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

Men Are More Likely than Women to Slow in the Marathon

Studies on nonelite distance runners suggest that men are more likely than women to slow their pace in a marathon. Purpose: This study determined the reliability of the sex difference in pacing across many marathons and after adjusting women\u27s performances by 12% to address men\u27s greater maximal oxygen uptake and also incorporating information on racing experience. Methods: Data were acquired from 14 US marathons in 2011 and encompassed 91,929 performances. For 2929 runners, we obtained experience data from a race-aggregating Web site. We operationalized pace maintenance as the percentage change in pace observed in the second half of the marathon relative to the first half. Pace maintenance was analyzed as a continuous variable and as two categorical variables, as follows: maintain the pace, defined as slowing=30%. Results: The mean change in pace was 15.6% and 11.7% for men and women, respectively (P \u3c 0.0001). This sex difference was significant for all 14 marathons. The odds for women were 1.46 (95% confidence interval, 1.41–1.50; P \u3c 0.0001) times higher than men to maintain the pace and 0.36 (95% confidence interval, 0.34–0.38; P \u3c 0.0001) times that of men to exhibit marked slowing. Slower finishing times were associated with greater slowing, especially in men (interaction, P \u3c 0.0001). However, the sex difference in pacing occurred across age and finishing time groups. Making the 12% adjustment to women’s performances lessened the magnitude of the sex difference in pacing but not its occurrence. Although greater experience was associated with less slowing, controlling for the experience variables did not eliminate the sex difference in pacing. Conclusions: The sex difference in pacing is robust. It may reflect sex differences in physiology, decision making, or both

Collisional stripping of planetary crusts

Geochemical studies of planetary accretion and evolution have invoked various degrees of collisional erosion to explain differences in bulk composition between planets and chondrites. Here we undertake a full, dynamical evaluation of 'crustal stripping' during accretion and its key geochemical consequences. We present smoothed particle hydrodynamics simulations of collisions between differentiated rocky planetesimals and planetary embryos. We find that the crust is preferentially lost relative to the mantle during impacts, and we have developed a scaling law that approximates the mass of crust that remains in the largest remnant. Using this scaling law and a recent set of N-body simulations, we have estimated the maximum effect of crustal stripping on incompatible element abundances during the accretion of planetary embryos. We find that on average one third of the initial crust is stripped from embryos as they accrete, which leads to a reduction of ~20% in the budgets of the heat producing elements if the stripped crust does not reaccrete. Erosion of crusts can lead to non-chondritic ratios of incompatible elements, but the magnitude of this effect depends sensitively on the details of the crust-forming melting process. The Lu/Hf system is fractionated for a wide range of crustal formation scenarios. Using eucrites (the products of planetesimal silicate melting, thought to represent the crust of Vesta) as a guide to the Lu/Hf of planetesimal crust partially lost during accretion, we predict the Earth could evolve to a superchondritic 176-Hf/177-Hf (3-5 parts per ten thousand) at present day. Such values are in keeping with compositional estimates of the bulk Earth. Stripping of planetary crusts during accretion can lead to detectable changes in bulk composition of lithophile elements, but the fractionation is relatively subtle, and sensitive to the efficiency of reaccretion.Comment: 15 pages, 9 figures. Accepted for publication in EPSL. Abstract shortened. Accompanying animations can be found at http://www.star.bris.ac.uk/pcarter/crust_strip

The emergency observation and assessment ward

A recent development to reduce ED crowding and increase urgent patient admissions is the opening of an Emergency Observation and Assessment Ward (EOA Ward). At these wards urgent patients are temporarily hospitalized until they can be transferred to an inpatient bed. In this paper we present an overflow model to evaluate the effect of employing an EOA Ward on elective and urgent patient admissions

Altered brainstem responses to modafinil in schizophrenia: implications for adjunctive treatment of cognition.

Candidate pro-cognitive drugs for schizophrenia targeting several neurochemical systems have consistently failed to demonstrate robust efficacy. It remains untested whether concurrent antipsychotic medications exert pharmacodynamic interactions that mitigate pro-cognitive action in patients. We used functional MRI (fMRI) in a randomized, double-blind, placebo-controlled within-subject crossover test of single-dose modafinil effects in 27 medicated schizophrenia patients, interrogating brainstem regions where catecholamine systems arise to innervate the cortex, to link cellular and systems-level models of cognitive control. Modafinil effects were evaluated both within this patient group and compared to a healthy subject group. Modafinil modulated activity in the locus coeruleus (LC) and ventral tegmental area (VTA) in the patient group. However, compared to the healthy comparison group, these effects were altered as a function of task demands: the control-independent drug effect on deactivation was relatively attenuated (shallower) in the LC and exaggerated (deeper) in the VTA; in contrast, again compared to the comparison group, the control-related drug effects on positive activation were attenuated in LC, VTA and the cortical cognitive control network. These altered effects in the LC and VTA were significantly and specifically associated with the degree of antagonism of alpha-2 adrenergic and dopamine-2 receptors, respectively, by concurrently prescribed antipsychotics. These sources of evidence suggest interacting effects on catecholamine neurons of chronic antipsychotic treatment, which respectively increase and decrease sustained neuronal activity in LC and VTA. This is the first direct evidence in a clinical population to suggest that antipsychotic medications alter catecholamine neuronal activity to mitigate pro-cognitive drug action on cortical circuits

A Wide-Field CCD Survey for Centaurs and Kuiper Belt Objects

A modified Baker-Nunn camera was used to conduct a wide-field survey of 1428 square degrees of sky near the ecliptic in search of bright Kuiper Belt objects and Centaurs. This area is an order of magnitude larger than any previously published CCD survey for Centaurs and Kuiper Belt Objects. No new objects brighter than red magnitude m=18.8 and moving at a rate 1"/hr to 20"/hr were discovered, although one previously discovered Centaur 1997 CU26 Chariklo was serendipitously detected. The parameters of the survey were characterized using both visual and automated techniques. From this survey the empirical projected surface density of Centaurs was found to be SigmaCentaur(m<18.8)=7.8(+16.0 -6.6)x10^-4 per square degree and we found a projected surface density 3sigma upper confidence limit for Kuiper Belt objects of SigmaKBO(m< 18.8)<4.1x10^-3 per square degree. We discuss the current state of the cumulative luminosity functions of both Centaurs and Kuiper Belt objects. Through a Monte Carlo simulation we show that the size distribution of Centaurs is consistent with a q=4 differential power law, similar to the size distribution of the parent Kuiper Belt Objects. The Centaur population is of order 10^7 (radius > 1 km) assuming a geometric albedo of 0.04. About 100 Centaurs are larger than 50 km in radius, of which only 4 are presently known. The current total mass of the Centaurs is 10^-4 Earth Masses. No dust clouds were detected resulting from Kuiper Belt object collisions, placing a 3sigma upper limit <600 collisionally produced clouds of m<18.8 per year.Comment: 13 pages, 5 figures, Accepted for Publication in A

Proactive and reactive cognitive control and dorsolateral prefrontal cortex dysfunction in first episode schizophrenia.

Cognitive control deficits have been consistently documented in patients with schizophrenia. Recent work in cognitive neuroscience has hypothesized a distinction between two theoretically separable modes of cognitive control-reactive and proactive. However, it remains unclear the extent to which these processes are uniquely associated with dysfunctional neural recruitment in individuals with schizophrenia. This functional magnetic resonance imaging (fMRI) study utilized the color word Stroop task and AX Continuous Performance Task (AX-CPT) to tap reactive and proactive control processes, respectively, in a sample of 54 healthy controls and 43 patients with first episode schizophrenia. Healthy controls demonstrated robust dorsolateral prefrontal, anterior cingulate, and parietal cortex activity on both tasks. In contrast, patients with schizophrenia did not show any significant activation during proactive control, while showing activation similar to control subjects during reactive control. Critically, an interaction analysis showed that the degree to which prefrontal activity was reduced in patients versus controls depended on the type of control process engaged. Controls showed increased dorsolateral prefrontal cortex (DLPFC) and parietal activity in the proactive compared to the reactive control task, whereas patients with schizophrenia did not demonstrate this increase. Additionally, patients' DLPFC activity and performance during proactive control was associated with disorganization symptoms, while no reactive control measures showed this association. Proactive control processes and concomitant dysfunctional recruitment of DLPFC represent robust features of schizophrenia that are also directly associated with symptoms of disorganization