Providing medical evaluations for possible child maltreatment to children with special health care needs

OBJECTIVE: Children with special health care needs are known to be at increased risk of all forms of child maltreatment when compared to children without such needs. We describe a health care team's experience providing medical evaluations for suspected child maltreatment to children with special health care needs. METHOD: Consecutive cases seen as outpatients in the Abuse Referral Clinic for Children with Disabilities were abstracted and analyzed. Mail and telephone follow-up contact was attempted after the medical evaluation to determine adherence with treatment recommendations. A subsample of cases for which complete financial information was available was reviewed to determine a reimbursement rate. RESULTS: During the study, 49 children received complete outpatient evaluations. Ages ranged from 3 to 16 years old, and 54% were males. Special needs spanned a wide range of physical, developmental/cognitive and behavioral conditions. The largest number of referrals came from child protective services (42%) followed by referrals from physicians (27%). After the team's comprehensive evaluation, 18% of the children were found to have a history or physical examination that was diagnostic for child maltreatment, 13% were thought to be at high risk, 25% were thought to be at low risk and 44% were thought to have non-abusive etiologies. The collection rate was 14% for an average reimbursement of $38 per case. Only 29 caregivers could be found at follow-up and 22 remembered the recommendations made by the team. Of the 25 cases that were referred for outpatient mental health counseling, 12 (48%) complied. CONCLUSION: Children with a wide range of special health care needs were evaluated in an outpatient special health care needs clinic that offered comprehensive medical evaluations for possible child maltreatment. Medical evaluation services for this group of children were poorly reimbursed. Mental health services were frequently recommended but often not accessed. Child maltreatment teams seeking to serve children with special health care needs will need to plan for service delivery to a potentially diverse group of children and families who may experience difficulty in carrying through on the team's treatment recommendations.     

Experimenting with global governance: understanding the potential for generational change

The appropriate role for the United Nations in international dispute resolution is a matter of high profile discussion and controversy. This paper begins with this ambivalence about the appropriate role for the United Nations in the world and examines several sets of issues that relate to the future of support for the UN within the US and the prospects for global governance more generally. First, we briefly review two thematic strands in previous and contemporary scholarship:(1) arguments for increased global governance in contemporary world affairs, driven by perceptions of the changing nature of the political, social, economic and military challenges in the contemporary world system. This debate is also put in the context of the relevance of public support for global governance institutions; and (2) why it is valuable to study how the current generation of adolescents perceive issues of global governance and the impact that their views may have on that nexus in the coming years. We then move to an analysis of data generated from an experimental study of American adolescents and their attitudes toward global governance.     

Let’s stop the pretence of consistent marking: exploring the multiple limitations of assessment criteria

Unreliability in marking is well documented, yet we lack studies that have investigated assessors’ detailed use of assessment criteria. This project used a form of Kelly’s repertory grid method to examine the characteristics that 24 experienced UK assessors notice in distinguishing between students’ performance in four contrasting subject disciplines: that is their implicit assessment criteria. Variation in the choice, ranking and scoring of criteria was evident. Inspection of the individual construct scores in a sub-sample of academic historians revealed five factors in the use of criteria that contribute to marking inconsistency. The results imply that, whilst more effective and social marking processes that encourage sharing of standards in institutions and disciplinary communities may help align standards, assessment decisions at this level are so complex, intuitive and tacit that variability is inevitable. We conclude that universities should be more honest with themselves and with students, and actively help students to understand that application of assessment criteria is a complex judgement and there is rarely an incontestable interpretation of their meaning.     

Identifying mentors’ observations for providing feedback

Mentors’ feedback can assist preservice teachers’ development; yet feedback tends to be variable from one mentor to the next. What do mentors observe for providing feedback? In this study, 24 mentors observed a final-year preservice teacher through a professionally video-recorded lesson and provided written notes for feedback. They observed the lesson for a second time and focused their feedback on the preservice teacher’s questioning only. Findings showed that the mentors’ written feedback varied considerably when open observations occurred. However, there were fewer items when they focused on one teaching practice (i.e. questioning), which also provided a deeper analysis of this specific practice. Research is required around the dimensions of observations (i.e. visual, auditory and conceptual), observations of specific practices, and methodological approaches for observing and collecting data about a preservice teacher’s practice.     

The NICE OECD countries' geographic search filters: Part 2—validation of the MEDLINE and Embase (Ovid) filters

Objective:We previously developed draft MEDLINE and Embase (Ovid) geographic search filters for Organisation for Economic Co-operation and Development (OECD) countries to assess their feasibility for finding evidence about the countries. Here, we describe the validation of these search filters.Methods:We identified OECD country references from thirty National Institute for Health and Care Excellence (NICE) guidelines to generate gold standard sets for MEDLINE (n=2,065) and Embase (n=2,023). We validated the filters by calculating their recall against these sets. We then applied the filters to existing search strategies for three OECD-focused NICE guideline reviews (NG103 on flu vaccination, NG140 on abortion care, and NG146 on workplace health) to calculate the filters'' impact on the number needed to read (NNR) of the searches.Results:The filters both achieved 99.95% recall against the gold standard sets. Both filters achieved 100% recall for the three NICE guideline reviews. The MEDLINE filter reduced NNR from 256 to 232 for the NG103 review, from 38 to 27 for the NG140 review, and from 631 to 591 for the NG146 review. The Embase filter reduced NNR from 373 to 341 for the NG103 review, from 101 to 76 for the NG140 review, and from 989 to 925 for the NG146 review.Conclusion:The NICE OECD countries'' search filters are the first validated filters for the countries. They can save time for research topics about OECD countries by finding the majority of evidence about OECD countries while reducing search result volumes in comparison to no filter use.     

Correlation network analysis shows divergent effects of a long-term,high-fat diet and exercise on early stage osteoarthritis phenotypes in mice

Background:Obesity increases knee osteoarthritis(OA) risk through metabolic,inflammatory,and biomechanical factors,but how these systemic and local mediators interact to drive OA pathology is not well understood.We tested the effect of voluntary running exercise after chronic diet-induced obesity on knee OA-related cartilage and bone pathology in mice.We then used a correlation-based network analysis to identify systemic and local factors associated with early-stage knee OA phenotypes among the different diet and exercise groups.Methods:Male C57 BL/6 J mice were fed a defined control(10% kcal fat) or high fat(HF)(60% kcal fat) diet from 6 to 37 weeks of age.At 25 weeks,one-half of the mice from each diet group were housed in cages with running wheels for the remainder of the study.Histology,micro computed tomography,and magnetic resonance imaging were used to evaluate changes in joint tissue structure and OA pathology.These local variables were then compared to systemic metabolic(body mass,body fat,and glucose tolerance),inflammatory(serum adipokines and inflammatory mediators),and functional(mechanical tactile sensitivity and grip strength) outcomes using a correlation-based network analysis.Diet and exercise effects were evaluated by two-way analysis of variance.Results:An HF diet increased the infrapatellar fat pad size and posterior joint osteophytes,and wheel running primarily altered the subchondral cortical and trabecular bone.Neither HF diet nor exercise altered average knee cartilage OA scores compared to control groups.However,the coefficient of variation was≥25% for many outcomes,and some mice in both diet groups developed moderate OA(>33% maximum score).This supported using correlation-based network analyses to identify systemic and local factors associated with early-stage knee OA phenotypes.In wheel-running cohorts,an HF diet reduced the network size compared to the control diet group despite similar running distances,suggesting that diet-induced obesity dampens the effects of exercise on systemic and local OA-related factors.Each of the 4 diet and activity groups showed mostly unique networks of local and systemic factors correlated with early-stage knee OA.Conclusion:Despite minimal group-level effects of chronic diet-induced obesity and voluntary wheel running on knee OA pathology under the current test durations,diet and exercise substantially altered the relationships among systemic and local variables associated with early-stage knee OA.These results suggest that distinct pre-OA phenotypes may exist prior to the development of disease.     

INFLUENCE OF PERCEIVED CONTROL OVER TIME ON COLLEGE STUDENTS' STRESS AND STRESS-RELATED OUTCOMES

Assertions that time management results in less stress, healthier employees, and more effective organizations have received little empirical examination. This study investigates the influence of perceived time management (operationalized as perceived control over time) as a stress coping strategy among college students. Also, the influence of perceived time management on valued student outcomes such as academic performance, problem-solving ability, and health are also investigated. Results from a sample of 164 college students found low levels of stress and high levels of academic performance, problem-solving ability, and health for students that perceived high levels of perceived control over time compared to students who perceived low control over time. Discussion of the study findings, implications, and direction for future research is presented.