Moving Beyond Lip Service: The Clinical Reasoning Behind Practicing Strengths

Social work has a long tradition of advocating for practice from the strengths perspective. However, it is unclear whether schools are truly preparing students for strengths based practice or whether they are simply teaching them to use the vocabulary of strengths without the clinical reasoning skills to switch paradigms from deficits to strengths, moving beyond lip service to real strengths-based practice. To explore this issue, data from an exercise in an MSW course was explored using qualitative methodology. The findings support that in addition to using a strengths vocabulary, other components are necessary for true implementation of a strengths approach. First, the data revealed a strengths-oriented structural model of an ideal process of clinical reasoning for approaching a client situation. Second, the process includes recognizing client strengths, reflecting on them with the client, and encouraging repetition and reinforcement of the client’s positive attitudes and actions. Finally, true strengths based understanding requires moving from social worker in the role of expert to social worker engaged in collaborative empowerment practice. These findings have implications for social work practice and education

Addressing the Needs of Young Children and Families:Early Childhood Education and Services in Catholic Schools and Catholic Charities

Nationally, focus is increasing on the developmental experiences of young children (birth to age 8). Twenty four (arch)dioceses in large metropolitan areas participated in a survey identifying the extent and nature of services provided by Catholic schools and Catholic Charities programs to young children and their families. Six hundred and seventy Catholic schools and 100 Catholic Charities programs completed surveys. Key findings suggest that Catholic schools and Catholic Charities programs are engaged in a plethora of early childhood services and educational activities with young children and families. Both entities provide direct education and services to young children, are engaged in supporting families through a variety of initiatives, and have complementary as well as distinctive approaches. Opportunities were identified within Catholic Schools and within Catholic Charities programs. The potential benefits of increasing collaborations between Catholic schools and Catholic Charities programs, and with others, were highlighted to comprehensively meet the varied (and, at times, extensive) needs of young children and families. Abordando las necesidades de los niños y sus familias: educación en la primera infancia y servicios en las escuelas católicas y los centros católicos de beneficencia A nivel nacional, el foco se incrementa en las experiencias de desarrollo de niños pequeños (desde el nacimiento hasta los ocho años). Veinticuatro diócesis y archidiócesis en grandes zonas metropolitanas participaron en una encuesta con el objetivo de identificar el alcance y la índole de los servicios ofrecidos por las Escuelas católicas y los programas católicos de beneficencia a los niños pequeños y sus familias. Completaron la encuesta seiscientas setenta escuelas católicas y cien programas católicos de beneficencia. Los resultados clave sugieren que las escuelas católicas y los programas católicos de beneficencia están comprometidos en un sinfín de servicios para la primera infancia y actividades educativas para niños y familias. Ambas entidades proveen educación y servicios directos a niños y están comprometidas en el apoyo a las familias mediante una variedad de iniciativas, y disponen de planteamientos complementarios así como distintivos. Se identificaron oportunidades en las escuelas católicas y en los programas católicos de beneficencia. Se resaltaron las ventajas potenciales del aumento de colaboración entre las escuelas católicas y los programas católicos de beneficencia con otros para cumplir de manera comprensiva con las necesidades variadas (y a veces extensas) de los niños pequeños y las familias. Palabras clave: escuelas católicas, centros católicos de beneficencia, primera infancia, servicios a la familia, colaboración Répondre aux besoins des jeunes enfants et des familles : éducation et services à la petite enfance dans les écoles et organisations caritatives catholiques Au plan national, l’attention est de plus en plus axée sur le développement et les expériences vécues par les jeunes enfants (de la naissance à huit ans. Dans les grandes zones métropolitaines, 24 diocèses et archidiocèses ont participé à des enquêtes pour établir l\u27étendue et la nature des services rendus aux jeunes enfants et à leurs familles par les écoles et programmes caritatifs catholiques. 670 écoles catholiques et 100 programmes caritatifs ont répondu aux enquêtes. Les principales constatations montrent que les écoles et organisations caritatives catholiques sont impliquées dans une pléthore de services et activités éducatives pour la petite enfance, destinés aux jeunes enfants et aux familles. Les deux entités fournissent directement un enseignement et des services aux jeunes enfants, agissent pour aider les familles par le biais d\u27initiatives diverses et adoptent des approches complémentaires bien que distinctes. Des possibilités d’action ont été établies au sein des écoles catholiques et des programmes caritatifs. L\u27accent a été mis sur les avantages potentiels qu\u27apporterait une collaboration accrue entre les écoles et organisations caritatives catholiques, et autres, en vue de satisfaire totalement les besoins variés (parfois substantiels) des jeunes enfants et des familles. Mots-clés : Écoles catholiques, organisations caritatives, petite enfance, services familiaux, collaboratio

Random Matrices and Chaos in Nuclear Physics

The authors review the evidence for the applicability of random--matrix theory to nuclear spectra. In analogy to systems with few degrees of freedom, one speaks of chaos (more accurately: quantum chaos) in nuclei whenever random--matrix predictions are fulfilled. An introduction into the basic concepts of random--matrix theory is followed by a survey over the extant experimental information on spectral fluctuations, including a discussion of the violation of a symmetry or invariance property. Chaos in nuclear models is discussed for the spherical shell model, for the deformed shell model, and for the interacting boson model. Evidence for chaos also comes from random--matrix ensembles patterned after the shell model such as the embedded two--body ensemble, the two--body random ensemble, and the constrained ensembles. All this evidence points to the fact that chaos is a generic property of nuclear spectra, except for the ground--state regions of strongly deformed nuclei.Comment: 54 pages, 28 figure

Evidence-based decision support for pediatric rheumatology reduces diagnostic errors.

BACKGROUND: The number of trained specialists world-wide is insufficient to serve all children with pediatric rheumatologic disorders, even in the countries with robust medical resources. We evaluated the potential of diagnostic decision support software (DDSS) to alleviate this shortage by assessing the ability of such software to improve the diagnostic accuracy of non-specialists. METHODS: Using vignettes of actual clinical cases, clinician testers generated a differential diagnosis before and after using diagnostic decision support software. The evaluation used the SimulConsult® DDSS tool, based on Bayesian pattern matching with temporal onset of each finding in each disease. The tool covered 5405 diseases (averaging 22 findings per disease). Rheumatology content in the database was developed using both primary references and textbooks. The frequency, timing, age of onset and age of disappearance of findings, as well as their incidence, treatability, and heritability were taken into account in order to guide diagnostic decision making. These capabilities allowed key information such as pertinent negatives and evolution over time to be used in the computations. Efficacy was measured by comparing whether the correct condition was included in the differential diagnosis generated by clinicians before using the software ( unaided ), versus after use of the DDSS ( aided ). RESULTS: The 26 clinicians demonstrated a significant reduction in diagnostic errors following introduction of the software, from 28% errors while unaided to 15% using decision support (p \u3c 0.0001). Improvement was greatest for emergency medicine physicians (p = 0.013) and clinicians in practice for less than 10 years (p = 0.012). This error reduction occurred despite the fact that testers employed an open book approach to generate their initial lists of potential diagnoses, spending an average of 8.6 min using printed and electronic sources of medical information before using the diagnostic software. CONCLUSIONS: These findings suggest that decision support can reduce diagnostic errors and improve use of relevant information by generalists. Such assistance could potentially help relieve the shortage of experts in pediatric rheumatology and similarly underserved specialties by improving generalists\u27 ability to evaluate and diagnose patients presenting with musculoskeletal complaints. TRIAL REGISTRATION: ClinicalTrials.gov ID: NCT02205086

Atypical maternal interaction is associated with elevated levels of hair cortisol in children

The quality of maternal caregiving is an important factor in the healthy development of a child. One consequence of prolonged insensitive and atypical maternal interaction behavior (e.g., withdrawing from interactions with the child and role-reversal, i.e., the takeover of the parental role or parts of it by the child) in mother-child-dyads can cause alteration of the child's stress response system. Higher salivary cortisol concentrations were reported in infants and toddlers directly after negative interactions with their parents. However, no study to date has examined the association between atypical maternal interaction behavior and hair cortisol concentrations (HCC) in infants. Here, we studied the association of maternal interaction behavior with HCC of the child. Mother-child dyads (N = 112) participated in the longitudinal study My Childhood—Your Childhood. The AMBIANCE scale and its subscales were used to assess atypical maternal interaction behavior during the Strange Situation Procedure. Chronic stress levels in the child were assessed by HCC of 3 cm hair strands at the age of 12 months. Maternal educational level (operationalized in highest education level) served as a control variable. Robust multiple linear regression analyses revealed that role/boundary confusion was associated with HCC, i.e., the higher atypical interaction behavior of the mother the higher the HCC in the children. By measuring hair cortisol in this study, it is possible to determine the average long-term activity of the child's stress response system.Thus, atypical maternal interaction behavior could be a risk factor for persistent stress in children, contributing to a higher risk for negative health outcomes in later life. The results of this study highlight the importance of early intervention programs that focus on the relationship between mother and child

I’m deleting as fast as I can: Negotiating learning practices in cyberspace

Learning in and through work is one of the many spaces in which pedagogy may unfold. Web technologies amplify this fluidity and online learning now encompasses a plethora of practices. In this paper I focus on the delete button and deleting practices of self-employed workers engaged in informal work-related learning in online communities. How the relational and material aspects of online pedagogical practices are being negotiated is explored. While deleting appears to be an everyday practice, understanding the delete button as a fluid object in fluid space begins to illuminate its complexity and multiple enactments. Deleting practices which work to stem the tide of information pushing itself onto screens, as well as those practices that attempt to delete traces left behind on screens and ‘in the cloud’, are examined. Actor Network Theory provides the theoretical and conceptual tools for this exploration. I conclude with observations on the politics of the delete button and implications for more sophisticated digital fluency in everyday pedagogy

From Quantum Systems to L-Functions: Pair Correlation Statistics and Beyond

The discovery of connections between the distribution of energy levels of heavy nuclei and spacings between prime numbers has been one of the most surprising and fruitful observations in the twentieth century. The connection between the two areas was first observed through Montgomery's work on the pair correlation of zeros of the Riemann zeta function. As its generalizations and consequences have motivated much of the following work, and to this day remains one of the most important outstanding conjectures in the field, it occupies a central role in our discussion below. We describe some of the many techniques and results from the past sixty years, especially the important roles played by numerical and experimental investigations, that led to the discovery of the connections and progress towards understanding the behaviors. In our survey of these two areas, we describe the common mathematics that explains the remarkable universality. We conclude with some thoughts on what might lie ahead in the pair correlation of zeros of the zeta function, and other similar quantities.Comment: Version 1.1, 50 pages, 6 figures. To appear in "Open Problems in Mathematics", Editors John Nash and Michael Th. Rassias. arXiv admin note: text overlap with arXiv:0909.491

Updated standardized definitions for efficacy endpoints in adjuvant breast cancer clinical trials: STEEP Version 2.0

Purpose The Standardized Definitions for Efficacy End Points (STEEP) criteria, established in 2007, provide standardized definitions of adjuvant breast cancer clinical trial end points. Given the evolution of breast cancer clinical trials and improvements in outcomes, a panel of experts reviewed the STEEP criteria to determine whether modifications are needed.Methods We conducted systematic searches of ClinicalTrials.gov for adjuvant systemic and local-regional therapy trials for breast cancer to investigate if the primary end points reported met STEEP criteria. On the basis of common STEEP deviations, we performed a series of simulations to evaluate the effect of excluding non-breast cancer deaths and new nonbreast primary cancers from the invasive disease-free survival end point.Results Among 11 phase III breast cancer trials with primary efficacy end points, three had primary end points that followed STEEP criteria, four used STEEP definitions but not the corresponding end point names, and four used end points that were not included in the original STEEP manuscript. Simulation modeling demonstrated that inclusion of second nonbreast primary cancer can increase the probability of incorrect inferences, can decrease power to detect clinically relevant efficacy effects, and may mask differences in recurrence rates, especially when recurrence rates are low.Conclusion We recommend an additional end point, invasive breast cancer-free survival, which includes all invasive disease-free survival events except second nonbreast primary cancers. This end point should be considered for trials in which the toxicities of agents are well-known and where the risk of second primary cancer is small. Additionally, we provide end point recommendations for local therapy trials, low-risk populations, noninferiority trials, and trials incorporating patient-reported outcomes

Seismic Expression of Pleistocene Paleoceanographic Changes in the California Borderland from Digitally Acquired 3.5 Khz Subbottom Profiles and Ocean Drilling Program Leg 167 Drilling

We correlate processed 3.5 kHz seismic profiles with physical properties of cores collected during ODP Leg 167 from the Tanner, East Cortes, and San Nicolas Basins through much of the Pleistocene succession. Results indicate that seismic horizons in the unconsolidated Pleistocene sediments (top 50 m) are mainly controlled by density contrasts. Removing of the compaction trend from the density reveals a very interesting relationship between density and composition - the density closely and inversely correlates with organic carbon indicating that large-scale variations in organic carbon are responsible for seismic reflections through their influence on density. This is a significant discovery since there apparently is no other paleoceanographic setting that we know of where such a close linkage between acoustic properties and organic carbon has been established. The variations in organic carbon are mainly marine in origin and derive from variations in primary productivity associated with upwelling and the preservation regime related to oxygenation of water. Pleistocene reflections on 3.5 kHz profiles in the Borderland province thus record regional cyclical fluctuations in the paleoclimatic signals. The close resemblance in the density profiles at the three different basins indicates that the sedimentary regime was similar in those basins through the Pleistocene. These common density patterns produce regional seismic horizons that correlate well among the basins. It is likely these correlated and dated horizons could be extrapolated to other Borderland basins (e.g., San Clemente), where they can potentially be used as time markers for neotectonic studies in the region