8% pre-PECARN and 26.5% post-PECARN). Nine (5.7%) subjects had incidental findings (similar for both study periods), of which 3 prompted additional diagnostic testing or invasive intervention. Among those who did not meet PECARN criteria, the most common mechanism of injury was fall ( less then 3 ft).  https://www.selleckchem.com/products/decursin.html  Conclusions Implementation of PECARN guidelines at our center remained limited in the 5 years after publication of this practice guide. Clinically insignificant incidental findings were often detected and may heighten patient anxiety.Objectives Chest pain is a common cause to admission to the pediatric emergency department and often leads to an extensive cardiac evaluation. The objective of this study was to evaluate the usefulness of the troponin (TN) plasma level determination in the initial phase of the differential diagnosis of chest pain in children. Methods This is a retrospective observational study on 107 patients, aged 0 to 19 years, admitted for chest pain to the pediatric emergency department of our institution. Demographics, clinical data, and patient outcomes were analyzed. Troponin values of >0.03 ng/mL but 0.1 ng/mL were indicative of cardiac pathology. In these latter patients, an echocardiographic examination was also performed. Results Only 99 patients were evaluated with electrocardiogram (ECG). In 91 of 99 patients of our series, both TN determination and ECG recording were performed. Troponin was higher than the cutoff value (0.03 ng/mL) in 9 patients (9.1%). Only 2 of the 9 patients who presented high TN values showed a nonpathological ECG, whereas 16 (17.5%) of 91 patients in whom both ECG and TN determination were performed had ECG abnormalities without a simultaneous elevation of TN. Of the 26 patients who had medical history and suggestive targets of cardiac pathology, only in 6 (23.1%) of them the diagnosis was confirmed. The final diagnosis of the 99 patients was idiopathic chest pain in 45.4% of cases. Conclusions Even with the low cost and the relatively easiness for the plasma level determination, TN should be measured only in children with chest pain associated to familiar history suggestive of cardiovascular disease and/or clinical symptoms and/or ECG alterations.In recent years, great efforts have been exerted to minimize the rates of deterioration in clinical practice, especially in child psychotherapy. The present study explored the potential effect of routine outcome monitoring (ROM) with parents as a preventive intervention to reduce deterioration in children. Twenty-five children receiving treatment for emotional problems were randomized to parent-based, ROM-assisted group psychotherapy or to treatment as usual (TAU). A mixed-methods approach was utilized, with the number of deteriorating cases compared at the group level and two case illustrations assessed at the individual level. At the group level, there were fewer cases of deterioration in child's anxiety, parental stress, and quality of parent's alliance in the ROM-assisted group, compared with TAU. Case studies illustrated how ROM can be used as a tool to communicate with parents to prevent deterioration. Routine outcome monitoring in child psychotherapy may thus benefit therapy process and outcome. Limitations and directions for future research are discussed.A constellation of psychosocial factors contributes to the complex trauma symptoms that survivors of torture may experience. We examined the roles of pretrauma, peritrauma, and postmigration factors as predictors of posttraumatic stress disorder, depression, and anxiety in a sample of 101 culturally heterogeneous torture survivors residing in the United States. Predictors included demographic variables (sex, education, marital status), peritrauma torture type variables generated by principal components analysis (PCA), and postmigration variables (employment status, legal immigration status, and family separation). Of the torture factors identified through PCA (torture inflicted on the self and torture inflicted on family members), torture inflicted on the self significantly predicted anxiety. Undocumented legal status and female sex were related to poorer psychological outcomes. Results highlight the importance of considering postmigration factors, specifically legal status, rather than elements of the torture experience itself, in the delivery of trauma-informed psychological interventions and policy development for survivors of torture.Young refugees are a high-risk group for mental disorders, particularly for posttraumatic stress disorder (PTSD). Individuals with PTSD suffer from an altered time perspective with a focus on negative experiences in the past and a disregard for positive life events and the future. This study investigates time perspectives and psychological distress in 30 adolescent refugees from Syria and Afghanistan in Germany. Time perspective was assessed using the Zimbardo Time Perspective Inventory. The refugees exhibited a distorted time perspective that is common for individuals with PTSD a high orientation toward the negative past and a low orientation toward the positive past and future. A high orientation toward the negative past was associated with high levels of general psychological distress, PTSD symptoms, and depression. A low orientation toward the future was related to high levels of anxiety. Taking time perspective and corresponding beliefs into consideration may be advantageous when treating refugees with trauma-related disorders.Strangulation is commonly associated with certain findings at autopsy, including petechial hemorrhages in the conjunctiva and oral mucosa, contusions or abrasions of the neck, hemorrhage within the anterior and posterior neck musculature, and fractures of the hyoid bone or thyroid cartilage. We present the case of a 68-year-old woman who was found dead in her bedroom, with her husband being found dead in the garage. Her husband had shot himself, and the woman, who was lying partially on her side, had blood coming from her ear that was facing upward and was, at the scene, also believed to have been shot. Autopsy revealed no gunshot wound, but instead florid petechial hemorrhages of the face and conjunctivae, a few contusions of the left and right sides of the neck, a laceration of the lower lip, oral mucosal petechiae, focal hemorrhage in the soft tissue around the hyoid bone, and focal hemorrhages in the left and right sternohyoid muscle. The tongue had multiple contusions. Her cause of death was certified as homicidal asphyxiation, including probable strangulation.