RESUMEN
OBJECTIVES: Human trafficking is a public health issue that has substantial health consequences. However, research on the preparedness of health facilities to serve people who have experienced or are experiencing human trafficking is limited. We examined health facility preparedness related to human trafficking in Michigan. METHODS: We used a cross-sectional design to explore health facility preparedness related to human trafficking in Michigan. We sampled 10 prosperity regions according to health facility type (Federally Qualified Health Centers, health departments, and hospitals). An email invitation was sent to identified health facility personnel (eg, administrators, physicians, nurses) from May to June 2019 with a link to a 26-item survey with items about current policies, protocols, and areas for improvement related to human trafficking. RESULTS: Forty-two Federally Qualified Health Centers, health departments, and hospitals responded to the survey. Most health facilities had screening policies and response protocols related to child maltreatment (screening: 32/41 [78.0%]; response: 38/40 [95.0%]) and intimate partner violence (screening: 33/41 [80.5%]; response: 37/40 [92.5%]). However, fewer facilities had a screening policy (16/41 [39.0%]) and response protocol (25/40 [62.5%]) for human trafficking; more of these facilities focused on sex trafficking than on labor trafficking. The top needs related to human trafficking were (1) individual-level health care provider training, (2) health facility-level screening policies and response protocols, (3) community-level resources, and (4) societal-level awareness, funding allocation, and data. CONCLUSIONS: Facility-level resources are needed to ensure that health care providers have adequate training and support to address human trafficking in the health care system.
Asunto(s)
Trata de Personas , Niño , Estudios Transversales , Instituciones de Salud , Trata de Personas/prevención & control , Humanos , Michigan , Encuestas y CuestionariosRESUMEN
OBJECTIVE: To detail the 9-year experience of renal trauma at a modern Level 1 trauma centre and report on patterns of injury, management and complications. PATIENTS AND METHODS: We analysed 338 patients with renal injuries who presented to our institution over a 9-year period. Data on demographics, clinical presentation, management and complications were recorded. RESULTS: Males comprised 74.9% of patients with renal injuries and the highest incidence was amongst those aged 20-24 years. Blunt injuries comprised 96.2% (n = 325) of all the renal injuries, with road trauma being the predominant mechanism accounting for 72.5% of injuries. The distribution of injury grade was; 21.6% grade 1 (n = 73), 24.3% grade 2 (n = 82), 24.9% grade 3 (n = 84), 16.6% grade 4 (n = 56), and 12.7% grade 5 (n = 43). Conservative management was successful in all grade 1 and 2 renal injuries, and 94.9%, 90.7% and 35.1% of grade 3, 4 and 5 injuries respectively. All but one of the 13 patients with penetrating injuries were successfully managed conservatively. CONCLUSIONS: Road trauma is the greatest cause of renal injury. Most haemodynamically stable patients are successfully managed conservatively.
Asunto(s)
Riñón/lesiones , Heridas no Penetrantes/epidemiología , Heridas Penetrantes/epidemiología , Accidentes de Tránsito/estadística & datos numéricos , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Australia , Embolización Terapéutica/estadística & datos numéricos , Femenino , Humanos , Riñón/cirugía , Masculino , Persona de Mediana Edad , Nefrectomía/estadística & datos numéricos , Estudios Retrospectivos , Centros Traumatológicos/estadística & datos numéricos , Resultado del Tratamiento , Heridas no Penetrantes/terapia , Heridas Penetrantes/terapia , Adulto JovenRESUMEN
We report a case of compassionate use of a haemoglobin-based oxygen carrier in a severely injured Jehovah's Witness patient, for whom survival was considered unlikely. Severe anaemia and cardiac hypoxia were reversed after slow infusion of this agent. No vasoactive side effects were associated with the treatment, possibly due to the slow infusion, and the patient survived.
Asunto(s)
Anemia/tratamiento farmacológico , Sustitutos Sanguíneos/administración & dosificación , Hemoglobinas/administración & dosificación , Testigos de Jehová , Isquemia Miocárdica/tratamiento farmacológico , Religión y Medicina , Heridas y Lesiones/complicaciones , Accidentes de Tránsito , Adulto , Anemia/sangre , Anemia/etiología , Pérdida de Sangre Quirúrgica/prevención & control , Transfusión Sanguínea/ética , Ensayos de Uso Compasivo , Femenino , Humanos , Hipoxia/sangre , Hipoxia/tratamiento farmacológico , Hipoxia/etiología , Isquemia Miocárdica/etiología , Resultado del TratamientoRESUMEN
PURPOSE: To retrospectively compare computer-aided mammographic density estimation (MDEST) with radiologist estimates of percentage density and Breast Imaging Reporting and Data System (BI-RADS) density classification. MATERIALS AND METHODS: Institutional Review Board approval was obtained for this HIPAA-compliant study; patient informed consent requirements were waived. A fully automated MDEST computer program was used to measure breast density on digitized mammograms in 65 women (mean age, 53 years; range, 24-89 years). Pixel gray levels in detected breast borders were analyzed, and dense areas were segmented. Percentage density was calculated by dividing the number of dense pixels by the total number of pixels within the borders. Seven breast radiologists (five trained with MDEST, two not trained) prospectively assigned qualitative BI-RADS density categories and visually estimated percentage density on 260 mammograms. Qualitative BI-RADS assessments were compared with new quantitative BI-RADS standards. The reference standard density for this study was established by allowing the five trained radiologists to manipulate the MDEST gray-level thresholds, which segmented mammograms into dense and nondense areas. Statistical tests performed include Pearson correlation coefficients, Bland-Altman agreement method, kappa statistics, and unpaired t tests. RESULTS: There was a close correlation between the reference standard and radiologist-estimated density (R = 0.90-0.95) and MDEST density (R = 0.89). Untrained radiologists overestimated percentage density by an average of 37%, versus 6% for trained radiologists (P < .001). MDEST showed better agreement with the reference standard (average overestimate, 1%; range, -15% to +18%). MDEST correlated better with percentage density than with qualitative BI-RADS categories. There were large overlaps and ranges of percentage density in qualitative BI-RADS categories 2-4. Qualitative BI-RADS categories correlated poorly with new quantitative BI-RADS categories, and 16 (6%) of 260 views were erroneously classified by MDEST. CONCLUSION: MDEST compared favorably with radiologist estimates of percentage density and is more reproducible than radiologist estimates when qualitative BI-RADS density categories are used. Qualitative and quantitative BI-RADS density assessments differed markedly.
Asunto(s)
Neoplasias de la Mama/clasificación , Neoplasias de la Mama/diagnóstico por imagen , Mamografía , Interpretación de Imagen Radiográfica Asistida por Computador , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Persona de Mediana Edad , Estudios RetrospectivosRESUMEN
BACKGROUND: Cu-diacetyl-bis(N4-methylthiosemicarbazone) [Cu-ATSM], although excellent for oncology applications, may not be suitable for delineating cardiovascular or neurological hypoxia. For this reason, new Cu hypoxia positron emission tomography (PET) imaging agents are being examined to search for a higher selectivity for hypoxic or ischemic tissue at higher oxygen concentrations found in these tissues. Two approaches are to increase alkylation or to replace the sulfur atoms with selenium, resulting in the formation of selenosemicarbazones. METHODS: Three 64Cu-labeled selenosemicarbazone complexes were synthesized and one was screened for hypoxia selectivity in vitro using EMT-6 mouse mammary carcinoma cells. Rodent biodistribution and small animal PET images were obtained from BALB/c mice implanted with EMT-6 tumors. One alkylated thiosemicarbazone was synthesized and examined. RESULTS: Of the three bis(selenosemicarbazone) ligands synthesized and examined, only 64Cu-diacetyl-bis(selenosemicarbazone) [64Cu-ASSM] was isolated in high-enough radiochemical purity to undertake cell uptake experiments where uptake was shown to be independent of oxygen concentration. The bis(thiosemicarbazone) complex synthesized, 64Cu-diacetyl-bis(N4-ethylthiosemicarbazone) [64Cu-ATSE], showed hypoxia selectivity similar to 64Cu-ATSM although at a higher oxygen concentration. Biodistribution studies for 64Cu-ASSM and 64Cu-ATSE showed high tumor uptake at 20 min (64Cu-ASSM, 10.33+/-0.78% ID/g; 64Cu-ATSE, 7.71+/-0.46% ID/g). PET images of EMT-6 tumor-bearing mice visualized the tumor with 64Cu-ATSE and revealed hypoxia selectivity consistent with the in vitro data. CONCLUSION: Of the compounds synthesized, only 64Cu-ASSM and 64Cu-ATSE could be examined in vitro and in vivo. Although the stability of bis(selenosemicarbazone) complexes increased upon addition of methyl groups to the diimine backbone, the fully alkylated species, 64Cu-ASSM, demonstrated no hypoxia selectivity. However, the additional alkylation present in Cu-ATSE modifies the hypoxia selectivity and in vivo properties when compared with Cu-ATSM.
Asunto(s)
Hipoxia de la Célula , Radioisótopos de Cobre/farmacocinética , Neoplasias Mamarias Animales/diagnóstico por imagen , Neoplasias Mamarias Animales/metabolismo , Oxígeno/metabolismo , Semicarbazonas/farmacocinética , Animales , Línea Celular Tumoral , Femenino , Marcaje Isotópico/métodos , Tasa de Depuración Metabólica , Ratones , Ratones Endogámicos BALB C , Especificidad de Órganos , Tomografía de Emisión de Positrones/métodos , Radiofármacos/farmacocinética , Distribución TisularRESUMEN
Marsupials are good experimental animals for developmental studies as their offspring are born at a stage comparable to embryonic stages of eutherian species. The South American opossum, Monodelphis domestica, is particularly useful because of its small size and easy maintenance. This study was carried out to compare development of opossum fore- and hindlimbs during postnatal life, using light microscopy and whole mount alizarin staining. At birth, well-developed mobile forelimbs show cartilage models of bones and myotubular striated muscle fibres. However, hindlimbs are relatively underdeveloped paddle-like outgrowths. Two days later mesodermal condensations form models of the future hindlimb bones and mononucleate myoblast aggregates are present; by 6 days post partum (dpp) the hindlimb has reached a stage of development similar to that of the forelimb at birth. At this stage, periosteal buds have invaded forelimb long bones and nuclei in forelimb muscle fibres have become displaced to the periphery. The 16 dpp hindlimb shows long bones invaded by periosteal buds and closely packed, striated muscle fibres. Epiphyseal plates are now seen in the forelimb long bones and forelimb muscle fibres show mature characteristics. Musculoskeletal development is well correlated with the functional demands of the limbs during postnatal development in the opossum, which provides an excellent model for investigations into the genes and molecules controlling limb development.