splenic monocytes, neutrophils, and CD4 T cells were examined. Skin inflammation significantly improved in KC-Tie2 mice treated with each of the antibodies targeting IL-23, IL-17A, or IL-17RA, consistent with clinical efficacy observed in psoriasis patients. The time to occlusive thrombus formation lengthened in these mice and correlated with attenuated acanthosis. This decrease in skin inflammation paralleled decreases in splenic neutrophils (CD11b(+)Ly6G(+)) but not monocytes (CD11b(+)Ly6C(high)) or T cells (CD4(+)). Our data show that targeted inhibition of IL-23 or IL-17A improves psoriasis-like skin disease and also improves cardiovascular disease in mice.

Understanding and intervening at the intersection of climate change and child health disparities require pediatric providers to broaden their competency with structural determinants of health - even in the clinic. The environmental effects of climate change at the community level intersect in complex ways with structural racism and social influences of health. Climate injustice is further evident in policies and practices that disproportionately affect low-income communities and communities of color through exposure to harmful pollutants from industrial plants, heavy vehicular traffic, and flooding waterways, as well as to harm from degraded civic infrastructure such as leaking water lines and unsafe bridges. To support child health, pediatric providers must recognize the environmental health harms posed to children and multiplied by climate change as well as identify opportunities to center the voices of families and communities to dismantle these inequities. In this article, three case examples demonstrate the links between structural racism, climate change and child health. We then use a healing centered engagement approach to offer specific suggestions for how pediatric providers can actively promote health and resilience, advocate for patient needs, and contribute to efforts to change structural racism in existing practices and institutions.

We used a community-based participatory research approach to develop, implement, and evaluate one of the first health curricula for female intimate partner violence (IPV) survivors residing at a transitional housing program. The curriculum comprised 12 workshops that were developed based on the survivors’ experiences, needs, and interests. Evaluation participants included 20 of the 37 women who attended at least one workshop, 12 workshop facilitators, and two housing center staff. Participants found the curriculum to be engaging, interactive, and helpful in building a supportive community. Suggestions for curricular improvement as well as opportunities for further research and curricular development are discussed.

A memristor is a resistor with memory that exhibits a pinched hysteretic relationship in cyclic voltammetry. Recently, we have found memristors in the electrical circuitry of plants and seeds. There are no publications in literature about the possible existence of memristors and electrical differentiators in fruits. Here we found that the electrostimulation of Golden Delicious or Arkansas Black apple fruits by bipolar periodic waves induces hysteresis loops with pinched points in cyclic voltammograms at low frequencies between 0.1MHz and 1MHz. At high frequencies of 1kHz, the pinched hysteresis loop transforms to a non-pinched hysteresis loop instead of a single line I=V/R for ideal memristors because the amplitude of electrical current depends on capacitance of a fruit's tissue and electrodes, frequency and direction of scanning. Electrostimulation of electrical circuits in apple fruits by periodic voltage waves also induces electrotonic potential propagation due to cell-to-cell electrical coupling with electrical differentiators. A differentiator is an electrical circuit in which the output of the circuit is approximately directly proportional to the rate of change of the input. The information gained from electrostimulation can be used to elucidate and to observe electrochemical and electrophysiological properties of electrical circuits in fruits.

There are such fabrication systems in agro-industrial complex which a power supply by the alternating voltage with phases are displaced relatively from each other by 90 degrees is necessary. The devices supplied with asynchronous (two-winding) engines can be such installations. The existing technology solutions of this problem solve it not completely therefore it is required to develop the solution capable completely meet the current requirements to these systems.

Kallikrein-related peptidase 6 (KLK6) is a secreted serine protease hypothesized to promote inflammation via cleavage of protease-activated receptor 1 (PAR1) and PAR2. KLK6 levels are elevated in multiple inflammatory and autoimmune conditions, but no definitive role in pathogenesis has been established. Here, we show that skin-targeted overexpression of KLK6 causes generalized, severe psoriasiform dermatitis with spontaneous development of debilitating psoriatic arthritis-like joint disease. The psoriatic skin and joint phenotypes are reversed by normalization of skin KLK6 levels and attenuated following genetic elimination of PAR1 but not PAR2. Conservation of this regulatory pathway was confirmed in human psoriasis using vorapaxar, an FDA-approved PAR1 antagonist, on explanted lesional skin from patients with psoriasis. Beyond defining a critical role for KLK6/PAR1 signaling in promoting psoriasis, our results demonstrate that KLK6/PAR1-mediated inflammation in the skin alone is sufficient to drive inflammatory joint disease. Further, we identify PAR1 as a promising cytokine-independent target in therapy of psoriasis and psoriatic arthritis.

INTRODUCTION: The American Academy of Pediatrics discourages spanking, especially of infants and young toddlers. This study examines the association between maternal immigrant generation and reported spanking of 1-year-old children, and whether this association is impacted by domestic violence (DV). METHODS: We conducted a cross-sectional secondary data analysis using 1-year wave data from the Fragile Families and Child Wellbeing Study. We used descriptive statistics to explore demographic differences among first-generation, second-generation, and third-generation or higher (reference group) mothers. We conducted logistic regression to examine the association between immigrant generation and spanking, controlling for covariates. We used stratified logistic regression to evaluate how experiencing DV may impact the association between immigrant generation and spanking. RESULTS: The study included 370 first-generation mothers, 165 second-generation mothers, and 1754 reference group mothers. The prevalence of spanking differed across immigrant generations (p = 0.004). First-generation mothers had statistically significant lower odds of spanking compared with the reference group (adjusted OR 0.26; CI 0.11–0.64). Second-generation mothers also had lower odds of spanking compared with the reference group, although this result did not reach statistical significance (adjusted OR 0.60; CI 0.22–1.63). Mothers’ report of experiencing DV appeared to impact the relationship between immigrant generation and spanking. DISCUSSION: First-generation immigrant mothers had lower odds of reported spanking compared to reference group mothers, an association which is attenuated for both second-generation immigrant mothers and mothers who have experienced DV. Future work should explore the potential factors that drive variations in spanking between immigrant generations.

The chapter focuses on the free, and occasionally plagiarized adaptations of three major figures of early Egyptian romanticism - Muṣṭafā Luṭfī al-Manfalūṭī, Abbās Maḥmūd al-‘Aqqād, Ibrāhīm al-Mazinī. It reads the free appropriation of French romantic and sentimental fiction as well as British romantic thought paradigmatically as making possible prophetic narration with a displaced origin. The origin is forgotten in a translation that refuses to name itself as such. It explores the birth of a romantic notion of literary prophecy in relation to a history of plagiarism in Arabic literature, challenging readings of the absolute modernity of the translators studied. It also situates translation as appropriation in relation to the changing function of literature in the early 20th-century, pointing to its new agency in producing moral didacticism. Reading their translations and their essays/articles together, the chapter locates a different form of romantic prophecy that is not secular but rather disruptive of the hegemonies of colonial time.

Chapter three focuses on the more faithful translation aesthetic of Muḥammad al-Sibā‘ī, reading specifically his 1911 rendition of Thomas Carlyle’s lectures On Heroes, Hero-worship, and the Heroic in History (1841). Challenging Carlyle’s condescending approach to the Muslim prophet, al-Sibā‘ī’s translation rewrites the differences between the Prophet’s Muḥammad’s prophecy and Shakespeare’s genius that informs Carlyle’s account. The chapter argues that al-Sibā‘ī’s translation – apart from its translator’s original intention – offers a critique of colonial liberalism by noting the contradictions in Carlyle’s “secular” readings of Islam. As such, the chapter explores this “secularity” as a critique of the self-orientalizing mode of the translators under study. It extends this critique to al-Sibā‘ī’s adaptation of Charles Dickens in 1912 and its rewriting of the complicity between realism and liberalism in the British tradition.

* Abbreviations: COVID-19 — : coronavirus disease 2019 CUES — : Confidentiality, Universal Education and Empowerment, and Support IPV — : intimate partner violence The patient was well appearing but congested. Through gown, gloves, goggles, and a mask, I asked the mom if there was anyone at home who could help bulb suction. “He’ll never help,” she said. As tears dripped down her cheek, she described struggles with a partner who was controlling and disinterested in co-parenting, who took her money and tried to destroy her credit. She wanted him to leave, but the pandemic happened, and child care was limited. She had to keep working, and he was watching her children. She felt exhausted, saying, “Being here, in clinic, is like a break for me.” She shared that her partner has never physically abused her or injured her children. She felt safe taking resources about a local intimate partner violence (IPV) agency and was open to a follow-up visit. IPV, which includes physical, emotional, sexual, financial, or immigration-related abuse by a former or current partner, is a pervasive public health epidemic, with myriad child health impacts.1–3 During the coronavirus disease 2019 (COVID-19) pandemic, physical distancing, school and child care closures, and unemployment are contributing to additional stressors within households, associated with worsening IPV. Whereas empirical data on IPV and COVID-19 is nascent, emerging work, with data from Los Angeles and Indianapolis, reveals an increase in IPV reports in March to April 2020 compared with January to March 2020.4 Pediatric clinicians have a vital role in connecting adult caregivers with supports and resources to mitigate the consequences of IPV for both survivors and … Address correspondence to Maya I. Ragavan, MD, MPH, MS, Division of General Academic Pediatrics, University of Pittsburgh, 3414 Fifth Ave, Pittsburgh, PA 15213. E-mail: ragavanm{at}chp.edu

Psoriasis patients are at increased risk of heart attack and stroke and have elevated MRP8/14 levels that predict heart attack. The KC-Tie2 psoriasiform mouse model exhibits elevated MRP8/14 and is prothrombotic. Mrp14-/- mice, in contrast, are protected from thrombosis, but, surprisingly, KC-Tie2xMrp14-/- mice remain prothrombotic. Treating KC-Tie2xMrp14-/- mice with anti-IL-23p19 antibodies reversed the skin inflammation, improved thrombosis, and decreased IL-6. In comparison, IL-6 deletion from KC-Tie2 animals improved thrombosis despite sustained skin inflammation, suggesting that thrombosis improvements following IL-23 inhibition occur secondary to IL-6 decreases. Psoriasis patient skin has elevated IL-6 and IL-6 receptor is present in human coronary atheroma, supporting a link between skin and distant vessel disease in patient tissue. Together, these results identify a critical role for skin-derived IL-6 linking skin inflammation with thrombosis, and shows that in the absence of IL-6 the connection between skin inflammation and thrombosis comorbidities is severed.

Introduction Intimate partner violence (IPV) affects the physical and psychological health of survivors and their children; however, to our knowledge, no comprehensive health curriculum exists for this population. As a partnership between a transitional housing program (THP) and an academic medical center, we developed a health education curriculum for female IPV survivors using the principles of community-based participatory research (CBPR). Methods After partnering with a community-based organization, and recruiting participants (IPV survivors), the curriculum is then taught by health trainees. The materials needed to facilitate the 10 workshops are provided and include: a facilitator's guide; workshop materials, including PowerPoint slides and handouts; a training guide for a community partner to teach facilitators about IPV; a sample focus group guide for curricular evaluation that aligns with CBPR methodologies; a sample time line for curricular implementation; and CBPR resources. Results The curriculum was implemented for two 9-month periods between September 2014 and June 2016. During the first session, 80% of women attended at least one workshop and during the second session, 65% of women did the same. Participants and staff at the THP found the curriculum engaging and requested that it be implemented yearly. Discussion The community-academic partnership offered prehealth and health trainees the opportunity to learn effective methods of delivering health education and to understand some of the challenges associated with surviving IPV. Such education can be provided to trainees at any stage and across multiple specialties (e.g., medical, nursing, public health, or social work). There is potential to replicate this mutual learning curriculum in a wide variety of other settings serving mothers and children.

Few studies have explored the perspectives of survivors of intimate partner violence (IPV) regarding their health and their children’s health, their experiences accessing and utilizing health care, and health initiatives that would best serve their families’ needs. We facilitated focus groups with female IPV survivors and adolescents who witnessed IPV. Women described their health and their children’s health as poor and reported challenges with health care utilization, whereas teenagers generally perceived their health as typical for their age. Participants requested health education workshops, community resources, and social support. This study lays the foundation for further research and the development of health initiatives.

IL-6 inhibition has been unsuccessful in treating psoriasis, despite high levels of tissue and serum IL-6 in patients. In addition, de novo psoriasis onset has been reported after IL-6 blockade in patients with rheumatoid arthritis. To explore mechanisms underlying these clinical observations, we backcrossed an established psoriasiform mouse model (IL-17C+ mice) with IL-6-deficient mice (IL-17C+KO) and examined the cutaneous phenotype. IL-17C+KO mice initially exhibited decreased skin inflammation; however, this decrease was transient and reversed rapidly, concomitant with increases in skin Tnf, Il36α/β/γ, Il24, Epgn, and S100a8/a9 to levels higher than those found in IL-17C+ mice. A comparison of IL-17C+ and IL-17C+KO mouse skin transcriptomes with that of human psoriasis skin revealed significant correlation among transcripts of skin of patients with psoriasis and IL-17C+KO mouse skin, and confirmed an exacerbation of the inflammatory signature in IL-17C+KO mice that aligns closely with human psoriasis. Transcriptional analyses of IL-17C+ and IL-17C+KO primary keratinocytes confirmed increased expression of proinflammatory molecules, suggesting that in the absence of IL-6, keratinocytes increase production of numerous additional proinflammatory cytokines. These preclinical findings may provide insight into why patients with arthritis being treated with IL-6 inhibitors develop new onset psoriasis and why IL-6 blockade for the treatment of psoriasis has not been clinically effective.

A Network Intrusion Detection System (NIDS) is an alarm system for networks. NIDS monitors all network actions and generates alarms when it detects suspicious or malicious attempts. A false positive alarm is generated when the NIDS misclassifies a normal action in the network as an attack. We present a data mining technique to assist network administrators to analyze and reduce false positive alarms that are produced by a NIDS. Our data mining technique is based on a Growing Hierarchical Self-Organizing Map (GHSOM) that adjusts its architecture during an unsupervised training process according to the characteristics of the input alarm data. GHSOM clusters these alarms in a way that supports network administrators in making decisions about true and false alarms. Our empirical results show that our technique is effective for real-world intrusion data.

A memristor is a resistor with memory, which is a non-linear passive two-terminal electrical element relating magnetic flux linkage and electrical charge. Here we found that memristors exist in vivo. The electrostimulation of the Aloe vera by bipolar sinusoidal or triangle periodic waves induce electrical responses with fingerprints of memristors. Uncouplers carbonylcyanide-3-chlorophenylhydrazone and carbonylcyanide-4-trifluoromethoxy-phenyl hydrazone decrease the amplitude of electrical responses at low and high frequencies of bipolar periodic sinusoidal or triangle electrostimulating waves. Memristive behavior of an electrical network in the Aloe vera is linked to the properties of voltage gated ion channels: the K(+) channel blocker TEACl reduces the electric response to a conventional resistor. Our results demonstrate that a voltage gated K(+) channel in the excitable tissue of plants has properties of a memristor. The discovery of memristors in plants creates a new direction in the modeling and understanding of electrical phenomena in plants.

A memristor is a nonlinear element because its current-voltage characteristic is similar to that of a Lissajous pattern for nonlinear systems. We investigated the possible presence of memristors in the electrical circuitry of the Venus flytrap's upper and lower leaves. The electrostimulation of this plant by bipolar sinusoidal or triangle periodic waves induces electrical responses in the upper and lower leaves of the Venus flytrap with fingerprints of memristors. The analysis was based on cyclic voltammetric characteristics where the memristor, a resistor with memory, should manifest itself. Tetraethylammonium chloride, an inhibitor of voltage gated K(+) channels, or NPPB, a blocker of voltage gated Cl(-) and K(+) channels, transform a memristor to a resistor in plant tissue. Uncouplers carbonylcyanide-3-chlorophenylhydrazone (CCCP) and carbonylcyanide-4-trifluoromethoxy-phenyl hydrazone (FCCP) decrease the amplitude of electrical responses at low and high frequencies of bipolar periodic electrostimulating waves. Our results demonstrate that voltage gated K(+) channels in the Venus flytrap have properties of memristors of type 1 and type 2. The discovery of memristors in plants creates a new direction in the modeling and understanding of electrical phenomena in plants.

Background. Hypercoagulation is one of the cardiovascular risk factors in patients with metabolic syndrome (MS). It results from various factors including hyperhomocysteinemia, endothelial dysfunction, non-enzymatic glycation of proteins etc.The aim of this study was to assess clinical correlates of thrombodynamics in insulin resistant and non insulin resistant men with metabolic syndrome.Methods. We investigated 79 patients with MS diagnosed in accordance with IDF criteria (2009). The main group consisted of 44 men with MS including insulin resistance. The control group consisted of 35 men with MS not including insulin resistance. In addition to routine clinical tests we performed thrombodynamics assay and measured serum levels of asymmetric dimethylarginine (ADMA) and homocysteine. Mann-Whitney U-test and Spearmen’s correlation coefficient (rs) were used for statistical analysis.Results. There was no significant difference between thrombodynamics parameters, ADMA and homocysteine levels between the two groups. In both groups thrombodynamics parameters had no correlations with body mass index, hemoglobin level, platelet count and serum ADMA level. In patients with insulin resistance clot density correlated positively with serum level of C-reactive protein (rs=0.621, p=0.007); average and initial rates of clot growth correlated positively with homocysteine level (rs=0.539, p=0.017, and rs=0.554, p=0.014, respectively). In patients with insulin resistance clot density and rates of clot growth were not interrelated with the above mentioned parameters.Conclusions. The results of the study suggest that insulin resistant men with MS are characterized by clinical correlates between thrombodynamics parameters, homocysteine and C-reactive protein levels while patients without insulin resistance have other, unestablished determinants of clot density and rates of clot growth.

Evaluate oxygen jet ventilation in a patient with tracheal stenosis undergoing stent insertion.Manual intermittent low frequency oxygen jet ventilation was used during general anesthesia for fibreoptic bronchoscopy and stent insertion in a patient with tracheal stenosis. Oxygen jets were delivered via a Sander's injector adapted to the proximal end of the endotracheal tube on one side, and open to room air on the other side. Adequate oxygenation and carbon dioxide removal were ensured throughout the procedure.Low frequency jet ventilation in a patient with tracheal stenosis provided adequate ventilation as well as a non- obstructed field during fibreoptic bronchoscopy and stent insertion.

A multimodal approach to postcesarean pain management may enhance analgesia and reduce side effects after surgery. This study evaluates the postoperative analgesic effects of propacetamol and/or diclofenac in parturients undergoing elective cesarean delivery under spinal anesthesia.After randomization, 80 healthy parturients received the following: placebo (group M), 100 mg diclofenac rectally every 8 hours (group MD), 2 g propacetamol intravenously every 6 hours (group MP), or a combination of 2 g propacetamol and 100 mg diclofenac (group MDP) as described above. Drugs were administered for 24 hours after surgery. Postoperative pain was controlled with a patient controlled analgesia pump, using morphine. The visual analog scale (VAS) at rest and on coughing, as well as the morphine consumption, were evaluated at 2, 6, and 24 hours postoperatively. Also, the side effects experienced after undergoing the different regimens were compared.The patients' characteristics did not differ significantly between the 4 groups. VAS score at 2 hours, both at rest and on coughing were lower in group MDP and MD compared with group M (P.05). At 24 hours, there was still a tendency toward lower pain scores in the groups MDP and MD; however, this difference was only statistically significant at rest between the MDP group and the MP and M groups. Morphine consumption at 2, 6, and 24 hours was lower in the MDP and MD groups compared with the MP and M groups (P.05). The morphine-sparing effect was higher in groups MDP and MD compared with group MP (57% and 46%, respectively, v 8.2%, P.05). The incidence of side effects was similar in all groups. However, the power of the study was too low to permit an evaluation of potential side effects.Diclofenac after cesarean delivery improves analgesia and has a highly significant morphine-sparing effect. We were unable to demonstrate significant morphine-sparing effect of propacetamol or additive effect of propacetamol and diclofenac in this group of patients.

We investigated the incidence of transient neurologic symptoms (TNS) after the use of hyperbaric lidocaine as compared with hyperbaric bupivacaine in patients undergoing cesarean delivery under spinal anesthesia. Two hundred women scheduled for cesarean delivery were randomly allocated to receive spinal anesthesia with 75 mg hyperbaric lidocaine 5% (n = 100) or 12 mg hyperbaric bupivacaine 0.75% (n = 100). Spinal anesthesia was administered to all patients in the sitting position with a 25-gauge Whitacre needle. The level of sensory blockade, time to full recovery, and intraoperative hemodynamic profile were noted in all patients. The patients were interviewed postoperatively for three consecutive days to detect the occurrence of TNS. The incidence of TNS was zero (95% confidence interval 0%--3%) in both the Lidocaine and the Bupivacaine Groups. Our results indicate that the frequency of postoperative TNS does not exceed 3% in patients undergoing cesarean delivery at term using hyperbaric lidocaine 5% or hyperbaric bupivacaine 0.75%.

Degree of identity assurance has been realized in several different approaches to authentication assurance frameworks; to become one of the parameters used in decision making about whether to grant or deny a service. However, current approaches do not look at diversity of authentication mechanisms, used for establishing the identity of a user, as an application to mitigate identity threats and consequently affects identity assurance in the authentication operation. This paper revisits the area of authentication assurance to present a framework for using identity assurance in the context of risk-based service provisioning. It demonstrates identity assurance in the authentication operation as being affected by the diversity of authentication mechanisms. By considering diversity in mechanisms, this framework gives service providers confidence that services are only restricted to users who have satisfied a certain degree of identity assurance, by going through a rigorous mechanism for establishing identity. Moreover, by giving a user different mechanisms to authenticate to different services, this work is useful for enabling users to separate between identities used for services accessing information of different levels of criticality.

This report reviews the derangements of neuromuscular transmission in the different types of myopathy.The article covers recent literature on myopathy, whether prejunctional, junctional or postjunctional, as well as intensive care unit myopathy, and outlines the influence of myopathy on the action of both depolarizing and non-depolarizing muscle relaxants.The review classifies myopathy according to its cause, and sheds light on the upregulation and downregulation of endplate acetylcholine receptors. These findings are important for both clinical practice, and for research into neuromuscular transmission.

Cardiac diseases are present in 0.5-4% of pregnancies, and they remain a frequent cause of death during pregnancy. Pregnancy per se imposes significant hemodynamic changes, placing a major burden on the cardiovascular system. The early recognition and close follow-up of patients with cardiac diseases will improve maternal tolerance to the cardiovascular burden imposed by pregnancy, promote fetal growth and neonatal survival. Rheumatic heart disease remains the most frequent heart disease in the pregnant population with pulmonary edema as the most frequent complication. Atrial septal defect is the most frequent congenital heart disease in the adult population, whereas tetralogy of Fallot is the most common cyanotic congenital heart disease. An improvement in modern techniques of monitoring, a better understanding of the pathophysiology of cardiac disease, as well as multidisciplinary care has led to a substantial improvement in outcome of the pregnant cardiac patient. Management should be initiated before conception as it will provide optimal clinical conditions and sufficient information on the underlying pathophysiology.