Ross M. Clark

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.

There is no benefit to universal carotid artery duplex screening before a major cardiac surgical procedure.

BACKGROUND Perioperative stroke is a devastating complication after cardiac surgery. In an attempt to minimize this complication, many cardiac surgeons routinely preoperatively order carotid artery duplex scans to assess for significant carotid stenosis. We hypothesize that the routine screening of preoperative cardiac surgery patients with carotid artery duplex scans detects few patients who would benefit from carotid intervention or that a significant carotid stenosis reliably predicts stroke risk after cardiac surgery. METHODS A retrospective review identified 1,499 patients who underwent cardiac surgical procedures between July 1999 and September 2010. Data collected included patient demographics, comorbidities, history of previous stroke, preoperative carotid artery duplex scan results, location of postoperative stroke, and details of carotid endarterectomy (CEA) procedures before, in conjunction with, or after cardiac surgery. Statistical methods included univariate analysis and Fishers exact test. RESULTS Twenty-six perioperative strokes were identified (1.7%). In the 21 postoperative stroke patients for whom there is complete carotid artery duplex scan data, 3 patients had a hemodynamically significant lesion (>70%) and 1 patient underwent unilateral carotid CEA for bilateral disease. Postoperative strokes occurred in the anterior cerebral circulation (69.2%), posterior cerebral circulation (15.4%), or both (15.4%). Patient comorbidities, preoperative carotid artery duplex scan screening velocities, or types of cardiac surgical procedure were not predictive for stroke. Thirteen patients (0.86%) underwent CEA before, in conjunction with, or after cardiac surgery. Two of these patients had symptomatic disease, 1 of whom underwent CEA before and the other after his cardiac surgery. Of the 11 asymptomatic patients, 2 underwent CEA before, 3 concurrently, and 6 after cardiac surgery. Left main disease (≥50% stenosis), previous stroke, and peripheral vascular disease were found to be statistically significant predictors of carotid revascularization. A cost analysis of universal screening resulted in an estimated net cost of

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

378,918 during the study period. CONCLUSIONS The majority of postoperative strokes after cardiac surgery are not related to extracranial carotid artery disease and they are not predicted by preoperative carotid artery duplex scan screening. Consequently, universal carotid artery duplex scan screening cannot be recommended and a selective approach should be adopted.

Myocutaneous revascularization following graded ischemia in lean and obese mice

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.

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

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.

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

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

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.

DERIVATION AND VALIDATION OF A SHORT EMERGENCY DEPARTMENT SCREENING TOOL FOR PERPETRATORS OF INTIMATE PARTNER VIOLENCE: THE PERPETRATOR RAPID SCALE (PERPS)

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

PC234. Preliminary Investigation of Venous Flow Restoration in a Murine Model of Unilateral Hind Limb Venous Occlusion

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.