Putting Family First: The Need for Reform in Minnesota\u27s Foster Care Licensing Statutes and Processes to Support Relative Placement

Like many states, Minnesota’s child protection system faces serious challenges in its mission to protect children and support families. The balance between child safety and family preservation is elusive. Minnesota has swung the pendulum significantly to the side that prioritizes child removal by using investigative versus collaborative approaches to intervention and under-utilizing family foster care as the preferred removal placement. The last several years in Minnesota have brought an onslaught of policy changes in intake and screening processes relating to child protection, which, along with other factors (including a huge uptick in infant removals born with drugs in their system), has resulted in a dramatic and alarming increase in the number of children being removed from their parents’ care. The number of children placed in Minnesota’s foster care system has increased exponentially as there have been more than 25,000 children are reported for abuse or neglect each year. Most children are removed due to neglect—not serious physical or sexual abuse. Irrespective of the cause, the fact that Minnesota had the sixth-highest removal rate in the United States is alarming and reason for reform. This article tracks the history of foster care licensing requirements in Minnesota, discusses the real-life story of a grandmother with a grandchild placed in foster care, explains the federal mandates established through the Adam Walsh Act, discusses the existing flaws in the process, and highlights the ways in which Minnesota’s current statutory scheme and processes disproportionally impact communities of color. Finally, the article provides recommendations for both statutory and rule changes that will help relatives seeking to care for children through foster care

Solutions for Financial Inclusion: Serving Rural Women

This document presents a CaseStudy for solutions for financial inclusion. Using Uganda as a CaseStudy, Women's World Banking set out to better understand the needs of rural women and to use the research and lessons learned there to make recommendations on the design and delivery of microfinance products within Uganda and throughout sub-Saharan Africa. The research highlights the specific gender-based social, cultural and legal barriers that rural women face in accessing and using financial services and examines operational challenges to effectively serving this market

Baseline Predictors of Sputum Culture Conversion in Pulmonary Tuberculosis: Importance of Cavities, Smoking, Time to Detection and W-Beijing Genotype

Background: Time to detection (TTD) on automated liquid mycobacterial cultures is an emerging biomarker of tuberculosis outcomes. The M. tuberculosis W-Beijing genotype is spreading globally, indicating a selective advantage. There is a paucity of data on the association between baseline TTD and W-Beijing genotype and tuberculosis outcomes. Aim: To assess baseline predictors of failure of sputum culture conversion, within the first 2 months of antitubercular therapy, in participants with pulmonary tuberculosis. Design: Between May 2005 and August 2008 we conducted a prospective cohort study of time to sputum culture conversion in ambulatory participants with first episodes of smear and culture positive pulmonary tuberculosis attending two primary care clinics in Cape Town, South Africa. Rifampicin resistance (diagnosed on phenotypic susceptibility testing) was an exclusion criterion. Sputum was collected weekly for 8 weeks for mycobacterial culture on liquid media (BACTEC MGIT 960). Due to missing data, multiple imputation was performed. Time to sputum culture conversion was analysed using a Cox-proportional hazards model. Bayesian model averaging determined the posterior effect probability for each variable. Results: 113 participants were enrolled (30.1% female, 10.5% HIV-infected, 44.2% W-Beijing genotype, and 89% cavities). On Kaplan Meier analysis 50.4% of participants underwent sputum culture conversion by 8 weeks. The following baseline factors were associated with slower sputum culture conversion: TTD (adjusted hazard ratio (aHR) = 1.11, 95% CI 1.02; 1.2), lung cavities (aHR = 0.13, 95% CI 0.02; 0.95), ever smoking (aHR = 0.32, 95% CI 0.1; 1.02) and the W-Beijing genotype (aHR = 0.51, 95% CI 0.25; 1.07). On Bayesian model averaging, posterior probability effects were strong for TTD, lung cavitation and smoking and moderate for W-Beijing genotype. Conclusion: We found that baseline TTD, smoking, cavities and W-Beijing genotype were associated with delayed 2 month sputum culture. Larger studies are needed to confirm the relationship between the W-Beijing genotype and sputum culture conversion.Publisher's versio

Determinants of the urinary and serum metabolome in children from six European populations

Background Environment and diet in early life can affect development and health throughout the life course. Metabolic phenotyping of urine and serum represents a complementary systems-wide approach to elucidate environment–health interactions. However, large-scale metabolome studies in children combining analyses of these biological fluids are lacking. Here, we sought to characterise the major determinants of the child metabolome and to define metabolite associations with age, sex, BMI and dietary habits in European children, by exploiting a unique biobank established as part of the Human Early-Life Exposome project (http://www.projecthelix.eu). Methods Metabolic phenotypes of matched urine and serum samples from 1192 children (aged 6–11) recruited from birth cohorts in six European countries were measured using high-throughput 1H nuclear magnetic resonance (NMR) spectroscopy and a targeted LC-MS/MS metabolomic assay (Biocrates AbsoluteIDQ p180 kit). Results We identified both urinary and serum creatinine to be positively associated with age. Metabolic associations to BMI z-score included a novel association with urinary 4-deoxyerythronic acid in addition to valine, serum carnitine, short-chain acylcarnitines (C3, C5), glutamate, BCAAs, lysophosphatidylcholines (lysoPC a C14:0, lysoPC a C16:1, lysoPC a C18:1, lysoPC a C18:2) and sphingolipids (SM C16:0, SM C16:1, SM C18:1). Dietary-metabolite associations included urinary creatine and serum phosphatidylcholines (4) with meat intake, serum phosphatidylcholines (12) with fish, urinary hippurate with vegetables, and urinary proline betaine and hippurate with fruit intake. Population-specific variance (age, sex, BMI, ethnicity, dietary and country of origin) was better captured in the serum than in the urine profile; these factors explained a median of 9.0% variance amongst serum metabolites versus a median of 5.1% amongst urinary metabolites. Metabolic pathway correlations were identified, and concentrations of corresponding metabolites were significantly correlated (r > 0.18) between urine and serum. Conclusions We have established a pan-European reference metabolome for urine and serum of healthy children and gathered critical resources not previously available for future investigations into the influence of the metabolome on child health. The six European cohort populations studied share common metabolic associations with age, sex, BMI z-score and main dietary habits. Furthermore, we have identified a novel metabolic association between threonine catabolism and BMI of children

Putting Family First: The Need for Reform in Minnesota\u27s Foster Care Licensing Statutes and Processes to Support Relative Placement

Like many states, Minnesota’s child protection system faces serious challenges in its mission to protect children and support families. The balance between child safety and family preservation is elusive. Minnesota has swung the pendulum significantly to the side that prioritizes child removal by using investigative versus collaborative approaches to intervention and under-utilizing family foster care as the preferred removal placement. The last several years in Minnesota have brought an onslaught of policy changes in intake and screening processes relating to child protection, which, along with other factors (including a huge uptick in infant removals born with drugs in their system), has resulted in a dramatic and alarming increase in the number of children being removed from their parents’ care. The number of children placed in Minnesota’s foster care system has increased exponentially as there have been more than 25,000 children are reported for abuse or neglect each year. Most children are removed due to neglect—not serious physical or sexual abuse. Irrespective of the cause, the fact that Minnesota had the sixth-highest removal rate in the United States is alarming and reason for reform. This article tracks the history of foster care licensing requirements in Minnesota, discusses the real-life story of a grandmother with a grandchild placed in foster care, explains the federal mandates established through the Adam Walsh Act, discusses the existing flaws in the process, and highlights the ways in which Minnesota’s current statutory scheme and processes disproportionally impact communities of color. Finally, the article provides recommendations for both statutory and rule changes that will help relatives seeking to care for children through foster care

Land at Banbury Road, Southam, Warwickshire. Archaeological Evaluation (OASIS ID: cotswold2-316306)

In September 2017, an archaeological evaluation was undertaken by Cotswold Archaeology of land at Banbury Road, Southam, Warwickshire. The work was undertaken to fulfil a condition attached to planning consent for residential development of up to 47 dwellings. The fieldwork comprised the excavation of five trenches. Interest in the site derives from its location within the hinterland of Southam, a medieval settlement which developed into a small light-industrial town during the 19th and 20th centuries. A previous geophysical survey of the site did not identify any anomalies of archaeological origin; however, geophysical survey to the immediate west identified a possible round house and length of ditch of probable Iron Age or Romano-British date. The evaluation has recorded evidence for archaeological features, concentrated in the western part of the site, comprising three linear ditches. No dateable material was recovered from these features, which may represent further components of the putative Iron Age/Romano-British settlement identified to the west, outside of the site. The evaluation also identified a series of furrows on an east to west alignment, located across the site

Greening the operating room

Climate change will affect most populations in the next decades and put the health of billions of people at risk. Health care facilities represent a significant source of pollution around the world and contribute to environmental changes. To address this topic, we performed a review of the available literature on tactics to reduce operating room (OR) waste and the potential of these strategies to impact the environment. A literature search was performed querying PubMed, Web of Science, and Science Direct. No comparative data were found; most were opinion papers, white papers, and case studies. For this reason, we proceeded with a narrative review, which provides an overview of the evidence on this topic and identifies areas for future research. This systematic review summarizes the available literature on the 5 “Rs” of waste management: reduction, reusing, recycling, rethinking, and renewable energies. Surgery has a unique opportunity to transition to more environmentally-friendly operating room strategies, which may help decrease waste and lessen the impact of climate change. •Surgical waste is contributing to landfill mass and climate change.•Strategies such as repurposing and anesthetic gas reclaiming are potential strategies to address surgical waste.•Donation of unused or repurposed surgical supplies may help global surgery efforts while decreasing surgical waste