Comparison of heart rate monitoring with indirect calorimetry for energy expenditure evaluation

PurposeThe purpose of this study was to compare established methods with newly-developed methods for estimating the total energy expenditure (TEE).MethodsThe study subjects comprised 46 individuals, including 16 middle-aged men (mean age 51.4 years), 14 middle-aged women (mean age 49.9 years) and 16 young women (mean age 19.1 years). The TEE was estimated from 24-h heart rate (HR) data using newly-developed software (MoveSense HRAnalyzer 2011a, RC1, Suunto Oy, Vantaa, Finland), and was compared against the TEE determined using doubly labeled water (DLW). Agreement between the two methods was analyzed using Bland and Altman plots.ResultsThe HR method yielded similar TEE values as the DLW method at the group level, with an average of 8.6 kcal/day in the difference in the mean, but with large individual variations. Forty-four (96%) out of 46 subjects fell within ±2SD of the mean difference in TEE comparisons, and there was no tendency towards under- or over-estimation.ConclusionOur results indicate that the current software using HR analysis for the estimation of daily TEE needs further development for use with free-living individuals.     

Child protection and justice systems processing of serious child abuse and neglect cases

OBJECTIVE: The aim of this study was to examine the trajectory of cases through four systems: child protection, law enforcement, the dependency courts, and the criminal courts. METHOD: This study focused on a county selected from a 41-county telephone survey conducted for the National Incidence Study of Child Abuse and Neglect (NIS-3). For this analysis prospective samples were drawn from law enforcement (n=225) and the county child protection (CPS) agency (n=225) and followed through in-depth case tracking across all agencies and through both the dependency and criminal court systems. RESULTS: The percentage of CPS cases opened in dependency court was similar to prior studies (29%), but the acceptance and prosecution rates were much higher--92% of the cases referred from CPS, including many cases of physical abuse. Compared to referrals from CPS to law enforcement (93%), few cases were referred from law enforcement to CPS (17%). Anecdotally, case referral patterns appeared to be influenced by communication patterns and mutual positive regard, regardless of the collaborative protocols in place. One of the most instructive findings was the degree of difficulty in tracking cases across organizations and the types of obstacles that impeded success. Disorganization was not an issue, rather internal structures set up to facilitate intra-organizational processing were the same structures that actually impeded cross-organizational case finding. CONCLUSIONS: It is not sufficient to rely on the existence of multi-disciplinary teams or Child Advocacy Centers to ensure collaboration. More attention to daily tasks and activities as well as the nature and quality of communication is warranted. On the technical side, use of common case identifiers on cases that are cross-referred is strongly recommended. Future studies should broaden the scope of inquiry to include the consequences of all case trajectories, rather than solely focusing on the justice system.     

Reflections on the First International iPED Conference,Coventry TechnoCentre,UK, 10–11 September 2006

Through reflection on the First International iPED Conference 2006, and its overarching theme of ‘Pedagogical Research and Academic Identities’, this paper considers the achievement of the wider aims of the conference, which were to facilitate dialogue between researchers in order to explore the conference themes collaboratively, and to provide networking opportunities which would enable participants to build alliances. The abstracts for all papers mentioned are available via the conference website www.coventry.ac.uk/iped2006.     

Young adult outcomes of the Abecedarian and CARE early childhood educational interventions

Adult benefits for participants in Project CARE were compared with those of the Abecedarian Project, a closely related randomized study of early childhood educational intervention for children from low-income families who were at risk of developmental delays and school failure. CARE replicated Abecedarian's young adult treatment-related educational and vocational attainment gains. CARE data also supported the Abecedarian reduction in marijuana use. Treated individuals in both studies reported adopting a more active life style. The average age at birth of a first child, the number of children, and the proportion of teen parents were positively affected in the Abecedarian sample but not in CARE. Finding significant educational and vocational gains lasting into young adulthood in the CARE study reinforces Abecedarian young adult findings and strengthens the case for early childhood intervention for children from low-income families.     

The battered-child syndrome

The battered-child syndrome, a clinical condition in young children who have received serious physical abuse, is a frequent cause of permanent injury or death. The syndrome should be considered in any child exhibiting evidence of fracture of any bone, subdural hematoma, failure to thrive, soft tissue swellings or skin bruising, in any child who dies suddenly, or where the degree and type of injury is at variance with the history given regarding the occurrence of the trauma. Psychiatric factors are probably of prime importance in the pathogenesis of the disorder, but knowledge of these factors is limited. Physicians have a duty and responsibility to the child to require a full evaluation of the problem and to guarantee that no expected repetition of trauma will be permitted to occur.     

Use of grade-based norms versus age-based norms in psychoeducational assessment for a college population

Considerable discussion has occurred about the most appropriate methods for diagnosing learning disabilities (LD) in postsecondary students. Two of the many areas of controversy that have emerged include the appropriate diagnostic criteria to use and the appropriate referent group. A review of previous court cases demonstrates that the issue of whether to compare an individual to the general population or to a smaller referent population has not been adequately clarified. Furthermore, few empirical studies have examined the impact of choosing different referent groups on the likelihood that one will be diagnosed with LD. Therefore, this correlational study described the levels of agreement between three diagnostic models of LD, using both age- and grade-based norms to represent two referent groups for each of the three models. The sample included 155 postsecondary students referred for testing due to academic difficulties. The findings indicated that in two of the three models tested, comparing individuals to their grade-matched peers (i.e., using grade-based norms) resulted in more LD diagnoses than comparing individuals to their age-matched peers (i.e., age-based norms).     

Training program in child abuse for community health workers

A wide range of health workers in the community provide care for families that abuse or have a potential for abusing their children. Frequently these workers are unable to work effectively because of difficulty dealing with feelings aroused by contact with such families.An experimental child abuse training program for community health workers was designed by a pediatrician, a social worker, a public health nurse and two child psychiatrists. This program included a six-month study group which met weekly to focus on feelings and conflcts aroused during the course of work with abusing or potentially abusing families.Through analysis of the group experience, the leaders identified eleven sets of feelings or conflicts which seemed to interfere consistently with effective delivery of care: 1)anxieties about a) being physically harmed by angry parents and b) about the effects of a decision; 2) denial and inhibition of anger; 3) need for emotional gratification from clients; 4) lack of professional support; 5) feelings of incompetence; 6) denial and projection of responsbility; 7) feeling total responsibility for assigned families; 8) difficulty separating personal from professional responsibility; 9) feelings of being a victim; 10) ambivalent feelings a) toward clients and b) about one's professional role; 11) need to be in control.This type of group experience seems to be an effective method for exploration and resolution of feelings and conflicts.