Treatment of Choice or A Last Resort? A Review of Residential Mental Health Placements For Children and Adolescents

Residential treatment is often regarded as a treatment of ‘last resort’ and, increasingly, residential treatment programs are being asked to address the needs of very troubled children and adolescents. This paper is an effort to summarize what is currently known about the effects of residential treatment for children and adolescents. The review is organized into two sections: studies of the effectiveness of group home residential treatment and studies of the effectiveness of residential treatment delivered in residential treatment centres. In both areas, we attempt to identify trends within treatment, as well as patterns found in the literature that characterize post residential treatment adaptation. We also discuss several additional factors that appear to share a relationship with residential treatment outcomes crossing both short-term and long-term trends. We conclude our review with suggestions for future directions in residential treatment for children and adolescents

Orthopedic Injuries in Athletes

When thinking of athletes and orthopedic injuries, we often associate these injuries with more physical sports such as football, basketball, or even soccer. What we don’t realize is that an injury of any degree can occur in any sport, regardless of the level of physicality. An orthopedic injury is any injury to the bones, muscles, or joints of the musculoskeletal system. These injuries include, but are not limited to, ACL tears, meniscus tears, broken bones, muscle tears, sprains, dislocations, or fractures, obtained during a sport. Most injuries of this nature are hard to ignore, but depending on the area and severity of the injury, some may go unnoticed or be mistaken for another issue. If not properly examined and treated, the injury could severely worsen. Orthopedic doctors and surgeons typically examine, treat, help to prevent, and provide rehabilitation services for patients with orthopedic injuries. Since their main priority is to treat and rehabilitate patients, all treatments are provided with the intent of the patient returning to normal activities of daily living or his or her respective sport profession. This presentation will discuss the specific types of orthopedic injuries that can occur, how they are obtained, what age/gender group is most likely to obtain an orthopedic injury, the sports we most see them within, and lastly how they are examined, treated, and rehabilitated

Siege and Response: Families’ Everyday Lives and Experiences with Children’s Residential Mental Health Services (FULL REPORT)

Purpose Our purpose in interviewing parents with a child placed in residential mental health treatment was threefold: (1) to understand the functioning of children requiring residential mental health treatment before, during, and after treatment; (2) to characterize parents’ perceptions of their families’ involvement with residential treatment; and, (3) to address the popular notion that children requiring residential treatment come from highly dysfunctional and potentially harmful families by describing prevalent family functioning patterns. Methodology|This report is based on information obtained by interviewing 29 primary caregivers who had a child placed in residential care at one of two Ontario children’s mental health agencies. Parents were visited in their homes by an interviewer to engage in one-on-one dialogue to explore dimensions of their everyday lives and reflect on their service experiences. Interviews consisted of a series of open ended questions and were approximately 1 ½ to 2 hours in length. Because of the labour intensive nature of qualitative investigations, there are limitations to the number of cases that can practically be included in a study; however, what is lost in generalizability is compensated for by a richer sense of the struggles facing these families. Parents’ Perceptions of Residential Services Parents were generally pleased with their child’s placement in a residential treatment center. Parents feel respected, valued, and understood by service providers. They experience staff as competent, compassionate, and helpful. Residential services offered respite for families and containment for focal children. Many parents reported gains made for themselves and their children. Yet only 17% of parents felt that sufficient gains had been made to warrant the discharge of their child from the center. Parents tended not to blame the residential center for the lack of progress. The also seemed unable to articulate what the residential center could have done differently. Yet these parents, extremely hopeful when they first had their child placed in residence, had to come to terms with the realization that service outcomes had not matched their hopes. These stories highlight both the complexity and the tenacious nature of these children’s mental health difficulties. They also provide a challenge to service providers. What do we do when good is not good enough? Changes in Child Functioning Before, During and After Residential CareThese stories provide dramatic testimony that most of the older cohort children in this study leaving residential care had very serious ongoing problems in daily living. Problems which in many cases rivaled or exceeded the challenges faced prior to entering residential care. About one-third of these children had left home and many had unstable living arrangements or were “on the streets”. With the exception of living on their own and involvement in delinquent activities, and notwithstanding moderately more evidence of “successful” or partially “successful” adaptations, the after care daily living portraits of younger cohort residential care graduates were not notably more encouraging. About half of these younger children did not return to their original homes 6 after residential care. Serious areas of concern shared by both groups of children include continuing major adaptation problems at school and continued high levels of pressure on the parents and siblings of many of these children. Parent and Family FunctioningCaring for the focal child permeates every facet of daily life for these families including work, health, and relationships. Parents experience prolonged elevated levels of daily stress trying to juggle work schedules, appointments with professionals, household activities, and the needs of family members with caring for the focal child. Family climate is markedly tense and frequently involves conflict, particularly with the focal child. Relationships among other family members suffer as well, with parents reporting increased marital strain and little time to devote to siblings of the focal child. Caring for the focal child is taxing on parents’ own physical and mental health. Most families (70%) reported experiencing substantial relief, at least for a short period of time, from tensions within the home when the focal child entered residential care. Child Functioning Over Three Selected Developmental PeriodsOne of the interpretative challenges inherent in these stories is understanding the connection between the behaviour of these children, which is strikingly similar, and evidence suggestive of these children having a variety of problems, life histories and family environments. It can be argued that these children arrive at a similar point from many different trajectories. Who are the children represented in this sample? How are we to understand their difficulties? When it comes to understanding the behaviour of the focal children, both its presentation and its genesis, these stories raise as many questions as they answer. These stories challenge the notion of a single or root cause of extreme unmanageable behaviour. Instead they offer a complex and unsettling portrayal of these children, their familial and social environments, life histories, their strengths and challenges. These stories caution against the use of blanket or catch-all interpretations to help us understand the problematic behaviour of these children. ConclusionDespite the positive view of residential treatment held by parents long after treatment ends, the data suggest relatively poor outcome patterns for children leaving residential care. Serious areas of concern shared by both groups of children include continuing major adaptation problems at school and continued high levels of pressure on the parents and siblings of many of these children. The clearest area of benefit from these residential placements, at least in the short run, is for family members other than the focal child. This is an important consideration, given the incredible pressures families manage when the focal child is at home, and the extreme disruptions in family life described in these stories. An obvious question emanating from these stories is what can be expected for these children - in school, employment and relationships - over the years ahead. There is almost no support in our study for helping strategies predicated on “curing” or changing the focal child through short-term or medium-term interventions so that he or she can prosper in everyday life. Variations in living arrangements, enhancing school and employment opportunities, and continuing support to these children and their families with the challenges of daily living merit serious attention

Siege and Response: Families’ Everyday Lives and Experiences with Children’s Residential Mental Health Services (SUMMARY REPORT)

Our purpose in interviewing families who had a child placed in residential children’s mental health treatment was to provide insight into the lives and service experiences of these families as they struggle to care for their child and find appropriate services. As we endeavored to code, categorize, and make sense of the information shared with us by families several other more pointed purposes emerged as integral to our efforts. More specifically we became interested in understanding the functioning of children requiring residential mental health treatment before, during, and after treatment with the aim to comment on general patterns of change for these children across these three time periods. Secondly, we also aimed to characterize parents’ perceptions of their families’ involvement with residential treatment. In particular we address parents’ understanding of the services, their relationships with service providers, and parents’ perceptions of their children’s experiences. And thirdly, in order to provide a family context for children’s difficulties and the ensuing service involvement, we also discuss family functioning highlighting key family patterns under the domains of work, daily life, and relationships. The inclusion of prevalent family functioning patterns also helps us to address the popular notion that children requiring residential treatment come from highly dysfunctional and potentially 3 harmful families. Each of these three purposes are addressed in turn in an effort to provide a more complete picture of the families involved in residential treatment and their service experiences. We conclude with some implications for service delivery and thoughts to pursue in future investigations

Saran Wrap 2: Clip Handling Device

The common household Saran Wrap has been in production since 1933. A common problem comes in the handling of the plastic sheet after being torn from the roll. Corners frequently fold on themselves, the sheet bunches up, and renders some pieces useless. Our objective was to create a device along with a system to eliminate these problems, without compromising the simplicity and speed of the original box cutter

QUALITIES OF THE PROTECTIVE ANTIBODY RESPONSE AGAINST DENGUE VIRUS INFECTION

Dengue viruses (DENV1-4) cause 390 million annual infections across the globe. Primary DENV infection elicits an antibody response that is thought to provide lifelong protection against re-infection with the same serotype. A protective antibody response provided by vaccination would be the best tool available to prevent DENV related disease but the currently licensed DENV vaccine had variable efficacy. We still have large knowledge gaps that need to be addressed surrounding qualities of protective antibodies. My thesis defines three properties of the protective antibody response to DENV infection and vaccination. Isolation and characterization of potently neutralizing monoclonal antibodies identified the majority of these antibodies bind across multiple DENV E-proteins (quaternary epitopes) on the virion surface. For my thesis, I defined the epitope of a potently neutralizing antibody to the closely related Zika virus (ZIKV) and used its structure to guide questions about the mechanism of potent neutralization. I identify that targeting a quaternary epitope is essential for potent neutralization. Recently, a DENV vaccine that induced neutralizing antibodies did not demonstrate protection in DENV naïve individuals. To understand qualities of a protective neutralizing antibody response, I compared the antibody response elicited by WT DENV infection to the antibody response elicited in DENV vaccinated individuals who subsequently experience infection. I observed a specific fraction of the neutralizing antibody response correlated with protection. While antibody response to primary infection protects against clinically significant disease, it is unclear if the antibody response provides sterilizing immunity as rare, homotypic reinfections are reported. To understand if antibody response to primary infection provides sterilizing immunity, I used a unbalanced DENV vaccine as a human challenge model. The majority of individuals respond to the vaccine, regardless of DENV serostatus. My results help guide future development of DENV vaccines to achieve a protective, balanced vaccine.Doctor of Philosoph

Investing in Cyber Defense: A Value-Focused Analysis of Investment Decisions for Microgrids

To mitigate disruptions to commercial power grids, and to achieve operational efficiencies by managing energy use, many organizations are fielding smaller, local, self-contained microgrids. The computer control systems that operate the microgrids create new vulnerabilities to a rapidly-escalating array of cyber attacks. This creates a tension between the need to improve energy assurance and efficiency through microgrids, and the need to protect against cyber attacks that can disrupt and damage the organization\u27s energy systems. Through a series of interviews with subject matter experts and end-users, this exploratory study surfaces the decision-makers\u27 important values in this decision space and develops a network of those values to guide decision-makers to make better decisions in balancing these competing needs

Multi-signal quality monitoring of aluminium resistance spot welding using principal component analysis

The current migration to lighter materials in car bodies, such as aluminium, has resulted in significant challenges for joining in production. Resistance Spot Welding (RSW) is the primary sheet metal joining technique in the automotive industry due to its quick cycle time, low cost and high strength. However, aluminium RSW suffers from problems with quality consistency compared to steel, requiring more frequent interventions. This results in a higher cost in production through increased cycle times and the use of consumable electrodes. To address this issue, a new multi-signal quality monitoring technique is proposed to allow for complete real-time quality monitoring of aluminium spot welds in production. The proposed solution utilises multiple signals during welding and an efficient algorithm using Principal Component Analysis to determine the signal shapes of interest. It was found that an RMSE of 119N could be achieved when predicting the strength of aluminium spot welds using multiple signals, which is approximately ±5% of the mean strength of the welds and an improvement on previous attempts.This research was supported by an Australian Government Research Training Program (RTP) Scholarship

Peptide based low molecular weight gelators

Over the last 12 months a number of papers have been published which shed light on the processes that control the self-assembly of peptides into fibrous hydrogel networks. A number of new properties of dipeptide hydrogels have also been reported. This article highlights recent activity in the area of peptide self-assembly, with a particular focus on tri-peptides, di-peptides and protected amino acids

Cluster Cosmology Redux: A Compact Model of the Halo Mass Function

Massive halos hosting groups and clusters of galaxies imprint coherent, arcminute-scale features across the spectrophotometric sky, especially optical-IR clusters of galaxies, distortions in the sub-mm CMB, and extended sources of X-ray emission. Statistical modeling of such features often rely upon the evolving space-time density of dark matter halos -- the halo mass function (HMF) -- as a common theoretical ground for cosmological, astrophysical and fundamental physics studies. We propose a compact (eight parameter) representation of the HMF with readily interpretable parameters that stem from polynomial expansions, first in terms of log-mass, then expanding those coefficients similarly in redshift. We demonstrate good ($\sim \! 5\%$) agreement of this form, referred to as the dual-quadratic (DQ-HMF), with Mira-Titan N-body emulator estimates for halo masses above $10^{13.7} h^{-1} {\rm M}_\odot$ over the redshift range $0.1 < z < 1.5$, present best-fit parameters for a Planck 2018 cosmology, and present parameter variation in the $\sigma_8 - \Omega_{\rm m}$ plane. Convolving with a minimal mass-observable relation (MOR) yields closed-form expressions for counts, mean mass, and mass variance of cluster samples characterized by some observable property. Performing information-matrix forecasts of potential parameter constraints from existing and future surveys under different levels of systematic uncertainties, we demonstrate the potential for percent-level constraints on model parameters by an LSST-like optical cluster survey of 300,000 clusters and a richness-mass variance of $0.3^2$. Even better constraints could potentially be achieved by a survey with one-tenth the sample size but with a reduced selection property variance of $0.1^2$. Potential benefits and extensions to the basic MOR parameterization are discussed.Comment: 18 pages, 9 figure