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Exception from Informed Consent (EFIC) regulations detail specific circumstances in which Institutional Review Boards (IRB) can approve studies where obtaining informed consent is not possible prior to subject enrollment. To better understand how IRB members evaluate community consultation (CC) and public disclosure (PD) processes and results, semi-structured interviews of EFIC-experienced IRB members were conducted and analyzed using thematic analysis. Interviews with 11 IRB members revealed similar approaches to reviewing EFIC studies. Most use summaries of CC activities to determine community members' attitudes; none reported using specific criteria nor recalled any CC reviews that resulted in modifications to or denials of EFIC studies. Most interviewees thought metrics based on Community VOICES's domains (feasibility, participant selection, quality of communication, community perceptions, investigator/IRB perceptions) would be helpful. IRB members had similar experiences and concerns about reviewing EFIC studies. Development of metrics to assess CC processes may be useful to IRBs reviewing EFIC studies. [ABSTRACT FROM AUTHOR]

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]

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]

Objectives In 2014, the primary trauma care curriculum was delivered at a national trauma center in San Salvador, El Salvador. A quantitative analysis demonstrated that subsequent incorporation of primary trauma care algorithms did not occur. The purpose of this qualitative analysis is to explore why the delivery of the primary trauma care curriculum did not have a measurable effect on provider observance of primary trauma care algorithms. Methods Key informant interviews of primary trauma care instructors and students, trauma care observers, and hospital administrators involved in the delivery of the primary trauma care curriculum were conducted in February 2015. Interview transcripts were analyzed qualitatively using a grounded-theory approach and thematic analysis for insights and common themes. Results Four common themes emerged to explain why adherence to primary trauma care algorithms did not improve: Primary Trauma Care course delivery problems, insufficient equipment, insufficient nurse training, and unsystematic team response. Conclusions Despite the delivery of the primary trauma care curriculum, adherence to the primary trauma care algorithms did not improve as a result of problems integral to the primary trauma care model—including the teach-the-teachers method of curriculum dissemination—as well as local conditions at this hospital. These findings suggest that an isolated educational intervention may not be successful unless the host institution is able to commit to the implementation of the educational material in an ongoing and comprehensive fashion. [ABSTRACT FROM AUTHOR]

Given the significant global burden of human trafficking, the ability of clinicians to identify and provide treatment for trafficked persons is critical. Particularly in conflict settings, health care facilities often serve as the first and sometimes only point of contact for trafficked persons. As such, medical practitioners have a unique opportunity and an ethical imperative to intervene, even in nonclinical roles. With proper training, medical practitioners can assist trafficked persons by documenting human trafficking cases, thereby placing pressure on key stakeholders to enforce legal protections, and by providing adequate services to those trafficked. [ABSTRACT FROM AUTHOR]

Given the significant global burden of human trafficking, the ability of clinicians to identify and provide treatment for trafficked persons is critical. Particularly in conflict settings, health care facilities often serve as the first and sometimes only point of contact for trafficked persons. As such, medical practitioners have a unique opportunity and an ethical imperative to intervene, even in nonclinical roles. With proper training, medical practitioners can assist trafficked persons by documenting human trafficking cases, thereby placing pressure on key stakeholders to enforce legal protections, and by providing adequate services to those trafficked. [ABSTRACT FROM AUTHOR]

Objectives: Accurate and reliable criteria to rapidly estimate the probability of infection with the novel coronavirus-2 that causes the severe acute respiratory syndrome (SARS-CoV-2) and associated disease (COVID-19) remain an urgent unmet need, especially in emergency care. The objective was to derive and validate a clinical prediction score for SARS-CoV-2 infection that uses simple criteria widely available at the point of care. Methods: Data came from the registry data from the national REgistry of suspected COVID-19 in EmeRgency care (RECOVER network) comprising 116 hospitals from 25 states in the US. Clinical variables and 30-day outcomes were abstracted from medical records of 19,850 emergency department (ED) patients tested for SARS-CoV-2. The criterion standard for diagnosis of SARS-CoV-2 required a positive molecular test from a swabbed sample or positive antibody testing within 30 days. The prediction score was derived from a 50% random sample (n = 9,925) using unadjusted analysis of 107 candidate variables as a screening step, followed by stepwise forward logistic regression on 72 variables. Results: Multivariable regression yielded a 13-variable score, which was simplified to a 13-point score: +1 point each for age>50 years, measured temperature>37.5°C, oxygen saturation<95%, Black race, Hispanic or Latino ethnicity, household contact with known or suspected COVID-19, patient reported history of dry cough, anosmia/dysgeusia, myalgias or fever; and -1 point each for White race, no direct contact with infected person, or smoking. In the validation sample (n = 9,975), the probability from logistic regression score produced an area under the receiver operating characteristic curve of 0.80 (95% CI: 0.79–0.81), and this level of accuracy was retained across patients enrolled from the early spring to summer of 2020. In the simplified score, a score of zero produced a sensitivity of 95.6% (94.8–96.3%), specificity of 20.0% (19.0–21.0%), negative likelihood ratio of 0.22 (0.19–0.26). Increasing points on the simplified score predicted higher probability of infection (e.g., >75% probability with +5 or more points). Conclusion: Criteria that are available at the point of care can accurately predict the probability of SARS-CoV-2 infection. These criteria could assist with decisions about isolation and testing at high throughput checkpoints. [ABSTRACT FROM AUTHOR]

Background: This article reports on the use of the 'neighborhood method' to measure the prevalence and basic characteristics of children who became separated from their parents or usual caregivers subsequent to an attack by the M23 militia group in North Kivu, Democratic Republic of the Congo. Methods: A two-stage household cluster survey was conducted in 522 households in North Kivu in August 2014. Heads of households were asked about separated children in their household, as well as the households of their two closest neighbors. Separation was tracked in terms of children who arrived into the households after the M23 attacks and children who departed from the households after the recall event without their parent(s) or usual caregiver. For a subset of 44 neighbor pairs, respondents were asked to report on the same household to assess inter-rater reliability. Data about primary respondents and their neighbors were assessed to determine whether the neighborhood method was a comparable, reliable and efficient alternative to a traditional household survey about separated children. Results: The prevalence of separated children who arrived was 8.52 % [95 % CI: 6.75-10.75] in primary households and 4.46 % [95 % CI: 3.60-5.52] in neighbors' households (p-value = 0.0000). The prevalence of separated children who departed was 4.98 % [95 % CI: 3.45-7.19] in primary households and 3.19 % [95 % CI: 2.27-4.48] in neighbors' households (p-value = 0.0110). Kappa coefficients for the neighbor pairs indicated fair to moderate agreement for most demographic variables, but agreement was generally higher for variables related to current characteristics of the households than for variables describing the household in the past, especially before the M23 attack. Compared to a traditional household survey with similar power, the neighborhood method reduced data collection time by 50 % and lowered costs by 36 %. Conclusion: This pilot showed that, for measuring separated children in North Kivu, the results from neighbor households significantly underestimated the prevalence of separation when compared to data collected from respondents directly. Reliability was mixed. Although the neighborhood method did not yield valid results in this setting, given the potential the method holds to save scarce resources in humanitarian settings, additional pilots to refine and evaluate its validity and reliability in settings with shorter recall periods are recommended. [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]

The article discusses the author's call for U.S. public health research to prioritize the issue of human trafficking prevention, and it mentions America's Trafficking Victims Protection Act of 2000 and the various investigations into suspected human trafficking that were opened by the U.S. Department of Homeland Security and the nation's Department of Justice in fiscal year 2015. The health consequences of human trafficking are examined, along with reproductive health and mental health.