Sperm selection is a crucial step in any assisted reproduction treatment and will facilitate optimal results if the correct protocol is chosen as per the specifics of the case.

Although standard laboratory processes like classic swim-up or density gradients are suitable in a significant number of cases, special preparation methods are required for specific situations such as elevated sperm DNA fragmentation, infectious samples to avoid viral transmissions to partner or progeny, retrograde ejaculation, high viscosity semen, immotile spermatozoa, or testicular sperm.

The objective of this chapter is to supplement the information provided in the sixth edition of the WHO laboratory manual for the examination and processing of human semen by providing a clinical explanation of the various sperm preparation protocols and discussing the selection of the most appropriate technique for a given semen sample.

This chapter provides multiple-choice questions designed to reinforce and expand your knowledge of attention deficit hyperactivity disorder, including symptom presentation and assessment, neurobiology, treatment mechanisms, clinical characteristics of treatments, treatment strategies, and considerations for special populations.

Consideration of possible alternatives to child abuse as an explanation for skeletal abnormalities during a child abuse investigation is an essential element of due diligence by all healthcare professionals involved in these cases, including and, in particular, radiologists.

Conditions which may have features resembling sequelae of child abuse include bone fragility states, conditions with metaphyseal abnormalities resembling classical metaphyseal lesions and conditions featuring subperiosteal new bone formation. Further suspicion for child abuse may be raised when there are associated extraskeletal mimics of abuse, such as skin lesions.

This chapter explores a range of genetic, nutritional and other acquired disorders which may present in this fashion.

This chapter provides multiple-choice questions designed to reinforce and expand your knowledge of neuropathic pain, including symptom presentation and assessment, neurobiology, treatment mechanisms, clinical characteristics of treatments, treatment strategies, and considerations for special populations.

This chapter reviews the principles of evidence-based medicine and evidence-based radiology as they apply to child maltreatment clinical care and research. Common pitfalls and the rise of “predatory publishing” are discussed as important challenges to rigorous medical literature appraisal and its application to clinical care and research. An approach to critical appraisal is given, to help you determine whether a study is of high quality or not. A detailed discussion of the Swedish Agency for Health Technology Assessment and Assessment of Social Services (SBU) report is included as a particular example of the misuse of evidence-based edicine principles.

This chapter provides multiple-choice questions designed to reinforce and expand your knowledge of basic neuroscience, including synaptic neurotransmission, chemical neurotransmission, receptors, ion channels, enzymes, and the relationship between genes, environment, and behavior.

This chapter discusses skeletal injuries associated with obstetric trauma during the birth process. The prevalence of obstetric injuries has decreased with modern obstetric techniques, but major injuries still occur, providing valuable insights into the mechanisms involved in similar lesions seen in abuse cases.

This chapter highlights specific types of injuries, such as clavicular fractures, long bone injuries (including subperiosteal new bone formation and fractures) and rib fractures. Clavicular fractures are the most common site of obstetric fracture, often occurring with relatively uneventful vaginal births of large babies. Long bone injuries include subperiosteal new bone formation and fractures, which may present similarly to abuse-related injuries. Radiographs and sonography play a crucial role in characterizing the extent and nature of these injuries.

This chapter emphasizes the importance of understanding and differentiating obstetric injuries from abuse-related injuries, as well as providing valuable information about the biomechanics, natural history and imaging characteristics of inflicted skeletal injuries during birth.

Compared to the ribs, long bones and skull, injuries to the hands and feet are less common findings in child abuse. Particularly in infants, these fractures carry a strong association with inflicted injury and should be sought in all imaging evaluations for suspected abuse. Meticulous attention to technique assures optimal display of hand and foot fractures. In the hand, abusive fractures most commonly involve the metacarpals, to a lesser extent the proximal phalanges, and are rarely distal. In the foot, the metatarsals are most commonly involved, particularly the first metatarsal. Most fractures of the metacarpals, metatarsals and phalanges are buckle fractures. Other fracture patterns (transverse, physeal, corner fracture) are less common. Fractures of the hands and feet usually accompany other fractures of abuse; however, they are occasionally the skeletal injury. Radiography is the chief mode of imaging abusive hand and foot fractures, though fractures may be evident with other imaging modalities.

Medical providers involved in child abuse cases will encounter a variety of issues with legal implications, including informed consent, appropriate documentation, confidentiality, mandated reporting and potential liability. Consequently, all medical providers who may become involved in child abuse cases should have a fundamental understanding of child maltreatment laws in their jurisdiction. While informed consent is a well-established medicolegal doctrine in many countries, there are often jurisdiction-specific variations in cases of suspected child maltreatment. Complete, accurate and objective medical documentation is also imperative, as medical reports are frequently submitted in legal proceedings. Care should be taken, however, to ensure appropriate release and retention of medical records in accordance with country-specific legislation (e.g., Health Insurance Portability and Accountability Act and 21st Century Cures Act in the United States). Finally, medical providers should understand their responsibility to report to the appropriate protective services agency if there is reasonable suspicion that child maltreatment has occurred. A practitioner’s failure to adhere to statutory requirements may result in negative actions against the provider.

This chapter provides multiple-choice questions designed to reinforce and expand your knowledge of psychosis and schizophrenia, including symptom presentation and assessment, neurobiology, treatment mechanisms, clinical characteristics of treatments, treatment strategies, and considerations for special populations.

Fractures are common in physically abused infants and young children, and they are often central to the diagnosis of maltreatment. Given the anatomic and biologic framework provided in the preceding chapter, the discussion now moves on to the specific features of these important and frequently distinctive osseous injuries. The authors begin with a review of the epidemiology, anatomic distribution and specificity of fractures noted in abused infants and children. The discussion then proceeds to systematically describe the specific osseous alterations, providing radiologic correlations with histopathology to enhance the reader’s understanding of the various patterns of bony injury and repair. These correlations also help to elucidate the proposed mechanisms underlying these important indicators of abusive injury. Although this discussion of the imaging features focuses on fractures of the long bones, the principles presented here should serve as a background for subsequent chapters dealing with injuries of the axial skeleton.