Too Many Teens: Preventing Unnecessary Out-Of-Home Placements

The child welfare system was created to care for abused and neglected children. But too often, teenagers are landing in the system because they simply aren't getting along with their parents. This paper traces Casey's efforts to learn from communities that are preventing teens from landing in the system by helping families while the teen remains at home. A survey of the states, interviews with experts, secondary research and visits to several communities show common elements of successful programs.The paper presents information on related laws and policies, funding sources and programs for families while including the infrastructure and services needed to support such initiatives

Prologue to Autobiography

The guests had arrived for the christening. A steady stream of admiring relatives and close friends filed past the ruffled bassinet wherein lay the object of all eyes -- the baby. Last in that long line came the eighty year old great-grandmother, whose still clear eyes told of that indomitable spirit contained in her tiny form. With bated breath the rest of the family watched her stoop over the baby, catch her breath, and straighten up with an inscrutable smile on her rather thin lips

Investigating the risk of intracranial haemorrhage or focal neurological deficit in adults diagnosed with cerebral cavernous malformation

Background A cerebral cavernous malformation (CCM) is a small cluster of thin-walled, dilated blood vessels within the brain which is prone to bleed. Although the quantity of blood leaking tends to be small, even a small intracranial haemorrhage (ICH) can result in a clinically significant neurological deficit. Because some focal neurological deficits (FND) may in fact be haemorrhages that were undetected by imaging, FND were also included in the analysis wherever possible. In Scotland, between 2006 and 2010, the annual CCM detection rate was 0.8 per 100,000 people. Since estimates of prognosis inform decisions about whether to treat CCM, it is crucial that the untreated clinical course of the disease is fully understood. Aim The aims of this thesis are (i) to quantify the risk of ICH (or ICH or FND, referred to as ‘clinical event’) for an untreated adult within five years of CCM diagnosis, (ii) to identify prognostic factors for ICH (clinical event), and (iii) to create a model to predict, at the time of diagnosis, an individual’s risk of a subsequent ICH (clinical event). Methods Initially, a literature review was undertaken. Then data from adults diagnosed with CCM in the Scottish Intracranial Vascular Malformation Study (SIVMS) were analysed. SIVMS is a prospective, population-based cohort study: it includes all adults resident in Scotland at the time of diagnosis of a first-ever intracranial vascular malformation during the two five-year periods 1999–2003 and 2006–2010. Time-to-event methods were employed to compare the estimated risk of ICH (clinical event) for those who experienced a first ICH (clinical event) during untreated five-year follow-up with those who experienced a second ICH (clinical event). A statistical challenge when analysing clinical outcomes from patients with CCM is that the outcome event of ICH or FND is comparatively rare; therefore a larger cohort of CCM patients was required to identify more robustly potential predictors of ICH (clinical event) and to create a prognostic model to predict, at the time of diagnosis, an individual’s risk of a subsequent ICH (clinical event). Three research groups agreed to contribute their data to enable an individual patient data meta-analysis (IPDMA) to be undertaken. Results In the two SIVMS cohorts, 136 (1999–2003) and 165 adults (2006–2010) were diagnosed with CCM. In the earlier cohort, the estimated risk of a first ICH within five years of presentation (2.4%, 95% CI 0.0% to 5.7%) was significantly lower (p < 0.0001) than the risk of a recurrent ICH (31.9%, 95% CI 4.5% to 59.3%), but the annual risk of a recurrence declined over the five-year period. In the same cohort, women had an increased risk of a second clinical event (log-rank χ2(1) = 6.2, p = 0.01). The IPDMA was based on 988 adults, 62 of whom suffered a first ICH within five years of CCM diagnosis. When the data were pooled, the estimated adjusted hazard ratio for first ICH for clinical presentation (ICH/FND vs other presentation) was 4.5 (95% CI 1.5 to 13.4) and for brainstem location (brainstem vs other location) the adjusted hazard ratio was 3.3 (95% CI 1.5 to 7.2); age, sex and CCM multiplicity did not add any additional prognostic information. Conclusion In this thesis two risk factors have been identified that are independently associated with increased likelihood of experiencing an ICH (or clinical event) within five years of diagnosis. A prognostic model has been built and evaluated, based on these factors. Other areas to be explored in the future include external validation of the model and investigating the effects of (i) antithrombotic therapy and (ii) pregnancy on the progression of the disease

On the logical structure of Bell theorems without inequalities

Bell theorems show how to experimentally falsify local realism. Conclusive falsification is highly desirable as it would provide support for the most profoundly counterintuitive feature of quantum theory - nonlocality. Despite the preponderance of evidence for quantum mechanics, practical limits on detector efficiency and the difficulty of coordinating space-like separated measurements have provided loopholes for a classical worldview; these loopholes have never been simultaneously closed. A number of new experiments have recently been proposed to close both loopholes at once. We show some of these novel designs fail in the most basic way, by not ruling out local hidden variable models, and we provide an explicit classical model to demonstrate this. They share a common flaw, which reveals a basic misunderstanding of how nonlocality proofs work. Given the time and resources now being devoted to such experiments, theoretical clarity is essential. Our explanation is presented in terms of simple logic and should serve to correct misconceptions and avoid future mistakes. We also show a nonlocality proof involving four participants which has interesting theoretical properties.Comment: 8 pages, text clarified, explicit LHV model provided for flawed nonlocality tes

Forest land ownership change in Finland : COST Action FP1201 FACESMAP country report

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Book Reviews

Reviews of the following books: The Long Argument: English Puritanism and the Shaping of New England Culture, 1570-1700 by Stephen Foster; The Salem Witch Crisis by Larry Gragg; A Home for Everyman: The Greek Revival and Maine Domestic Architecture by Joyce K. Bibber; The Gunpowder Mills of Maine by Maurice W. Hitten; In the Hands of Providence: Joshua L. Chamberlain And The American Civil War by Alice Rains Trulock; Hurricane Island: The Town That Disappeared by Eleanor Motley Richardson; Home Front On Penobscot Bay: Rockland During The War Years, 1940-1945by Paul G. Merriam, Thomas J. Molloy, and Theodore W. Sylvester, Jr.; The History of Broadcasting in Maine: The First Fifty Yearsby Ellie Thompson; New Compass Points by Roy P. Fairfiel

Symptom Clusters in Acute Myocardial Infarction: A Secondary Data Analysis

Background: Early recognition of acute myocardial infarction (AMI) symptoms and reduced time to treatment may reduce morbidity and mortality. People having AMI experience a constellation of symptoms, but the common constellations or clusters of symptoms have yet to be identified. Objectives: To identify clusters of symptoms that represent AMI. Methods: This was a secondary data analysis of nine descriptive, cross-sectional studies that included data from 1,073 people having AMI in the United States and England. Data were analyzed using latent class cluster analysis, an atheoretical method that uses only information contained in the data. Results: Five distinct clusters of symptoms were identified. Age, race, and sex were statistically significant in predicting cluster membership. None of the symptom clusters described in this analysis included all of the symptoms that are considered typical. In one cluster, subjects had only a moderate to low probability of experiencing any of the symptoms analyzed. Discussion: Symptoms of AMI occur in clusters, and these clusters vary among persons. None of the clusters identified in this study included all of the symptoms that are included typically as symptoms of AMI (chest discomfort, diaphoresis, shortness of breath, nausea, and lightheadedness). These AMI symptom clusters must be communicated clearly to the public in a way that will assist them in assessing their symptoms more efficiently and will guide their treatment-seeking behavior. Symptom clusters for AMI must also be communicated to the professional community in a way that will facilitate assessment and rapid intervention for AMI

Site-Selective Aliphatic C–H Chlorination Using N -Chloroamides Enables a Synthesis of Chlorolissoclimide

Methods for the practical, intermolecular functionalization of aliphatic C-H bonds remain a paramount goal of organic synthesis. Free radical alkane chlorination is an important industrial process for the production of small molecule chloroalkanes from simple hydrocarbons, yet applications to fine chemical synthesis are rare. Herein, we report a site-selective chlorination of aliphatic C-H bonds using readily available N-chloroamides and apply this transformation to a synthesis of chlorolissoclimide, a potently cytotoxic labdane diterpenoid. These reactions deliver alkyl chlorides in useful chemical yields with substrate as the limiting reagent. Notably, this approach tolerates substrate unsaturation that normally poses major challenges in chemoselective, aliphatic C-H functionalization. The sterically and electronically dictated site selectivities of the C-H chlorination are among the most selective alkane functionalizations known, providing a unique tool for chemical synthesis. The short synthesis of chlorolissoclimide features a high yielding, gram-scale radical C-H chlorination of sclareolide and a three-step/two-pot process for the introduction of the β-hydroxysuccinimide that is salient to all the lissoclimides and haterumaimides. Preliminary assays indicate that chlorolissoclimide and analogues are moderately active against aggressive melanoma and prostate cancer cell lines

Developing the React to Falls resources to support care home staff in managing falls

Objectives: Care home residents are falling three times more often than elderly frail people living in their own homes and as such, the management of falls is an important area for care home staff to consider. This paper outlines the development of the ‘React to Falls’ training resources to support care home staff in the management of falls. Methods: The ‘React to Falls’ resources were developed in collaboration with falls prevention researchers, expert clinicians working in the field of falls management in care homes and care home staff and residents. Results: A freely accessible online and paper based resource was developed to meet the needs of different care home settings. Expert clinicians and care homes emphasised the importance of promoting activity and quality life and ensuring the resources were a learning tool that supported positive risk taking. Expert clinicians highlighted the need to convey the importance of continually reacting to reducing risk in the management of falls. Conclusions: This study has developed a set of training resources on falls management to support care home staff to continually react and consider the risks and management of falls. An evaluation of the impact of the resource on care staff behaviour and organisational changes is recommended