Improving child protection : a systematic review of training and procedural interventions

Aim: To synthesise published evidence regarding the effectiveness of training and procedural interventions aimed at improving the identification and management of child abuse and neglect by health professionals. Methods: Systematic review for the period 1994 to 2005 of studies that evaluated child protection training and procedural interventions. Main outcome measures were learning achievement, attitudinal change, and clinical behaviour. Results: Seven papers that examined the effectiveness of procedural interventions and 15 papers that evaluated training programmes met the inclusion criteria. Critical appraisal showed that evaluation of interventions was on the whole poor. It was found that certain procedural interventions (such as the use of checklists and structured forms) can result in improved recording of important clinical information and may also alert clinical staff to the possibility of abuse. While a variety of innovative training programmes were identified, there was an absence of rigorous evaluation of their impact. However a small number of onegroup pre- and post-studies suggest improvements in a range of attitudes necessary for successful engagement in the child protection process. Conclusion: Current evidence supports the use of procedural changes that improve the documentation of suspected child maltreatment and that enhance professional awareness. The lack of an evidence based approach to the implementation of child protection training may restrict the ability of all health professionals to fulfil their role in the child protection process. Formal evaluation of a variety of models for the delivery of this training is urgently needed with subsequent dissemination of results that highlight those found to be most effective

The 2007 Provincial Election and Electoral System Referendum in Ontario

Ontario’s general election in Oct. 10, 2007, was unprecedented for several reasons. The election was held on a date fixed by legislation and not one set by the premier or his caucus, something new to Ontario and relatively new to Canadian politics. Turnout declined to 53%, the lowest ever in Ontario history. The incumbent Liberals won a second consecutive majority government, something the party had not achieved since 1937. And finally, the election featured a referendum question that asked voters in Ontario to approve reforms to the electoral system, a proposal that was overwhelmingly rejected. This article explores each of the above-stated elements as they unfolded in the election

Applicability of DNA pools on 500 K SNP microarrays for cost-effective initial screens in genomewide association studies

<p>Abstract</p> <p>Background</p> <p>Genetic influences underpinning complex traits are thought to involve multiple quantitative trait loci (QTLs) of small effect size. Detection of such QTL associations requires systematic screening of large numbers of DNA markers within large sample populations. Using pooled DNA on SNP microarrays to screen for allelic frequency differences between groups such as cases and controls (called SNP Microarray and Pooling, or SNP-MaP) has been validated as an efficient solution on both 10 k and 100 k platforms. We demonstrate that this approach can be effectively applied to the truly genomewide Affymetrix GeneChip^®Mapping 500 K Array.</p> <p>Results</p> <p>In comparisons between five independent DNA pools (<it>N </it>~200 per pool) on separate Affymetrix GeneChip^®Mapping 500 K Array sets, we show that, for SNPs with minor allele frequencies > 0.05, the reliability of the rank order of estimated allele frequencies, assessed as the average correlation between allele frequency estimates across the DNA pools, was 0.948 (average mean difference across the five pools = 0.069). Similarly, validity of the SNP-MaP approach was demonstrated by a rank-order correlation of 0.937 (average mean difference = 0.095) between the average DNA pool allele frequency estimates and the allele frequencies of an independent (CEPH) sample of 60 unrelated individually genotyped subjects.</p> <p>Conclusion</p> <p>We conclude that SNP-MaP can be extended for use on the Affymetrix GeneChip^®Mapping 500 K Array, providing a cost-effective, reliable and valid initial screen of 500 K SNP microarrays in genomewide association scans.</p

Integral-Based Identification of an Inhomogeneity Model in Respiratory Mechanics

4-pagesIndividualized models of respiratory mechanics may help to reduce potential harmful effects of ventilation therapy by predicting the outcome of certain ventilator settings. The underlying models are commonly identified by iterative error-mapping methods, such as the Levenberg-Marquardt Algorithm, requiring initial estimates for the patient specific parameters. The quality of the initial estimates has a significant influence on identification efficiency and results. An iterative integral-based parameter identification method was applied to a linear 2nd order respiratory mechanics model. The method was compared to the Levenberg-Marquardt Algorithm using clinical data from 13 Acute Respiratory Distress Syndrome (ARDS) patients. The Iterative Integral-Based Method converged to the Levenberg-Marquardt solution two times faster and was independent of initial estimates. These investigations reveal that the Iterative Integral-Based Method is beneficial with respect to computing time, operator independence and robustness

Traversing the Fuzzy Valley: Problems caused by reliance on default simulation and parameter identification programs for discontinuous models

invited, 6-pagesThe Levenberg-Marquardt parameter identification method is often used in tandem with numerical Runge-Kutta model simulation to find optimal model parameter values to match measured data. However, these methods can potentially find erroneous parameter values. The problem is exacerbated when discontinuous models are analyzed. A highly parameterized respiratory mechanics model defines a pressure-volume response to a low flow experiment in an acute respiratory distress syndrome patient. Levenberg-Marquardt parameter identification is used with various starting values and either a typical numerical integration model simulation or a novel error-stepping method. Model parameter values from the error-stepping method were consistently located close to the error minima (median deviation: 0.4%). In contrast, model values from numerical integration were erratic and distinct from the error minima (median deviation: 1.4%). The comparative failure of Runge-Kutta model simulation was due to the method’s poor handling of model discontinuities and the resultant lack of smoothness in the error surface. As the Leven-berg-Marquardt identification system is an error gradient decent method, it depends on accurate measurement of the model-to-measured data error surface. Hence, the method failed to converge accurately due to poorly defined error surfaces. When the error surface is imprecisely identified, the parameter identification process can produce sub-optimal results. Particular care must be used when gradient decent methods are used in conjunction with numerical integration model simulation methods and discontinuous models

Syntheses and Properties of Salts of Chromophores with Ferrocenyl Electron Donor Groups and Quaternary Nitrogen Acceptors

A series of five new dipolar cations has been synthesized with ferrocenyl (Fc) electron donor groups connected to N-arylpyridinium, N-methylquinolinium, N-methylbenzothiazolium, or N-methylacridinium acceptors. Together with their known N-methylpyridinium analogue, these chromophores have been characterized as their PF_6^− salts by using various techniques including electronic absorption spectroscopy and cyclic voltammetry. Nine single-crystal X-ray structures have been determined, including two polymorphs of one salt obtained from a single crystallization experiment, and two of these are polar materials. A highly favorable degree of dipolar alignment for bulk NLO effects is observed in one case. Molecular quadratic nonlinear optical (NLO) responses have been determined by using femtosecond hyper-Rayleigh scattering (HRS) at 1300 nm and also via Stark (electroabsorption) spectroscopic studies on the intense π → π^* intraligand and d → π^* metal-to-ligand charge-transfer bands. A broad correlation between the electron acceptor strength and the HRS-derived first hyperpolarizabilities β and the static first hyperpolarizabilities β0 estimated from the Stark data is evident. This is the first time that meaningful (albeit indirectly determined) β_0 data have been reported for Fc compounds, allowing quantitative comparisons with the chromophore in the technologically important material (E)-4′-(dimethylamino)-N-methyl-4-stilbazolium (DAS) tosylate. The observed β_0 values are in several cases similar to that of [DAS]PF_6, and possibly even larger in one instance

Simple and objective prediction of survival in patients with lung cancer: staging the host systemic inflammatory response

Background. Prediction of survival in patients diagnosed with lung cancer remains problematical. The aim of the present study was to examine the clinical utility of an established objective marker of the systemic inflammatory response, the Glasgow Prognostic Score, as the basis of risk stratification in patients with lung cancer. Methods. Between 2005 and 2008 all newly diagnosed lung cancer patients coming through the multidisciplinary meetings (MDTs) of four Scottish centres were included in the study. The details of 882 patients with a confirmed new diagnosis of any subtype or stage of lung cancer were collected prospectively. Results. The median survival was 5.6 months (IQR 4.8–6.5). Survival analysis was undertaken in three separate groups based on mGPS score. In the mGPS 0 group the most highly predictive factors were performance status, weight loss, stage of NSCLC, and palliative treatment offered. In the mGPS 1 group performance status, stage of NSCLC, and radical treatment offered were significant. In the mGPS 2 group only performance status and weight loss were statistically significant. Discussion. This present study confirms previous work supporting the use of mGPS in predicting cancer survival; however, it goes further by showing how it might be used to provide more objective risk stratification in patients diagnosed with lung cancer

Analytical sun synchronous low-thrust manoeuvres

Article describes analytical sun synchronous low-thrust manoeuvres

Priorities, policies and (time)scales : the delivery of emissions reductions in the UK transport sector

Peer reviewedPreprin

An Information Theoretic perspective on perceptual structure: cross-accent vowel perception

Analytical tools from Information Theory were used to quantify behaviour in cross-accent vowel perception by Australian, London, New Zealand, Yorkshire and Newcastle UK listeners. Results show that Australian listeners impose expected patterns of perceptual similarity from their own accent experience on unfamiliar accents, regardless of the actual phonetic distance between accents