Brittany Coffman

Adult intimate partner violence perpetrators are significantly more likely to have witnessed intimate partner violence as a child than nonperpetrators

BACKGROUND In a previous study, no association was found between intimate partner violence (IPV) victims and being an adult who witnessed IPV as a child (ACW). OBJECTIVE The objective of the present study was to determine whether perpetrators of IPV (Perps) could be identified in a busy emergency department (ED) and whether Perps were more likely than non-Perps to be ACWs. The hypothesis was that Perps differed significantly from non-Perps in being ACWs, in being victims of IPV, and in demographics. METHODS The design was a cross-sectional cohort of patients presenting to an academic ED during randomized 4-hour shifts. A choice of computer touch screen data vs paper format was offered. Data collected included demographics as well as scales to determine whether subjects were a Perp, victim, and/or ACW of IPV. Six validated scales were used to screen and confirm victims, Perps, and ACWs. Predictor variables were ACW, ongoing IPV, and demographics. RESULTS Two hundred thirty-six subjects were entered, 207 had complete data sets. Forty-four (19%) were Perps. By univariate analysis, there was a significant correlation of Perps and ACW (P = .001 by single question) and between Perp and being victims (P = .001). No other univariate variables were significantly correlated. By regression analysis, significant predictors of Perp included ACW and spouse drug abuse. CONCLUSIONS The Perps were identified in a busy ED setting. Perps were significantly more likely than non-Perps to be ACWs, but not more likely to be victims. Spouse drug abuse and ACW were the 2 significant predictors of Perp.

Investigation of Open Abdomen Visceral Skin Graft Revascularization and Separation from Peritoneal Contents

Background: Despite increasing survival following damage control laparotomy and open abdomen technique, little is known about the biology of visceral skin graft revascularization and separation from peritoneal contents. Methods: Following laparotomy for trauma, patients with visceral edema preventing fascial closure underwent Vicryl mesh closure followed by visceral split-thickness skin grafting and readmission graft excision and abdominal wall reconstruction. Utilizing laser speckle contrast imaging, immunochemical staining of histologic sections, and RT-PCR array technology, we examined the revascularization, microvascular anatomy, morphology, and change in gene expression of visceral skin grafts. Results: Ten patients ranging in age from 25 to 46 years underwent visceral grafting for cutaneous coverage of an open abdomen. Skin graft perfusion peaked at a mean of 350 PU by post-operative day 14 synchronous with closure of meshed interstices, and remained constant until excision. Time to graft excision ranged from 6 to 18 months. CD-31 immunostaining documented a significant (p = 0.04) increase in vascular surface area in excised grafts compared to control skin. Trichrome staining revealed an 8-fold increase in excised graft thickness. Mesothelial cells were identified within the dermal matrix of excised grafts. RT-PCR demonstrated significant up-regulation of genes involved in matrix structure and remodeling, cytoskeleton regulation, and WNT signaling; and down-regulation of genes involved in inflammation and matrix proteolysis in excised grafts compared to control skin. Conclusion: Our data document early visceral skin graft perfusion and a plateau in revascularization. Histology reveals a robust dermal matrix populated by fibroblasts and mesothelial cells within a complex supporting vascular network. Genetic analysis of excised grafts reveals growth factor, collagen, and matrix remodeling gene expression.

Myocutaneous revascularization following graded ischemia in lean and obese mice

Background Murine models of diabetes and obesity have provided insight into the pathogenesis of impaired epithelialization of excisional skin wounds. However, knowledge of postischemic myocutaneous revascularization in these models is limited. Materials and methods A myocutaneous flap was created on the dorsum of wild type (C57BL/6), genetically obese and diabetic (ob/ob, db/db), complementary heterozygous (ob+/ob−, db+/db−), and diet-induced obese (DIO) mice (n=48 total; five operative mice per strain and three unoperated mice per strain as controls). Flap perfusion was documented by laser speckle contrast imaging. Local gene expression in control and postoperative flap tissue specimens was determined by quantitative reverse transcription polymerase chain reaction (RT-PCR). Image analysis of immunochemically stained histologic sections confirmed microvascular density and macrophage presence. Results Day 10 planimetric analysis revealed mean flap surface area necrosis values of 10.8%, 12.9%, 9.9%, 0.4%, 1.4%, and 23.0% for wild type, db+/db−, ob+/ob−, db/db, ob/ob, and DIO flaps, respectively. Over 10 days, laser speckle imaging documented increased perfusion at all time points with revascularization to supranormal perfusion in db/db and ob/ob flaps. In contrast, wild type, heterozygous, and DIO flaps displayed expected graded ischemia with failure of perfusion to return to baseline values. RT-PCR demonstrated statistically significant differences in angiogenic gene expression between lean and obese mice at baseline (unoperated) and at day 10. Conclusion Unexpected increased baseline skin perfusion and augmented myocutaneous revascularization accompanied by a control proangiogenic transcriptional signature in genetically obese mice compared to DIO and lean mice are reported. In future research, laser speckle imaging has been planned to be utilized in order to correlate spatiotemporal wound reperfusion with changes in cell recruitment and gene expression to better understand the differences in wound microvascular biology in lean and obese states.

Hibernoma: diagnostic and surgical considerations of a rare benign tumour

Hibernoma is a rare, benign tumour of brown fat origin. Less than 250 cases have been reported in the literature. We present a case of a 19-year-old man referred to surgical oncology for evaluation of a large soft tissue mass near the apex of his right scapula. Complete surgical excision was performed, sparing the overlying latissimus dorsi musculature. Surgical pathology revealed findings were consistent with hibernoma, grossly showing a well-encapsulated fluctuant mass measuring 21.4×14.4×5.3 cm, and histologically composed of brown fat adipocytes. The mainstay of treatment is surgical excision of the mass. Primary goals of the operation include complete removal of the mass to prevent recurrence and sparing of adjacent structures as it is a benign, non-invasive tumour. We present a case of a large chest wall hibernoma in a young adult, diagnosed on final pathology after complete surgical excision.

Management of splenic ectopic pregnancy presenting with massive haemoperitoneum.

Abdominal ectopic pregnancy (EP) accounts for only 1.3% of EPs and occurs when a fertilised ovum implants in an extrapelvic peritoneal location. Primary splenic pregnancy is a rare type of abdominal EP, with only 16 cases previously reported in the literature. Early diagnosis is essential as delay in treatment carries significant potential for morbidity and mortality. We present the case of a 27-year-old woman presenting with left upper quadrant abdominal pain, elevated human chorionic gonadotropin levels, absence of intrauterine gestational sac and massive haemoperitoneum on transvaginal ultrasound. The patient underwent emergent surgical exploration for high suspicion of ruptured abdominal EP. An open splenectomy was performed when the source of bleeding was confirmed to originate from the left upper quadrant. Final pathology confirmed subcapsular gestational sac implantation within the spleen. While two cases of medical management have been reported, splenectomy remains the current definitive management of rare cases of primary splenic pregnancy.

WITNESSING INTIMATE PARTNER VIOLENCE (IPV) AS A CHILD DOES NOT INCREASE THE LIKELIHOOD OF BECOMING AN ADULT AN ADULT VICTIM OF INTIMATE PARTNER VIOLENCE.: 34

Objective Intimate partner violence (IPV) perpetration has been associated with alcohol, drug use, and witnessing IPV as a child. Associations between being a child witness and being an IPV victim are not well established. The hypothesis of the present study was that child witnesses were different from non-child witnesses in race, education, gender, insurance, children in the home, marital status, income, age, and IPV positivity. Methods A confidential touch screen data entry program was used to collect demographic data. The Ongoing Violence Assessment Tool (OVAT), a validated screen of ongoing IPV, was used during a prospective study that used randomized 4-hour shifts in an academic ED. Randomized 4-hour shifts were determined via a random numbers table. Subjects were given an informational consent form before participation, following IRB procedure. Trained research associates approached potential subjects during shifts to enter the study. The power of the study was 80% to show a difference of 20% between groups, with a total of 260 patients entered and 20% positive for IPV. Results 280 subjects were entered in the study. Subjects were 50% male; 46% were Hispanic and 36% were Caucasian. Seventy-two (26%) subjects were child witnesses and 208 (74%) were non-child witnesses. Overall, 63 (23.5%) were positive for ongoing IPV. By univariate analysis there was no significant correlation of child witnessing of IPV with race, education, gender, insurance, children in the home, or marital status. Child witnesses were also not more likely to drink, use drugs, or have spouses who drink or use drugs. Correlation of child witnessing with IPV positivity (p = .07) was borderline in that 23 of 74 (32%) of the child witnesses and 39 of 184 (21%) of the non-child witnesses were positive for IPV. Significant correlations with child witnessing included age less than 40 (OR 3.9; 95% CI 1.7-8.9), income less than

WITNESSING INTIMATE PARTNER VIOLENCE (IPV) AS A CHILD DOES NOT INCREASE THE LIKELIHOOD OF BECOMING AN ADULT IPV VICTIM.: 7

20,000/year (OR 5.2; 95% CI 1.8-14.7), and abuse as a child (OR 9.8; 95% CI 4.6-20.7). Conclusions Child witnesses were more likely to have lower income, be younger, and have been abused as a child. They were not more likely to be positive for ongoing IPV, although there was a trend in that direction.

Witnessing Intimate Partner Violence as a Child Does Not Increase the Likelihood of Becoming an Adult Intimate Partner Violence Victim

Objective Intimate partner violence (IPV) perpetration has been associated with alcohol, drug use, and witnessing IPV as a child. Associations between being a child witness and being an IPV victim are not well established. The hypothesis of the present study was that child witnesses were different from non-child witnesses in race, education, gender, insurance, children in the home, marital status, income, age, and IPV positivity. Methods A confidential touch screen data entry program was used to collect demographic data. The Ongoing Violence Assessment Tool (OVAT), a validated screen of ongoing IPV, was used during a prospective study that used randomized 4-hour shifts in an academic ED. Randomized 4-hour shifts were determined via a random numbers table. Subjects were given an informational consent form before participation, following IRB procedure. Trained research associates approached potential subjects during shifts to enter the study. The power of the study was 80% to show a difference of 20% between groups, with a total of 260 patients entered and 20% positive for IPV. Results 280 subjects were entered in the study. Subjects were 50% male; 46% were Hispanic and 36% were Caucasian. Seventy-two (26%) subjects were child witnesses and 208 (74%) were non-child witnesses. Overall, 63 (23.5%) were positive for ongoing IPV. By univariate analysis there was no significant correlation of child witnessing of IPV with race, education, gender, insurance, children in the home, or marital status. Child witnesses were also not more likely to drink, use drugs, or have spouses who drink or use drugs. Correlation of child witnessing with IPV positivity (p = .07) was borderline in that 23 of 74 (32%) of the child witnesses and 39 of 184 (21%) of the non-child witnesses were positive for IPV. Significant correlations with child witnessing included age less than 40 (OR 3.9; 95% CI 1.7-8.9), income less than

Narrowing the FOXF1 distant enhancer region on 16q24.1 critical for ACDMPV

20,000/year (OR 5.2; 95% CI 1.8-14.7), and abuse as a child (OR 9.8; 95% CI 4.6-20.7). Conclusions Child witnesses were more likely to have lower income, be younger, and have been abused as a child. They were not more likely to be positive for ongoing IPV, although there was a trend in that direction.