Pediatric Behavioral Concerns : Does Physician Training Influence Their Referral and Recommendation Practices

Pediatric primary care physicians indicate behavioral health concerns to be the most frequently reported complaint of parents during well-child visits. Over the last few decades, graduate medical education and training requirements in the area of behavioral management have been expanded to better equip pediatric primary care physicians to appropriately address these issues in practice. Even so, physicians continue to report a lack of knowledge in addressing these issues. Many behavior management techniques, especially time-out, have been shown to be effective in reducing pediatric behavior concerns. While pediatric primary care physicians generally understand these techniques, it is difficult for them to adequately address behavior concerns due to the time constraints they face in practice. Behavior management techniques typically require a high level of individualization per case, and mental health professionals who have the training and time to appropriately address pediatric behavior concerns may be better suited to handle these types of cases. The goal of this study was to examine how pediatric training in the area of behavioral management influences appropriate referral and recommendation practices of 232 pediatric primary care physicians regarding behavioral concerns. Additionally, differences between pediatricians and family physicians in their referrals and recommendations were evaluated. Preexisting data from the circulation of the Pediatric Behavior Management Survey for Physicians (PBMSP) was used in this study. Correlational analyses indicated that pediatric primary care physicians have a greater likelihood to refer their patients with behavior concerns to a psychologist regardless of the type of training they obtained in the area of behavior management. Additionally, those who received specific training in time-out or received supervised training had a greater likelihood to refer to a behavior analyst or social worker than those who only received training in general discipline. A multiple regression analysis indicated that type of training does not appear to predict whether physicians will make appropriate referrals to outside professionals, r²= .047, F(4,227)= 2.821, p <.05. A logistical regression indicated that the type of training and appropriateness of referral significantly predicted whether or not a physician recommends time-out, X² (5, N=230) = 17.820, p<.01. Independent samples t-tests pediatricians (M = 5.734, SD =.189) were significantly more likely to refer patients to psychologists than were family physicians (M = 4.928, SD =.117), r²= .054, t(229)= -3.627, p = .0004. A chi-square test indicated that there is a difference between specialty and the recommendation of time-out, X² (1, N=230) = 6.301, p <.05, and that family physicians are less likely to recommend time-out than pediatricians, p < .01. Limitations of this study include small sample size, generalizability, and survey construction. The results from this study provide insight into whether the changes that have been made in pediatric education and whether the push for collaboration amongst professionals have been successfully integrated into pediatric practice.M.A

Redistribution with Sloth—Britain's problem?

SUMMARY Many if not most analyses of Britain's economic difficulties suggest that slow growth is at the heart of the problem—and an acceleration of growth the obvious cure. Past experience in Britain and in the Third World casts doubts on this. The eradication of unemployment poverty and other social problems depends as much on structural change as on growth. Economic policy, therefore, needs to be directed much more explicitly towards what is needed to restructure the British economy in the short and over the longer run. It is not even clear that aggregate growth has more than a minor part to play in the process. RESUME La redistribution paresseuse—le problème britannique? Plusieurs, sinon la plupart, des analyses des difficultés économiques britanniques placent la lenteur du développement au coeur du problème—et proposent l'accélération du développement comme remède évident. Cette théorie est mise en question par l'expérience vécue en Grande?Bretagne ainsi que dans le Tiers Monde. L'élimination du chômage, de la pauvreté et d'autres problèmes sociaux dépend autant de l'évolution structurale que de la croissance. La politique économique devrait, par conséquent, s'orienter beaucoup plus explicitement vers ce qui est nécessaire à la restructuration de l'économie britannique à courte et à longue échéance. Il n'est même pas évident que la croissance globale ait autre qu'un rôle mineur dans le processus. RESUMEN La lentitud en la redistribución, uno de los problemas principales de la Gran Bretaña de hoy Muchos, si no la mayoría de los análisis de las dificultades económicas de la Gran Bretaña, sugieren que el problema fundamental es su desarrollo demasiado lento y que la solución se halla en una aceleración del crecimiento. Esta afirmación parece ser ociosa a la vista de la experiencia pasada de la Gran Bretaña y del Tercer Mundo. La supresión del paro, la pobreza y otros problemas sociales depende tanto de los cambios estructurales como del crecimiento. La política económica, así pues, debería orientarse hacia una reestructuración de la economía británica, tanto a corto como a largo plazo. El crecimiento de conjunto no parece tener más que escasa importancia en este proceso

Invariance and plasticity in the Drosophila melanogaster metabolomic network in response to temperature

BACKGROUND: Metabolomic responses to extreme thermal stress have recently been investigated in Drosophila melanogaster. However, a network level understanding of metabolomic responses to longer and less drastic temperature changes, which more closely reflect variation in natural ambient temperatures experienced during development and adulthood, is currently lacking. Here we use high-resolution, non-targeted metabolomics to dissect metabolomic changes in D. melanogaster elicited by moderately cool (18°C) or warm (27°C) developmental and adult temperature exposures. RESULTS: We find that temperature at which larvae are reared has a dramatic effect on metabolomic network structure measured in adults. Using network analysis, we are able to identify modules that are highly differentially expressed in response to changing developmental temperature, as well as modules whose correlation structure is strongly preserved across temperature. CONCLUSIONS: Our results suggest that the effect of temperature on the metabolome provides an easily studied and powerful model for understanding the forces that influence invariance and plasticity in biological networks. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1186/s12918-014-0139-6) contains supplementary material, which is available to authorized users