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Copyright © 2016 by the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies.Objectives: To describe the epidemiology, morbidity, and mortality of new or progressive multiple organ dysfunction syndrome in children with severe sepsis. Design: Secondary analysis of a prospective, cross-sectional, point prevalence study. Setting: International, multicenter PICUs. Patients: Pediatric patients with severe sepsis identified on five separate days over a 1-year period. Interventions: None. Measurements and Main Results: Of 567 patients from 128 PICUs in 26 countries enrolled, 384 (68%) developed multiple organ dysfunction syndrome within 7 days of severe sepsis recognition. Three hundred twenty-seven had multiple organ dysfunction syndrome on the day of sepsis recognition. Ninety-one of these patients developed progressive multiple organ dysfunction syndrome, whereas an additional 57 patients subsequently developed new multiple organ dysfunction syndrome, yielding a total proportion with severe sepsis-associated new or progressive multiple organ dysfunction syndrome of 26%. Hospital mortality in patients with progressive multiple organ dysfunction syndrome was 51% compared with patients with new multiple organ dysfunction syndrome (28%) and those with single-organ dysfunction without multiple organ dysfunction syndrome (10%) (p < 0.001). Survivors of new or progressive multiple organ dysfunction syndrome also had a higher frequency of moderate to severe disability defined as a Pediatric Overall Performance Category score of greater than or equal to 3 and an increase of greater than or equal to 1 from baseline: 22% versus 29% versus 11% for progressive, new, and no multiple organ dysfunction syndrome, respectively (p < 0.001). Conclusions: Development of new or progressive multiple organ dysfunction syndrome is common (26%) in severe sepsis and is associated with a higher risk of morbidity and mortality than severe sepsis without new or progressive multiple organ dysfunction syndrome. Our data support the use of new or progressive multiple organ dysfunction syndrome as an important outcome in trials of pediatric severe sepsis although efforts are needed to validate whether reducing new or progressive multiple organ dysfunction syndrome leads to improvements in more definitive morbidity and mortality endpoints.

Copyright © 2016 by the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies.Objectives: Pediatric severe sepsis remains a significant global health problem without new therapies despite many multicenter clinical trials. We compared children managed with severe sepsis in European and U.S. PICUs to identify geographic variation, which may improve the design of future international studies. Design: We conducted a secondary analysis of the Sepsis PRevalence, OUtcomes, and Therapies study. Data about PICU characteristics, patient demographics, therapies, and outcomes were compared. Multivariable regression models were used to determine adjusted differences in morbidity and mortality. Setting: European and U.S. PICUs. Patients: Children with severe sepsis managed in European and U.S. PICUs enrolled in the Sepsis PRevalence, OUtcomes, and Therapies study. Interventions: None. Measurements and Main Results: European PICUs had fewer beds (median, 11 vs 24; p < 0.001). European patients were younger (median, 1 vs 6 yr; p < 0.001), had higher severity of illness (median Pediatric Index of Mortality-3, 5.0 vs 3.8; p = 0.02), and were more often admitted from the ward (37% vs 24%). Invasive mechanical ventilation, central venous access, and vasoactive infusions were used more frequently in European patients (85% vs 68%, p = 0.002; 91% vs 82%, p = 0.05; and 71% vs 50%; p < 0.001, respectively). Raw morbidity and mortality outcomes were worse for European compared with U.S. patients, but after adjusting for patient characteristics, there were no significant differences in mortality, multiple organ dysfunction, disability at discharge, length of stay, or ventilator/vasoactive-free days. Conclusions: Children with severe sepsis admitted to European PICUs have higher severity of illness, are more likely to be admitted from hospital wards, and receive more intensive care therapies than in the United States. The lack of significant differences in morbidity and mortality after adjusting for patient characteristics suggests that the approach to care between regions, perhaps related to PICU bed availability, needs to be considered in the design of future international clinical trials in pediatric severe sepsis.

This article explores the difference between ethnic identity scores for Africandescended MSW students who are native to this country, who are first generation born of immigrant parents, and who are foreign-born Black immigrants. The research further explores whether ethnic identity is associated with the students' commitment to work with their own ethnic groups. Results indicate that all three groups of students demonstrate high ethnic identity, and variability in group means was not statistically significant. However, statistically significant difference existed among the 3 groups on 1 of the measures of propensity for practice. Also determined was a significant relationship between ethnic identity and the propensity for practice items. Implications for social work education and additional research are highlighted.

The purpose of this study is to examine the attitudes of MSW practitioners toward lesbians and gay men using a recently developed instrument. Whereas prior research focused on blatantly homophobic or heterosexist attitudes, this research uses a measurement tool based on the concept of queer consciousness (QC) and measures subtle forms of prejudice, including both positive and negative attitudes along four dimensions: Value gay and lesbian progress/diversity, resist traditional sex and gender roles, positive beliefs about lesbians, and positive beliefs about gay men. Research findings indicate negative attitudes toward lesbians and gay men in three out of the four dimensions for the sample of social work practitioners. This article concludes with suggestions for social work educators who want to redress areas of subtle prejudice and promote higher levels of QC.

Unethical behavior seems to be increasing exponentially in every facet of today’s business environment. Property and production deviance are just two of the unethical behaviors exhibited by employees. According to a study conducted by S. Nonis and C. Swift (2001), students who engage in dishonest acts in college classes are more likely to engage in dishonest acts in the workplace. Research conducted during the three year period 2002 - 2005 by Don McCabe in conjunction with The Center for Academic Integrity at Duke University reveals that 70 percent of the 50,000 undergraduate students surveyed admit to some cheating (McCabe 2005). This article reports the results of a student survey documenting the self-reported cheating habits of business and non-business majors and their reported involvement in deviant activities in the workplace. The research indicates that a higher percentage of non-business majors report cheating on tests and homework than business majors and students who cheat in high school and/or college are more likely to engage in certain deviant behaviors in the workplace. In addition, the article also compares the percentage of students engaging in property and production deviance with the results of an earlier study by R. C. Hollinger and J. P. Clark examining workplace deviance among employees in the retail sector.

Results from survey research of 51 Black ministers indicate that the Black church is potentially an untapped resource for the placement of African American children in permanent homes. The study population indicated knowledge of the need for African American foster care and adoptive families but did not include this need as part of the focus of work for their respective churches. Implications for additional research are highlighted.

CCR5 is the major coreceptor for macrophage-tropic strains of the human immunodeficiency virus type I (HIV-1). Homozygotes for a 32-base pair (bp) deletion in the coding sequence of the receptor (CCR5Delta32) were found to be highly resistant to viral infection, and CCR5 became, therefore, one of the paradigms illustrating the influence of genetic variability onto individual susceptibility to infectious and other diseases. We investigated the functional consequences of 16 other natural CCR5 mutations described in various human populations. We found that 10 of these variants are efficiently expressed at the cell surface, bind [(125)I]-MIP-1beta with affinities similar to wtCCR5, respond functionally to chemokines, and act as HIV-1 coreceptors. In addition to Delta32, six mutations were characterized by major alterations in their functional response to chemokines, as a consequence of intracellular trapping and poor expression at the cell surface (C101X, FS299), general or specific alteration of ligand binding affinities (C20S, C178R, A29S), or relative inability to mediate receptor activation (L55Q). A29S displayed an unusual pharmacological profile, binding and responding to MCP-2 similarly to wtCCR5, but exhibiting severely impaired binding and functional responses to MIP-1alpha, MIP-1beta, and RANTES. In addition to Delta32, only C101X was totally unable to mediate entry of HIV-1. The fact that nonfunctional CCR5 alleles are relatively frequent in various human populations reinforces the hypothesis of a selective pressure favoring these alleles. (Blood. 2000;96:1638-1645)

VioLit summary: OBJECTIVE: This paper by Pierce and Singleton introduced the concept of improvisation to better understand and treat violence among African-American youth. METHODOLOGY: The authors employed a non-experimental critical review of the literature. FINDINGS/DISCUSSION: The authors argued that African-American youth employ a strategy of improvisation to achieve their goals. They defined improvisation as "the means of making do with what one has, using the resources immediately available" (p. 445). According to the authors, African-Americans were forced, due to limited resources, to use the strategy of improvisation throughout their history in the United States. First, African-Americans in the days of slavery employed several improvisational strategies. Slaves developed their own language to preserve their cultural heritage. They performed the role of the 'happy slave.' They also used spiritual gatherings as a mechanism to develop and maintain some sort of social support network. During and after Reconstruction, the environment remained hostile for African-Americans in the United States. Again, their access to the means of achievement was limited. The improvisational strategies commonly employed in this time were to script or plan interactions with whites and to develop and maintain their own social support networks. The authors argued that throughout their history in the U.S., African-Americans learned that the future was unpredictable and learned to focus on short term goals to survive, i.e., they learned to become oriented to the present rather than the future. According to the authors, both of these lessons contribute to the violence common among African-Americans. However, the authors acknowledged current lessons that also contribute to the prevalence of violence. First, it was argued that African-Americans deny their feelings and experiences, hence, losing some of their empathic ability. Second, it was argued that African-American youth learn to mimic conventional behavior just to get by. Third, the authors contended that games such as 'dozens' are improvisational techniques that enables the youth to practice defending themselves in unpredictable situations. According to the authors, each of these improvisational strategies helped many in this community cope with the limited opportunities available to African-Americans in the U.S. AUTHORS' RECOMMENDATIONS: The authors suggested that the concept of improvisation could not only help shed light on violence committed by African-American youth but could serve as a guide to construct meaningful and cost efficient intervention strategies. In general, the authors suggested that role playing exercises, accompanied by analyses of performance, could help young people come to grips with their fears in certain everyday violence-provoking situations. Moreover, they suggested alternative, non-violent improvisational strategies could be identified and practiced. The authors argued that such role playing could also help develop empathy by having individuals play victims. (CSPV Abstract - Copyright © 1992-2007 by the Center for the Study and Prevention of Violence, Institute of Behavioral Science, Regents of the University of Colorado) Juvenile Offender Juvenile Treatment Juvenile Violence Violence Treatment African American Violence African American Offender African American Juvenile Minority Group Violence Intervention Violence Causes Violence Treatment Literature Review Social Organization Sociocultural Factors Socioeconomic Factors Environmental Factors History of Crime-Violence Racism Racial Factors 10-03

In-depth interviews were conducted with faculty from four East Coast schools of social work. Personal comfort in the teaching of oppression content was analyzed using grounded theory methodology. Findings about the origins, nature, consequences and management of discomfort are presented.

Klinefelter Syndrome (KS) is a genetic condition that occurs only in males. In adult men, KS is associated with reproductive, cardiometabolic, bone and psychosocial health problems that are believed to emerge during peri-puberty. In children, the condition is under-diagnosed and not well understood due to the wide-ranging spectrum of physical features. Although pediatric studies are rare, androgen deficiency is believed to underlie many of the KS-related abnormalities in both physical and emotional well-being. The purpose of this dissertation was to systematically describe the physical and psychosocial health of peri-pubertal boys with KS. Aim I of the study was to explore associations between physical and psychosocial health while Aim II explored body composition and bone mineral density. For Aim I, a cross-sectional exploratory study examining the associations between physical phenotype, reproductive hormones, cardiometabolic risk factors, and psychosocial health was conducted in a sample of 43 boys with KS between the ages of 8 and 18 years. Physical examination, laboratory and self-administered psychosocial health data were analyzed using descriptive statistics and univariate and multivariate linear regression techniques. For Aim II, a retrospective chart review examining body composition and bone mineral density (BMD) was conducted of 20 KS patients ages 8-18 years who attended a pediatric endocrine practice at a Columbia University-affiliated hospital. Aim I participants demonstrated a range of physical phenotype features. On average, boys showed at least 5 KS physical traits. Gonadotropins were elevated without androgen deficiency in most boys. Adverse cardiovascular risk factors were observed in about a third of the boys with higher frequency in pubertal boys. Quality of life and self-esteem scores were low compared to reference standards; average scores for self-concept and depression were within the normal range. Physical phenotype was inversely associated with quality of life, but not with the other measures of psychosocial health. Low testosterone was associated with interpersonal problem subscale of the Children's Depression Inventory, but not for other psychosocial measures. Serum testosterone was not associated with cardiometabolic biomarkers. For Aim II, boys with KS demonstrated a higher mean body fat by Dual Energy Xray Aborptiometry (DEXA) compared to a healthy reference group and overall mean normal lumbar spine BMD. Four of the oldest boys demonstrated lower BMD than expected for age. Findings from this study suggest that in peri-pubertal boys with KS, phenotype may adversely influence quality of life especially with respect to school and physical function. The adverse psychosocial health of boys with KS may not be related to androgen deficiency. Biomarkers of cardiometabolic risk were most evident in pubertal boys. Testosterone does not appear to be a main mediating factor in cardiometabolic risk in this age group. KS boys may have increased fat as measured by DEXA and normal BMD. The onset of bone loss present in KS men may begin in late adolescence. The implications from this study include recommendations that primary care providers and developmental specialists become more familiar with the clinical pattern of KS as represented by physical, hormonal as well as behavioral signs and symptoms. In primary care, it is recommended that complete genital examination including testicular volume measurement be conducted during well-child visits and that karyotype be ordered on boys who show a high index of suspicion for this diagnosis. A multidisciplinary team-approach for management KS-related symptoms needs to be created for each child and family affected by KS with integration of services between pediatrician, endocrinologist, developmental, psychological and school specialists. It is also recommended that boys with KS be referred for baseline bone mineral assessment during adolescence.

Introduction Consensus criteria for pediatric severe sepsis have standardized enrollment for research studies. However, the extent to which critically ill children identified by consensus criteria reflect physician diagnosis of severe sepsis, which underlies external validity for pediatric sepsis research, is not known. We sought to determine the agreement between physician diagnosis and consensus criteria to identify pediatric patients with severe sepsis across a network of international pediatric intensive care units (PICUs). Methods We conducted a point prevalence study involving 128 PICUs in 26 countries across 6 continents. Over the course of 5 study days, 6925 PICU patients Results Of the 706 patients, 301 (42.6 %) met both definitions. The inter-rater agreement (κ ± SE) between physician diagnosis and consensus criteria was 0.57 ± 0.02. Of the 438 patients with a physician’s diagnosis of severe sepsis, only 69 % (301 of 438) would have been eligible to participate in a clinical trial of pediatric severe sepsis that enrolled patients based on consensus criteria. Patients with physician-diagnosed severe sepsis who did not meet consensus criteria were younger and had lower severity of illness and lower PICU mortality than those meeting consensus criteria or both definitions. After controlling for age, severity of illness, number of comorbid conditions, and treatment in developed versus resource-limited regions, patients identified with severe sepsis by physician diagnosis alone or by consensus criteria alone did not have PICU mortality significantly different from that of patients identified by both physician diagnosis and consensus criteria. Conclusions Physician diagnosis of pediatric severe sepsis achieved only moderate agreement with consensus criteria, with physicians diagnosing severe sepsis more broadly. Consequently, the results of a research study based on consensus criteria may have limited generalizability to nearly one-third of PICU patients diagnosed with severe sepsis.

hen young adolescents hurt each other withinthe contexts of attraction and dating, questions emergeconcerning the etiology and prevention of such actions.The subject of dating violence among teens has beenstudied in the literature since 1981 (Makepeace, 1981).The purpose of this work is to present a case reportregarding relationship abuse and to review the litera-ture on the subject of dating violence prevention inmiddle school and high school youth. The case reportwas generated from a health care maintenance visitconducted at a hospital-based middle school cliniclocated in the Bronx, New York. The review will examinethe problem of relational abuse among young datingadolescents, risk factors, gender differences, and currentprogram strategies for intervention. This paper willalso discuss additional strategies to assist teens in theacquisition and carry-over of newly-learned relation-ship skills as they apply to the development of inti-mate relationships.

Objective. To determine the bone marrow homing efficiency (20 hours) of cultured compared to noncultured umbilical cord blood (UCB)-derived human hematopoietic cells in the nonobese diabetic/severe combined immunodeficient (NOD/SCID) mouse, and to explain the difference in homing between these populations. Methods. Human UCB CD34 + cells were cultured for up to 5 days, reselected, and used for transplantation, phenotype analysis, and functional studies, including adhesion and trans-endothelial migration assays. Seeding of CD34 + cells was measured after labeling of cells with 111-Indium, while homing of colony-forming cells (CFC) and SCID-repopulating (SRC) cells was determined using functional assays. Results. Short-term culture was associated with a decrease in the 20-hour homing of CD34 + cells, CFC, and SRC to the BM. Although cultured compared to noncultured cells showed increased expression and function (adhesion/migration) of several cell adhesion molecules described to play a role in homing and engraftment, culture also induced expression of Fas/CD95 and rendered cells more susceptible to apoptosis. Finally, we demonstrate that the level of Fas/CD95 on cultured cells was inversely related to the ability of CFC to home to the BM, and that the homing of cultured CFC could be restored by incubating cells prior to transplantation with Fas/CD95-blocking mAb ZB4. Conclusion. These data implicate Fas/CD95 in the homing defect of cultured human hematopoietic cells in the NOD/SCID transplant model and suggest that prevention of apoptosis may be an important strategy to improve engraftment of ex vivo–manipulated HSC in a clinical setting.