Systematic review of interventions for the secondary prevention and treatment of emotional abuse of children by primary carers

Background Emotional abuse (or psychological maltreatment, as it is more commonly called in the US) is an inadequately researched and poorly understood concept, despite increasing awareness about the harm it can cause to children‟s lives. Although it unifies and underpins all types of maltreatment it also occurs alone and when it does, tends to elude detection and intervention. There have to date been no systematic reviews of the literature on the secondary prevention and treatment involving the parents or primary carers of emotionally abused children. Objective The objective of the review was to identify studies that evaluate the effectiveness of interventions in the secondary prevention and treatment of child emotional abuse involving the parents or primary carers of children aged 0 – 19 years. Methods Studies were included if they involved any intervention which was directed at emotionally abusive parenting and that measured change in (i) emotional unavailability (ii) negative attributions (i.e. that involve the parent attributing negative intentions, beliefs or attitudes toward the child); (iii) developmentally inappropriate interactions; (iv) lack of recognition of children‟s boundaries; (v) inconsistency of parenting role; (vi) missocialisation or consistent failure to promote the child‟s social adaptation. The primary outcomes evaluated involved proxy measures of a range of parent, family and child outcomes including parental psychopathology, parenting attitudes and practices, family functioning and/or child behaviour and the child‟s development and adaptation. . A broad search strategy was developed in order to identify as many relevant studies as possible. An electronic search of a wide range of databases was carried about. No study type was excluded. The search was augmented by direct contact with academics and practitioners known in this field. The search included studies written in English, Spanish, French and German. Studies were included if the intervention was described, and the impact on at least one indicator of emotional abuse was assessed. Included studies were critically appraised by two reviewers using standard criteria. Data were extracted using a standard proforma, and a qualitative synthesis of results was carried out. Results The initial search yielded 4248 publications of potential interest. Of these, 175 were obtained for possible inclusion or as background material. A total of 21 studies of 18 interventions, met all the inclusion criteria. A further 43 studies were relevant, but did not meet all of the inclusion criteria. Studies were organised according to the type of emotional abuse targeted: emotionally abusive parenting; parents of infants with faltering growth; missocialisation: parenting interventions with substance-abusing mothers. Twelve included studies had quantitative designs. Of these, 6 comprised randomised controlled trials; 1 comprised a follow-up of a randomised controlled trial; 2 were controlled studies; and 3 had one-group pre- and post-designs. The remaining 9 were case studies. Included studies involved a wide range of interventions. The 8 studies for parents which address emotionally abusive parenting (rejection, misattribution, parent-child role reversal and anger management) involved evaluations of cognitive-behavioural training (CBT), behavioural training and parent-infant psychotherapy. Two further case studies involved cognitive-behavioural training, mentalisation and family-based therapy. The 9 interventions with parents of infants with faltering growth evaluated CBT, behavioural training, parent infant psychotherapy and interaction guidance; lay home visitors, and a range of therapeutic options based on the diagnostic condition of the parents. The 3 studies of interventions for substance abusing mothers evaluated a relational psychotherapy group for mothers, and a residential treatment for substance abuse with a parenting component. The sample sizes for quantitative studies were small and ranged from 17 to 98 participants. Ten interventions involved mothers alone, while a further 11 included fathers, either at the outset or at a later stage, and in 3 cases extended family members. Interventions for emotionally abusing parents The findings from the 8 included studies evaluating CBT, psychotherapy, and behavioural approaches suggest that group-based CBT may be an effective means of intervening with this group of parents, although it cannot currently be recommended with parents experiencing symptoms of severe psychopathology. While one comparative study showed a psychotherapeutic intervention to be more effective than a CBT focused intervention, the outcomes measured in this study (i.e. parent and child representations) favoured the former. Behavioural case work involving the use of problem-solving techniques may also have a role to play with some parents, although further research is still needed. Interventions to enhance parental sensitivity The findings from a systematic review of 81 interventions that aimed at enhancing parental sensitivity and / or infant attachment found strong evidence that short term (less than 16 sessions) interventions, with a behavioural focus and aimed exclusively at enhancing maternal sensitivity were also most effective in enhancing infant attachment security. This supports the notion of a causal role of sensitivity in shaping attachment. Interventions that included fathers as well as mothers showed higher effect sizes but results are tentative since they are based on a small number of small scale trials. Parental behaviours associated with faltering growth Nine studies evaluated a range of interventions with parents of babies with faltering growth including interaction guidance, home visiting; parent-child psychotherapy, behavioural casework and multi-component interventions. The findings show that interaction guidance and parent-infant psychotherapy may be potentially effective means of working with this group of clients along with behavioural casework, but that further research is needed before these can be recommended. Missocialisation: Parenting interventions for substance-abusing parents 5 studies (one of which was a 6-month follow-up) evaluated interventions for substance abusing mothers, including a relational psychotherapy group and a residential treatment for substance abusing adults with a parenting component. The findings show that initial gains made in the former were not sustained at 6-months and few benefits from residential intervention. Conclusions Emotional abuse is a complex issue resulting in part from learned behaviours, psychopathology and/or unmet emotional needs in the parents, and often compounded by factors in the families‟ immediate and wider social environment. As such, a „one-approach-fits-all‟ is unlikely to lead to sustained change. The evidence base is weak, but suggests that some caregivers respond well to cognitive behavioural therapy. However, the characteristics that define these parents are not clear. There is currently no evidence to support the use of this intervention alone in the treatment of severely emotionally abusive parents. Some of the evidence suggests that a certain form of emotional abuse (for example, highly negative parent affect, which may be expressed as frightened and frightening behaviours in the parent) stemming from unresolved trauma and loss, is less amenable to CBT. There is some evidence that interaction guidance and psychotherapeutic approaches can generate change in parents with more severe psychopathology. Further research is urgently needed to evaluate the benefits of both psychotherapeutic and cognitive behavioural interventions, including those which take the form of family therapy, with parents at the more severe end of the spectrum, with fathers, and with older children. There is also a need to gain further understanding about which forms of emotional abuse respond best to different treatments

Deep spatial and tonal data optimisation for homogeneous diffusion inpainting

Difusion-based inpainting can reconstruct missing image areas with high quality from sparse data, provided that their location and their values are well optimised. This is particularly useful for applications such as image compression, where the original image is known. Selecting the known data constitutes a challenging optimisation problem, that has so far been only investigated with model-based approaches. So far, these methods require a choice between either high quality or high speed since qualitatively convincing algorithms rely on many time-consuming inpaintings. We propose the frst neural network architecture that allows fast optimisation of pixel positions and pixel values for homogeneous difusion inpainting. During training, we combine two optimisation networks with a neural network-based surrogate solver for difusion inpainting. This novel concept allows us to perform backpropagation based on inpainting results that approximate the solution of the inpainting equation. Without the need for a single inpainting during test time, our deep optimisation accelerates data selection by more than four orders of magnitude compared to common model-based approaches. This provides real-time performance with high quality results

Essays on Banking for Micro and Small Enterprises

This thesis provides new evidence concerning the way financial intermediaries fulfill the role of distributing capital efficiently to micro and small enterprise and diversify intertemporal risk at different stages of development. Chapter 2 and 3 present results about intertemporal risk sharing services provided by relationship banks to microentrepreneurs in developing countries after an aggregate income shock. The analysis is based on a data set in which the customer data of the microfinance institution ProCredit Ecuador is merged with the monthly data of seismic activity and explosions of the volcano Tungurahua in Ecuador from 2001 to 2006. Results indicate that new clients are less likely to receive a loan after the shock, but old clients face no lending restrictions. Additionally, old clients also pay lower interest rates after the shock and have lower default rates. The conclusion is that relationship banking facilitates intertemporal risk sharing for individuals that have a long term relationship with a bank. Chapter 4 empirically analyzes the competition between banks with different lending technologies, relationship lending and transaction lending, in the credit business with micro and small entrepreneurs in developing countries. I analyze a unique dataset consisting of a combination of credit bureau data with customer data of an Ecuadorian microfinance institution. The results support the hypothesis that especially transaction lending contributes to the problem of overindebtedness in developing countries. However, clients prefer to pay their installments to relationship banks, because they offer additional services. Chapter 5 analyzes management behavior in German credit cooperatives. One key feature of their institutional structure in the past was the fact that members have no ownership rights on the retained profits in order to assure the sustainability of the institution. Nowadays when members are mainly financially motivated and their incentives to monitor the management are weak, this institutional feature has the potential to generate negative incentives for the cooperatives management. I present a model on the incentive effects of this institutional feature and test the implications on a dataset of German credit cooperatives

Effect of Stocking Biomass on Solids, Phytoplankton Communities, Common Off-Flavors, and Production Parameters in a Channel Catfish Biofloc Technology Production System

The effect of initial channel catfish (Ictalurus punctatus, Rafinesque, 1818) fingerling biomass (1.4, 1.8, or 2.3 kg m-3) on phytoplankton communities, common off-flavours and stocker catfish production parameters was evaluated in biofloc technology production tanks. Stocker catfish size (145.5–172.6 g fish-1) at harvest did not differ among treatments, but net yield increased linearly as initial biomass increased (R2 = 0.633). Mean total feed consumption increased linearly with initial catfish biomass (R2 = 0.656) and ranged from 10.7 to 15.8 kg m -3. Total suspended solids (TSS) in all treatments increased linearly with total feed addition, and high TSS appeared to impact negatively daily feed consumption. Initial phytoplankton populations were dominated by small colonial green algae and diatoms, and later transitioned to populations dominated by a small, filamentous cyanobacteria and diatoms. Low, variable concentrations of 2-methylisoborneol and geosmin were present in biofloc tank water during most of the study and two tanks yielded catfish with 2-methylisoborneol or geosmin concentrations that might be classified as off-flavour. One isolate of actinomycete was isolated sporadically from some biofloc tanks, but its abundance was not correlated with 2-methylisoborneol concentration in tank waters. The microbial sources of 2-methylisoborneol and geosmin in biofloc tanks remain unidentified

Integration and acceleration of virtual microscopy as the key to successful implementation into the routine diagnostic process

<p>Abstract</p> <p>Background</p> <p>The virtual microscopy is widely accepted in Pathology for educational purposes and teleconsultation but is far from the routine use in surgical pathology due to the technical requirements and some limitations. A technical problem is the limited bandwidth of a usual network and the delayed transmission rate and presentation time on the screen.</p> <p>Methods</p> <p>In this study the process of secondary diagnostic was evaluated using the "T.Konsult Pathologie" service of the Professional Association of German Pathologists within the German breast cancer screening program. The characteristics of the access to the WSI (Whole Slide Images) have been analyzed to explore the possibilities of prefetching and caching to reduce the presentation and transfer time with the goal to increase user acceptance. The log files of the web server were analyzed to reconstruct the movements of the pathologist on the WSI and to create the observation path. Using a specialized tool the observation paths were extracted automatically from the log files. The attributes linearity, 3-point-linearity, changes per request, and number of consecutive requests were calculated to design, develop and evaluate different caching and prefetching strategies.</p> <p>Results</p> <p>The analysis of the observation paths showed that a complete accordance of two image requests is a very rare event. But more frequently a partial covering of two requested image areas can be found. In total 257 diagnostic paths from 131 WSI have been extracted and analysed. On average a diagnostic path consists of 16 image requests and takes 189 seconds between first and last image request. The mean linearity was 0,41 and the mean 3-point-linearity 0,85. Three different caching algorithms have been compared with respect to hit rate and additional image requests on the WSI server. Tests demonstrated that 95% of the diagnostic paths could be loaded without any deletion of entries in the cache (cache size 12,2 Megapixel). If the image parts are stored after JPEG compression this complies with less than 2 MB.</p> <p>Discussion</p> <p>WSI telepathology is a technology which offers the possibility to break the limitations of conventional static telepathology. The complete histological slide may be investigated instead of sets of images of lesions sampled by the presenting pathologist. The benefit is demonstrated by the high diagnostic security of 95% accordance between first and second diagnosis.</p

Connections Between Numerical Algorithms for PDEs and Neural Networks

We investigate numerous structural connections between numerical algorithms for partial differential equations (PDEs) and neural architectures. Our goal is to transfer the rich set of mathematical foundations from the world of PDEs to neural networks. Besides structural insights, we provide concrete examples and experimental evaluations of the resulting architectures. Using the example of generalised nonlinear diffusion in 1D, we consider explicit schemes, acceleration strategies thereof, implicit schemes, and multigrid approaches. We connect these concepts to residual networks, recurrent neural networks, and U-net architectures. Our findings inspire a symmetric residual network design with provable stability guarantees and justify the effectiveness of skip connections in neural networks from a numerical perspective. Moreover, we present U-net architectures that implement multigrid techniques for learning efficient solutions of partial differential equation models, and motivate uncommon design choices such as trainable nonmonotone activation functions. Experimental evaluations show that the proposed architectures save half of the trainable parameters and can thus outperform standard ones with the same model complexity. Our considerations serve as a basis for explaining the success of popular neural architectures and provide a blueprint for developing new mathematically well-founded neural building blocks

New pest damaging apples and other woody plants in Germany: Pest Risk Assessment on Saperda candida

Der Rundköpfige Apfelbaumbohrer, Saperda candida, trat im Juli 2008 erstmals in Europa in Schleswig-Holstein auf der Insel Fehmarn in den Ortsteilen Johannisberg und Mattiasfelde auf. 2009 wurden drei tote und ein lebender Käfer an einem Weißdorn im Befallsgebiet festgestellt. Der Einschleppungsweg ist nicht abschließend geklärt, es wird jedoch vermutet, dass die Einschleppung mit aus Nordamerika importierten, befallenen Apfelbäumen erfolgte. Diese Bockkäferart, die insbesondere Apfelbäume, alle relevanten Baumobstarten und auch andere Gehölze wie Eberesche, Weiß- und Rotdorn, Zwergmispel und Felsenbirne befällt, kann durch den Bohrfraß der Larven in den Leitungsbahnen und im Holz einzelne Bäume aber auch ganze Apfelanlagen zum Absterben bringen. Die klimatischen Gegebenheiten in Deutschland sind mit jenen im Ursprungsgebiet des Schadorganismus (östliches Nordamerika und Kanada) vergleichbar. Auf Fehmarn hat bereits eine Vermehrung des Käfers stattgefunden. Da außerdem überall in Deutschland Wirtspflanzen weit verbreitet sind und der Apfelbaumbohrer auch gesunde Bäume befällt, wird das Risiko durch S. candida als hoch eingestuft. Sowohl im erwerbsmäßigen Apfelanbau als auch in Privatgärten, an Straßenbäumen oder Landschaftsgehölzen können die Schäden durch S. candida erheblich sein. Als Gegenmaßnahmen kommen Vorbeugungs- und Bekämpfungsmaßnahmen, wie der Einsatz feinmaschiger Netze, die Vernichtung befallenen Pflanzenmaterials, die Entfernung von Wildwirten in der Nähe von Apfelanlagen, das Einstreichen der Stämme mit Latex/Wasser-Mischungen zur Verhinderung der Eiablage oder aber der Einsatz wirksamer Insektizide in Frage.In July 2008 the round-headed apple tree borer, Saperda candida, occurred for the first time in Europe in Schleswig-Holstein on the island of Fehmarn in the districts Johannisberg and Mattiasfelde. In 2009 three dead and one living beetle were detected on a Crataegus in the infested area. The pathway has not yet been finally clarified, however, it is suspected that the introduction occurred in the course of the importation of infested apple trees from Northern America. This longhorn beetle species which especially affects apple trees, all relevant tree fruit species (Cydonia, Prunus, Pyrus) and also other woody plants like Amelanchier, Aronia, Cotoneaster, Crataegus and Sorbus, can cause dieback of single trees but also of complete apple tree plantings by the larvae boring galleries in the vessels and in the wood. The climatic conditions in Germany are comparable to those in the areas of origin of the pest (Eastern parts of Northern America and Canada). On Fehmarn the beetle has already reproduced. Since host plants are widely distributed throughout Germany and the round-headed apple tree borer also affects healthy trees the risk caused by S. candida is classified as high. In commercial apple growing as well as in private gardens, on roadside or landscape trees the damage caused by S. candida may be significant. Plant protection measures could be preventive and control measures, e. g. the use of fine-meshed nets, the destruction of infested plant material, the removal of wild host plants close to apple tree plantings, the painting of the stems with Latex/water-mixtures for preventing oviposition or the use of effective insecticides