Voiceprints: The Determination of Admissibility

One of the most crucial issues facing courts in recent years is the admissibility of novel scientific evidence. There is obviously a strong temptation to use a scientific process or machine that purports to provide unbiased information free from the many competency and credibility problems associated with testimonial evidence. One such process, called spectrographic analysis, is now being favorably received by the courts despite its substantial shortcomings. Spectrographic analysis-popularly known as voiceprints - is a technique for the identification of voices with the aid of a machine known as the sound spectrograph. The purpose of this comment is to examine the reliability of this technique to determine if the present state of the art justifies the reliance that has been placed upon it

Abortion: Right of Minors to Abortion without Parental Consent

Abortion: Right of Minors to Abortion Without Parental Consent, State v. Koome, 84 Wash.2d 901, 530 P.2d 260 (1975). The Supreme Court of Washington recently has shed some light upon the murky legal area of the constitutional rights of minors. In State v. Koome, the Court held that the state could not require an unmarried pregnant woman under the age of eighteen to obtain her parents’ permission in order to have an abortion. This decision extended the now constitutionally protected right of privacy with regard to abortion as set out for adults by the United States Supreme Court to all women, regardless of age, who are capable of childbirth

INVESTIGATING THE ROLE OF EXPECTATIONS OF DISCLOSURE IN THE RELATIONSHIP BETWEEN TRAUMA-RELATED SHAME AND SEEKING MENTAL HEALTH SERVICES

Sexual assault (SA) is a prevalent health concern. Previous research indicates that the quality of social reactions received upon disclosure of SA greatly impacts the psychological adjustment of survivors (Ullman, 2000). Negative social reactions upon disclosure (e.g., victim-blaming) has been associated with greater self-blame and shame and may deter survivors from seeking mental health services. Presently, little research on survivors’ expectations of disclosure exists. The current study investigated whether expectations of disclosure mediate the relationship between shame and seeking mental health services. Participants completed the Trauma-Related Shame Inventory, Expectations of Disclosure Questionnaire, and the Disclosure Questionnaire. Results revealed shame predicted negative expectations of disclosure; b = 0.72, t (84) = 10.60, p \u3c 0.001, 95% CI [0.58, 0.85]. Positive expectations of disclosure predicted disclosure to mental health professionals; b = 0.08, t (83) = 4.53, p \u3c 0.001, 95% CI [0.0461, 0.1182], as did shame, b = 0.04, t (82) = 2.36, p \u3c 0.05, 95% CI [0.01, 0.09]. Neither positive (b = -0.001, p \u3e 0.05, 95% CI [-0.0209, 0.0095]) or negative expectations of disclosure (b = -0.02, p \u3e 0.05, 95% CI [-0.05, 0.01]) mediated the relationship between trauma-related shame and disclosure to mental health professionals. Findings can lead to new approaches in crisis interventions for individuals who had been sexually assaulted

Cell signaling pathways elicited by asbestos.

In recent years, it has become apparent that minerals can trigger alterations in gene expression by initiating signaling events upstream of gene transactivation. These cascades may be initiated at the cell surface after interaction of minerals with the plasma membrane either through receptorlike mechanisms or integrins. Alternatively, signaling pathways may be stimulated by active oxygen species generated both during phagocytosis of minerals and by redox reactions on the mineral surface. At least two signaling cascades linked to activation of transcription factors, i.e., DNA-binding proteins involved in modulating gene expression and DNA replication, are stimulated after exposure of lung cells to asbestos fibers in vitro. These include nuclear factor kappa B (NF kappa B) and the mitogen-activated protein kinase (MAPK) cascade important in regulation of the transcription factor, activator protein-1 (AP-1). Both NF kappa B and AP-1 bind to specific DNA sequences within the regulatory or promoter regions of genes that are critical to cell proliferation and inflammation. Unraveling the cell signaling cascades initiated by mineral dusts and pharmacologic inhibition of these events may be important for the control and treatment of mineral-associated occupational diseases

PHysical activity Implementation Study In Community-dwelling AduLts (PHISICAL): study protocol

Background: Falls in older people are a leading causes of unintentional injury. Due to an ageing population, injuries are likely to increase unless more is done to reduce older people’s falls risk. In clinical trials, the Falls Management Exercise (FaME) programme has reduced the rate of falls and falls-related injuries in community-dwelling older adults. However, the commissioning of FaME is inconsistent across England, potentially due to a lack of evidence that FaME can be delivered effectively in a ‘real world’ setting. The PHISICAL study is designed to study the implementation of FaME in a range of different settings in England. Methods: The PHISICAL study will use mixed-methods triangulation multi-level design to explore the implementation of FaME. Framework analysis of semi-structured interviews with up to 90 stakeholders (exercise programme users, service providers, referrers and commissioners) and observational data from locally-led communities of practice will identify the factors that influence FaME’s implementation. Quantitative, anonymised, routine service data from up to 650 exercise programme users, including measures of falls and physical activity, will allow assessment of whether the benefits of FaME reported in clinical trials translate to the ‘real world’ setting. Conclusion: The findings from this study will be used to develop a toolkit of resources and guidance to inform the commissioning and delivery of future FaME programmes. This study has the potential to inform public health prevention strategies, and in doing so may reduce the number of falls in the older population, whilst delivering cost savings to health and social care services

Evaluation of the effectiveness, implementation and cost-effectiveness of the Stay One Step Ahead home safety promotion intervention for pre-school children: a study protocol

Background: Unintentional injuries in children under 5 commonly occur in the home and disproportionately affect those living in disadvantaged circumstances. Targeted home safety promotion should be offered to families most at risk but there is a paucity of standardised evidence-based resources available for use across family-support practitioners. Objective: To assess the effectiveness, implementation and cost-effectiveness of a 2-year home safety programme (Stay One Step Ahead) developed by parents, practitioners and researchers, and delivered by a range of family support providers in inner-city localities, compared to usual care in matched control localities. Methods: Parents of children aged 0-7 months will be recruited to a controlled before and after observational study. The primary outcome is home safety assessed by the proportion of families with a fitted and working smoke alarm, safety gate on stairs (where applicable) and poisons stored out of reach, assessed using parent-administered questionnaires at baseline, 12 and 24 months.Secondary outcomes include: the impact on other parent-reported safety behaviours, medically-attended injuries, self-efficacy for home safety and knowledge of child development and injury risk using questionnaires and emergency department attendance data; implementation (reach, acceptability, barriers, facilitators) of home safety promotion assessed through interviews and observations; and cost-effectiveness using medically-attended injury costs ascertained from healthcare records.Conclusions: If shown to be effective and cost-effective this study will provide a practical resource to underpin national guidance. The study could inform public health prevention strategies to reduce home injury in children most at risk, whilst delivering cost savings to health and care services

Evaluating the effect of child home safety training upon three family support practitioner groups: a mixed-methods study

Aims:Unintentional injuries in the home contribute substantially to preschool child morbidity and mortality. Practitioners such as health visitors, family mentors and children’s centre staff are well-positioned to facilitate child injury prevention by providing home safety advice to families, and training may enhance their ability to do so. We aimed to assess the impact of child home safety training for these practitioners.Methods:An explanatory mixed-methods design was used. Practitioners completed questionnaires before, and up to 7 months after, receiving child home safety training and took part in interviews. Seventy-eight health visitors, 72 family mentors and 11 children’s centre staff members completed questionnaires. Items were used to calculate scores on home safety knowledge, confidence to provide home safety advice and belief that child home safety promotion is important. Thematic analysis of interviews with seven health visitors and nine family mentors, open-ended responses to the questionnaires and an additional evaluation form was conducted to explore attendees’ perceptions of the training and its impact. In addition, seven health visitors and six children’s centre staff who had received no training were interviewed.Results:Knowledge was greater post-training than pre-training across all participants (p < .001). When practitioner groups were analysed separately, there were significant increases in family mentors’ knowledge (p < .001) and belief (p = .016), and health visitors’ confidence (p = .0036). Qualitative findings indicated that most training session attendees valued the training, believed their practice relating to child home safety had improved as a result, and felt further similar training sessions would be beneficial. Those who had not attended the sessions described a need for more child home safety training.Conclusions:Delivering training to practitioners providing child home safety promotion to families with preschool children can enhance injury prevention knowledge, beliefs and confidence and positively impact on home safety promotion by practitioners

Cost-effectiveness of the ‘Stay One Step Ahead’ Home Safety programme for the prevention of injuries among children under 5 years

Background Unintentional injuries are a common cause of morbidity and mortality in the under-5s, but undertaking home safety practices can reduce injury risk. Stay One Step Ahead (SOSA) is an evidence-based standardised home safety programme. This study evaluates the cost-effectiveness of SOSA versus usual care in Nottingham, UK.Methods Cost-effectiveness analysis from a National Health Service and personal social services perspective. SOSA activity data, injury occurrence and associated short-term healthcare costs were collected within a controlled before-and-after study from 2017 to 2020. The primary outcome was the incremental cost-effectiveness ratio (ICER) per additional home adopting three key safety practices (working smoke alarm, safe poisons storage and fitted stair gate). Secondary outcomes were ICERs per injury avoided and quality-adjusted life-years (QALYs) gained.Results SOSA costs £30 per child but reduces short-term healthcare expenditure by £42. SOSA increased the number of homes with three key safety practices by 0.02 per child, reduced injuries per child by 0.15 and gained 0.0036 QALYs per child. SOSA was dominant as it was cheaper and more effective than current practice. ICERs were −£590 per additional home deemed safe, −£77 per injury avoided and −£3225 per QALY gained. Focusing on healthcare expenditure alone, SOSA saved £1.39 for every pound spent.Conclusions SOSA is a cost-saving intervention. Commissioners should consider implementing SOSA