Evaluating Children’s Advocacy Centers’ Response to Child Sexual Abuse

Children’s Advocacy Centers (CACs) play an increasingly significant role in the response to child sexual abuse and other child maltreatment in the United States. First developed in the 1980s, CACs were designed to reduce the stress on child abuse victims and families created by traditional child abuse investigation and prosecution procedures and to improve the effectiveness of the response. According to several experts (Fontana, 1984; Pence and Wilson, 1992; Whitcomb, 1992), child victims were subjected to multiple, redundant interviews about their abuse by different agencies, and were questioned by professionals who had no knowledge of children’s developmental limitations or experience working with children. Child interviews would take place in settings like police stations that would further stress already frightened children. Moreover, the response was hampered because the multiple agencies involved did not coordinate their investigations, and children’s need for services could be neglected

Altered in-stent hemodynamics may cause erroneous upgrading of moderate carotid artery restenosis when evaluated by duplex ultrasound

ObjectiveTo assess the influence of stent application on in-stent hemodynamics under standardized conditions.MethodsOvine common carotid arteries before and after stent (6 × 40 mm, sinus-Carotid-RXt, combined open-closed cell design; Optimed, Ettlingen, Germany) application were used. Plastic tubes, 10 mm in length, simulating stenosis were placed in the middle of the applied stent to induce different degrees of stenosis (moderate 57.8% and severe 76.4%). Flow velocity and dynamic compliance were, respectively, measured with ultrasound and laser scan; proximal, in-stent, and distal to the stented arterial segment (1 cm proximal and distal) in a pulsatile ex vivo circulation system.ResultsStent insertion caused the in-stent peak systolic velocity to increase 22% without stenosis, 31% with moderate stenosis, and 23% with severe stenosis. Stent insertion without stenosis caused no significant increase in in-stent end-diastolic velocity (EDV) but a 17% increase with moderate stenosis. In severe stenosis, EDV was increased 56% proximal to the stenosis. Compliance was reduced threefold in the middle of the stented arterial segment where flow velocity was significantly increased.ConclusionsWith or without stenosis, stent introduction caused the in-stent peak systolic velocity to become significantly elevated compared with a nonstented area. EDV was also increased by stent insertion in the case of moderate stenosis. The stent-induced compliance reduction may be causal for the increase in flow velocity since the stent-induced flow velocity elevation appeared in the stented area with low compliance. Because of altered hemodynamics caused by stent introduction when measured by duplex ultrasound, caution is prudent in concluding that carotid artery stenting is associated with a higher restenosis rate than carotid endarterectomy. Mistakenly upgrading moderate to severe restenosis could result in unnecessary reintervention.Clinical RelevanceClinical experience and prior studies support the supposition that restenosis after carotid artery stenting in carotid lesions displays erroneously elevated velocity when evaluated by duplex ultrasound (DUS), thus contributing to misleading interpretation of the degree of stenosis. This study, in contrast to studies of other groups, employs exactly the same conditions to measure flow with DUS in an unstented and then stented section of the carotid artery. Since DUS is the first-choice tool for carotid artery evaluation, knowledge about inexactness of the method is essential to avoid errors in treatment or follow-up decisions

Critical Behaviour of Non-Equilibrium Phase Transitions to Magnetically Ordered States

We describe non-equilibrium phase transitions in arrays of dynamical systems with cubic nonlinearity driven by multiplicative Gaussian white noise. Depending on the sign of the spatial coupling we observe transitions to ferromagnetic or antiferromagnetic ordered states. We discuss the phase diagram, the order of the transitions, and the critical behaviour. For global coupling we show analytically that the critical exponent of the magnetization exhibits a transition from the value 1/2 to a non-universal behaviour depending on the ratio of noise strength to the magnitude of the spatial coupling.Comment: 4 pages, 5 figure