Reclaiming social work? an evaluation of systemic units as an approach to delivering children’s services

This report presents the findings of an evaluation of the systemic unit model as an approach to the delivery of Children‘s Social Services. The systemic unit model has sometimes been referred to as the ―Hackney Model‖ or ―Reclaiming Social Work‖ (Cross et al, 2010; Munro, 2011a; Trowler and Goodman, 2012). The evaluation is an in-depth comparative description of practice and the factors shaping it in three local authorities. One of the authorities used the systemic unit model; the other two authorities differed but both had a more conventional model for the structure of services. This involved individual allocation to social workers who received supervision from a line manager

A randomized controlled trial of training in Motivational Interviewing for child protection.

There has been interest in developing more evidence-based approaches to child and family social work in the UK in recent years. This study examines the impact of a skills development package of training and supervision in Motivational Interviewing (MI) on the skills of social workers and the engagement of parents through a randomized controlled trial. All workers in one local authority were randomly assigned to receive the package (n = 28) or control (n = 33). Families were then randomized to trained (n = 67) or untrained (n = 98) workers. Family meetings with the worker shortly after allocation were evaluated for MI skill. Research interviews gathered data including the WAI. Follow-up interviews 20 weeks later repeated the WAI, and other outcome measures including Goal Attainment Scaling (GAS) and rating of family life. Between group analysis found statistically significant difference in MI skills, though these were not substantial (2.49 in control, 2.91 MI trained, p = .049). There was no statistically significant difference between groups in any other outcome measures. The package of training and supervision did not create sufficient increase in MI skills to influence engagement or outcomes. Implications for understanding the relationship between skills, engagement and organizational change are discussed

Long-term nitrofurantoin:an analysis of complication awareness, monitoring, and pulmonary injury cases

BACKGROUND: Long-term nitrofurantoin (NF) treatment can result in pulmonary and hepatic injury. Current guidelines do not outline the type or frequency of monitoring required for detection of these injuries. AIM: To assess 1) awareness of NF complications among prescribers; 2) monitoring practice; and 3) to describe the pulmonary sequelae of NF-related complications. DESIGN & SETTING: Evaluation of prescribing habits by questionnaires and review of GP databases, and case-note review in secondary care. METHOD: The following study procedures were undertaken: 1) an electronic questionnaire was distributed to prescribers, interrogating prescribing and monitoring practices, and awareness of complications; 2) an analysis was undertaken (June–July 2020) of NF monitoring among GPs in the local clinical commissioning group (CCG); and 3) a case review was carried out of patients diagnosed with NF-induced interstitial lung disease (NFILD) at the interstitial lung disease (ILD) centre (2014–2020). RESULTS: A total of 125 prescribers of long-term NF responded to the questionnaire (82.4% GPs; 12.0% urologists). Many were unaware of the potential for liver (42.4%) and lung (28.0%) complications; 40.8% and 52.8% never monitored for these, respectively. Only 53.3% of urologists believed themselves responsible for arranging monitoring, while nearly all GPs believed this to be the prescriber’s responsibility (94.2%). One-third of all responders considered current British National Formulary (BNF) guidelines 'not at all sufficient/clear', with mean clarity scoring of 2.2/5. Among patients with NFILD (n = 46), NF had been prescribed most often (69.6%) for treatment of recurrent UTI and 58.6% (n = 27) were prescribed for >6 months. On withdrawal of the medication 61.4% displayed resolution (completely or minimal fibrosis), while 15.9% of patients had progressive lung fibrosis. CONCLUSION: NF can cause marked or irreversible lung complications and there is currently a shortfall in awareness and monitoring. Existing monitoring guidelines should be augmented

What is the relationship between worker skills and outcomes for families in child and family social work?

Communication skills are fundamental to social work, yet few studies have directly evaluated their impact. In this study, we explore the relationship between skills and outcomes in 127 families. An observation of practice was undertaken on the second or third meeting with a family. Practice quality was evaluated in relation to seven skills, which were grouped into three dimensions: relationship building, good authority and evocation of intrinsic motivation. Outcomes at approximately six months were parent-reported engagement (Working Alliance Inventory), Goal Attainment Scaling (GAS), an eleven-point family life satisfaction rating, the Family Environment Scale and General Health Questionnaire and service outcomes from agency records including children entering care. Relationship-building skills predicted parent-reported engagement, although good authority and evocation had stronger relationships with outcome measures. Where workers visited families more often, relationships between skills and outcomes were stronger, in part because workers had more involvement and in part because these families were more likely to have significant problems. The relationship between skills and outcomes was complicated, although the findings provide encouraging evidence that key social work skills have an influence on outcomes for families

Case Reports1. A Late Presentation of Loeys-Dietz Syndrome: Beware of TGFβ Receptor Mutations in Benign Joint Hypermobility

Background: Thoracic aortic aneurysms (TAA) and dissections are not uncommon causes of sudden death in young adults. Loeys-Dietz syndrome (LDS) is a rare, recently described, autosomal dominant, connective tissue disease characterized by aggressive arterial aneurysms, resulting from mutations in the transforming growth factor beta (TGFβ) receptor genes TGFBR1 and TGFBR2. Mean age at death is 26.1 years, most often due to aortic dissection. We report an unusually late presentation of LDS, diagnosed following elective surgery in a female with a long history of joint hypermobility. Methods: A 51-year-old Caucasian lady complained of chest pain and headache following a dural leak from spinal anaesthesia for an elective ankle arthroscopy. CT scan and echocardiography demonstrated a dilated aortic root and significant aortic regurgitation. MRA demonstrated aortic tortuosity, an infrarenal aortic aneurysm and aneurysms in the left renal and right internal mammary arteries. She underwent aortic root repair and aortic valve replacement. She had a background of long-standing joint pains secondary to hypermobility, easy bruising, unusual fracture susceptibility and mild bronchiectasis. She had one healthy child age 32, after which she suffered a uterine prolapse. Examination revealed mild Marfanoid features. Uvula, skin and ophthalmological examination was normal. Results: Fibrillin-1 testing for Marfan syndrome (MFS) was negative. Detection of a c.1270G > C (p.Gly424Arg) TGFBR2 mutation confirmed the diagnosis of LDS. Losartan was started for vascular protection. Conclusions: LDS is a severe inherited vasculopathy that usually presents in childhood. It is characterized by aortic root dilatation and ascending aneurysms. There is a higher risk of aortic dissection compared with MFS. Clinical features overlap with MFS and Ehlers Danlos syndrome Type IV, but differentiating dysmorphogenic features include ocular hypertelorism, bifid uvula and cleft palate. Echocardiography and MRA or CT scanning from head to pelvis is recommended to establish the extent of vascular involvement. Management involves early surgical intervention, including early valve-sparing aortic root replacement, genetic counselling and close monitoring in pregnancy. Despite being caused by loss of function mutations in either TGFβ receptor, paradoxical activation of TGFβ signalling is seen, suggesting that TGFβ antagonism may confer disease modifying effects similar to those observed in MFS. TGFβ antagonism can be achieved with angiotensin antagonists, such as Losartan, which is able to delay aortic aneurysm development in preclinical models and in patients with MFS. Our case emphasizes the importance of timely recognition of vasculopathy syndromes in patients with hypermobility and the need for early surgical intervention. It also highlights their heterogeneity and the potential for late presentation. Disclosures: The authors have declared no conflicts of interes

Recommendations for Addressing Priority Io Science in the Next Decade

Io is a priority destination for solar system exploration. The scope and importance of science questions at Io necessitates a broad portfolio of research and analysis, telescopic observations, and planetary missions - including a dedicated New Frontiers class Io mission

The Science Case for Io Exploration

Io is a priority destination for solar system exploration, as it is the best natural laboratory to study the intertwined processes of tidal heating, extreme volcanism, and atmosphere-magnetosphere interactions. Io exploration is relevant to understanding terrestrial worlds (including the early Earth), ocean worlds, and exoplanets across the cosmos

Effect of angiotensin-converting enzyme inhibitor and angiotensin receptor blocker initiation on organ support-free days in patients hospitalized with COVID-19

IMPORTANCE Overactivation of the renin-angiotensin system (RAS) may contribute to poor clinical outcomes in patients with COVID-19. Objective To determine whether angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) initiation improves outcomes in patients hospitalized for COVID-19. DESIGN, SETTING, AND PARTICIPANTS In an ongoing, adaptive platform randomized clinical trial, 721 critically ill and 58 non–critically ill hospitalized adults were randomized to receive an RAS inhibitor or control between March 16, 2021, and February 25, 2022, at 69 sites in 7 countries (final follow-up on June 1, 2022). INTERVENTIONS Patients were randomized to receive open-label initiation of an ACE inhibitor (n = 257), ARB (n = 248), ARB in combination with DMX-200 (a chemokine receptor-2 inhibitor; n = 10), or no RAS inhibitor (control; n = 264) for up to 10 days. MAIN OUTCOMES AND MEASURES The primary outcome was organ support–free days, a composite of hospital survival and days alive without cardiovascular or respiratory organ support through 21 days. The primary analysis was a bayesian cumulative logistic model. Odds ratios (ORs) greater than 1 represent improved outcomes. RESULTS On February 25, 2022, enrollment was discontinued due to safety concerns. Among 679 critically ill patients with available primary outcome data, the median age was 56 years and 239 participants (35.2%) were women. Median (IQR) organ support–free days among critically ill patients was 10 (–1 to 16) in the ACE inhibitor group (n = 231), 8 (–1 to 17) in the ARB group (n = 217), and 12 (0 to 17) in the control group (n = 231) (median adjusted odds ratios of 0.77 [95% bayesian credible interval, 0.58-1.06] for improvement for ACE inhibitor and 0.76 [95% credible interval, 0.56-1.05] for ARB compared with control). The posterior probabilities that ACE inhibitors and ARBs worsened organ support–free days compared with control were 94.9% and 95.4%, respectively. Hospital survival occurred in 166 of 231 critically ill participants (71.9%) in the ACE inhibitor group, 152 of 217 (70.0%) in the ARB group, and 182 of 231 (78.8%) in the control group (posterior probabilities that ACE inhibitor and ARB worsened hospital survival compared with control were 95.3% and 98.1%, respectively). CONCLUSIONS AND RELEVANCE In this trial, among critically ill adults with COVID-19, initiation of an ACE inhibitor or ARB did not improve, and likely worsened, clinical outcomes. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT0273570

Diversity, Equity, and Inclusion - Library Audit Report

In Fall 2020, President Callahan announced several Diversity, Equity and Inclusion (DEI) projects that the university would commence, including a DEI Audit of the Library’s collections. We formed a planning group, did initial research on equivalent DEI audits at other institutions, and decided to involve students in the process by hiring 9 as Interns in Spring 2021. The students will meet weekly with the planning group to discuss the project, audit specific portions of the collection (based on disciplinary interest), and provide recommendations for collection diversification. This presentation will cover the initial results of hiring students, finalizing methodology for the audits in concert with the students, and student feedback on the project and their learning outcomes for the semester-long project. IN ADDITION, the Library received a grant of $10,000 to purchase new ebooks to diversity the collection this semester. We will be sharing information on the books chosen and purchased in concert with the Research Interns. We ALSO will be raffling off THREE prizes during the presentation as part of the celebration from Zeus Collegiate, a clothing company founded by a Pacific alum with Pacific branded gear: #1: sports hoodie & mug #2: crew sweatshirt & mug #3: t-shirt & mug Winners will be able to pick their sizes and colors where applicable