Search

In this article, we argue for a new approach to child welfare—one that replaces existing child protection systems beset by scandals and tragedies with broad-scale system re-alignment that places public health prevention and early intervention at the forefront of efforts to engage, support, and empower families. We explain that the ‘rescue and removal’ orientation that drives policies and practices in contemporary child welfare and child protection systems is deeply flawed in its orientation, lacking in its evidence of effectiveness, and fiscally unsustainable. We point to differential response as one attempt to reform child welfare systems from within, but note that the changes DR brings, while promising, are insufficient to achieve what is required to eradicate child maltreatment and bring about a more just and sustainable practice of promoting the welfare of children. Here, we also share some emerging and encouraging initiatives from around the globe to illustrate the promise of prevention and early intervention approaches—what we call beacons of hope. For the sake of all children, it is time think boldly about the potential that exists in broad-scale, systemic and cross-sectoral reform that fully and unabashedly embraces universal and primary prevention as a means to ensure children’s right to personal security.

Background/Context The literature review by Phelps in this special issue highlights the challenges of research–practice partnerships and other forms of insider–outsider collaboration in education. In addition to addressing well-known challenges, this case study article focuses on the full-service community school model as a strategy to address holistic needs of students, families, and staff in poverty-impacted school contexts. Purpose/Objective/Research Question/Focus of Study This article documents work that was conducted across five years, when a large research university partnered with an urban elementary school to establish a full-service community school. It provides an account of the assets, challenges, and processes that impacted our work, from the planning phase through four years of implementation. It describes efforts around four main areas: academic excellence, extended learning, holistic health and wellness, and family engagement. Research Design This is a participatory case study with university educators and researchers working collaboratively with school professionals, community-based organizations, and families. Data Collection and Analysis Many sources of data were included in our case analysis, including formative and summative student assessments, student attendance, service referrals, and office referrals for behavior. Running records of meetings, documentation of events, presentations, and reports submitted were also included. Interviews with key actors in the project were also collected and analyzed. Conclusions/Recommendations Our partnership experienced some of the major challenges discussed in the literature. Turnover was overwhelmingly the most significant challenge. Student mobility and district boundary changes, new curricular adoptions for mathematics and literacy, new student assessments, new data tracking system, new bell times, and measures to cut transportation costs also impacted the effort. In spite of these challenges, we also experienced important successes. Centering relationships in our work has been an essential part of the success we experienced and is itself a success. At every phase, we remained at the table together, working to build relationships and sharing visions, goals, and practices. This resulted in important changes with stronger systems for tracking and using student data in educational decision making, health and wellness services now available to all students, and a universal social-emotional curriculum now in place. Family engagement and parent leadership are now essential dimensions of the school, with parents of color playing important roles to amplify their own and other parents’ voices. Preservice teachers learned about full-service community schools in situ. We highlight the rich and complex narrative that emerged, which is not simply one of challenge but also one of resilience and strength. Carefully documenting this initiative can contribute to guiding implementation and refinement of a full-service community school model.

BACKGROUND We aim to describe the outcomes of Geriatric Emergency Room Innovations for Veterans (GERI-VET), the first comprehensive Veterans Affairs Geriatric ED program. METHODS In this prospective observational cohort study at an urban Veterans Affairs Medical Center ED, participants included Veterans aged 65 years and older treated in the ED from January 7, 2017 to February 29, 2020. Veterans with an Identification of Seniors At Risk (ISAR) score >2 were considered eligible for GERI-VET, receiving geriatric screens and care coordination in addition to standard ED treatment. The control group included GERI-VET eligible Veterans who did not receive GERI-VET care. Propensity score matching was used to compare outcomes in the GERI-VET group (N = 725) and a matched control group (n = 725). Key measures included ED resource utilization, outpatient referrals, ED admission, and 30-day admission. RESULTS In the ED, the GERI-VET group received more consults to pharmacy (315 [43.4%] vs. 195 [26.9%], p

Background The long-term health effects of physical child abuse are well documented in self-report, retrospective studies. However, there have been few longitudinal, multimethod studies on physiological responses to stress and the onset of chronic disease, thereby slowing the advancement of prevention and intervention programs. Objectives This study used survey data from an extended longitudinal study to examine prospective and retrospective associations between measures of physical child abuse and adult health in the 40s. Participants and setting Data are from an ongoing longitudinal study of the correlates and consequences of child maltreatment that began in the 1970s with a sample of 457 children. Methods Bivariate correlations and multiple regression models with covariates were used to assess associations between measures of physical child abuse and outcomes of self-reported health in adulthood. Results Physical child abuse, measured retrospectively, was moderately related to reports of overall health, as well as a number of adult health problems and conditions, such as back and chest pain, hypertension, and certain forms of cancer. Associations were also observed for lifetime alcohol problems and past-year doctor and emergency room visits. Fewer associations between prospective parent self-report measures of physical child abuse and adult health were identified, although child welfare (official record) reports performed similarly to retrospective measures. Conclusions This study adds important information on the long-term health effects of child physical abuse, as well as measurement differences in the prediction of adult health outcomes. Conclusions drawn from prospective and retrospective studies of abuse are at best inconsistent, and possibly incompatible.

The special issue highlights work across systems that include child welfare, education, juvenile justice and health, as well as agencies serving adults who are at-risk for high levels of childhood and adult trauma exposure. While articles appearing in the special issue are not divided equally across these systems, they cover important and overlapping concepts within each. Some articles span more than a single system or domain of research, whereas others fit primarily within single area or domain. Articles provide new insights from research on practices, programs, and policies that help to transform systems so they are increasingly more responsive to the needs of vulnerable populations.

A public health model aimed at promoting children’s well-being by reducing risks in the environment and enhancing protection at the individual, family, and community levels is frequently re...

Efforts to support cognitive function in the emergency department (ED) setting should be performed given the significant volume of patients with dementia and delirium and opportunities for intervention in the ED. Older adults prioritize retention of their memory and independence; therefore, detection of new or progressive cognitive impairment in the ED can facilitated patient- and caregiver-centered care. Delirium detection can be performed with the Confusion Assessment Method, a well-validated tool with widespread use by clinicians and non-clinicians. Aging-friendly EDs should adopt both delirium preventive and treatment measures into their care of older adults. Multiple dementia assessments are available, with the Short Blessed Test being both sensitive and time efficient. Opportunities for specialized inpatient programs, such as Acute Care for Elders, and early outpatient referrals should be considered for patients diagnosed with new or progressive dementia in the ED.

This chapter summarises the major themes and key messages presented in the book and explores the new and emerging opportunities described by contributing authors. It pulls together the critical issues that are likely to continue to beset the development and implementation of public health approaches and system reform processes. The major learnings thus far are highlighted and some of the possible directions in program and service development are explored for their application across various jurisdictions. The key features and principles for designing and implementing public health approaches are outlined and the issues stemming from these examined with respect to addressing the imperatives of involving all stakeholders, including end users and especially children, in the development of new initiatives and reforms.

Background Unacceptably high staff turnover has plagued traditional approaches to child protection, seemingly forever. Around the globe, numerous studies, reports and inquiries have highlighted how statutory agencies, focusing on risk-oriented investigations of suspected maltreatment, experience significant issues with worker stress and its occupational and organisational consequences. Yet, promoting staff resilience within child protection agencies’ workforces has proved to be quite elusive at a systems level. While concern about child protection services often centers on the children and families agencies they intend to assist, the experiences of workers within the system provide further evidence that the system is itself failing. As a result, governments around the world are increasingly embracing system reforms that promote public health approaches focusing on early intervention and prevention to build child, family and neighbourhood support capacity and resilience and thereby reduce child maltreatment. Objective We review the workforce issues affecting traditional child protection approaches and its impacts. In light of this, we examine the knowledge to be applied in the development of public health approaches that embrace integrated and coordinated systems of community care. Such reforms, with altered organisational remits that are far broader than narrow tertiary responses of investigation and removal, utilize evidence-based interventions targeted at differentiated risk and service user needs to provide effective supports and reduce maltreatment. This article unpacks the strategies needed to build and properly prepare a re-tooled workforce capable of implementing a public health model of preventive interventions. Participants and setting Not applicable. Methods Current public health reforms are examined through the lens of their potential impacts upon contemporary workforce issues. Focusing upon building a stable, resilient and appropriately skilled workforce for a public health model, we examine the implications for key stakeholders including workers, program and organisational leaders, educators, researchers, academics and community members, especially children and vulnerable families. Results and conclusions Public health approaches to protecting children seek to provide effective supports and services in timely ways in order to prevent unnecessary statutory interventions, which affect those from cultural and poor communities disproportionately. But remodelling systems to embrace these approaches entails complex practice, program, policy and legislative changes, using evidence to intervene in ways that are primarily voluntary rather than coercive. In doing so they provide potential to recast the basis of the helping relationship to attend better to the relational aspects of changed behaviour. Embedding workforce resilience strategies in reformed systems is necessary to address retention and ensure service effectiveness and responsiveness to the diversity of needs of struggling families and impoverished communities. Thereby, public health approaches are well placed to achieve their true potential.

Background: Effective teamwork is highly reliant on both technical and non-technical skills (such as communication, decision making and situational awareness). In healthcare, the role of non-technical skills fails to take priority and can hinder a team’s performance. Methods: Our objective was to determine the effectiveness and efficacy of delivering a full-day professional development symposium focused on communication strategies and culture building to the operating room staff at a hospital with over 250 acute beds. A prospective, observational cohort study including all members of the operating room was designed. Improvement was measured through an anonymous, voluntary, web-based survey and surrogate metrics of improved communication and positive work culture (staff turnover, sick days and spending). Results: 82 participants completed at least one survey. At three months post-symposium, more than 60% of participants noticed that their colleagues made active efforts to communicate positively and effectively in their interactions (p = 0.009). At this same interval, staff reported a reduction in common challenges routinely encountered in the operating room. Sick days fell from 622 in the year preceding the symposium to 218 in the year following the symposium. Staff turnover fell from nine to two in that same interval while OR spending was reduced by 4.2%. Interpretation: Results from our cohort suggest that a focused, professional development symposium with emphasis on communication strategies may improve operating room culture and yield both cost savings and improved patient care. More quality-controlled research with a rigorous study design is needed to assess the impact of communication training in an OR setting.

Older adults made over 21 million Emergency Room (ER) visits accounting for nearly 46% of all ER hospital admissions in 2015. The ER setting provides not only a unique opportunity to assess patients’ health, functional status and social issues, but also provide recommendations to help coordinate care. Geriatric ER assessments have been associated with reduced avoidable hospitalizations, functional decline, and institutionalization. However, few ER clinicians including physicians, nurses and technicians have received adequate training to perform geriatric screenings and implement timely referrals. In 2014 American College of Emergency physicians and American Geriatric Society published guidelines for care. Based on these guidelines A” Geri-Vet Bootcamp” Program was developed and piloted at the Northeast Ohio VAMC. This program included: simulation emphasizing standardized screenings, and the use of decision support aides for management and referrals for older adults seen in the ER. Following this multi-modal education program, 91% clinicians reported greater ability to apply knowledge learned, 82% clinicians were able to more accurately identify geriatric syndromes, and 86% were able to identify additional resources. Of the patients screened over one year, 73% of patients were identified as being at high risk for falls, 32% had high family caregiver burden, 15% had moderate to severe dementia, and 14% had positive delirium screens. Those veterans screened by Geri Vet trained Staff received significantly more referrals than usual care staff, home care 28.7% vs.15.6%, geriatric clinic 20.5% vs. 11.7% and caregiver support 5.0% vs. 1.3%. Data show hospital admissions have decreased 5-7%. Education and dissemination continues

Background TNFα inhibitors are a well-known risk factor for active tuberculosis but less is known about the link between TNFα inhibitors and other mycobacterial diseases, particularly M. marinum. With the increase in use of these medications, and the trend toward more outdoors activities that include aquatic environment exposure, focus should be on better understanding of the link between use of TNFα inhibitors and the development of a severe M. marinum infection that might require earlier diagnosis and more aggressive antibiotic therapy. Methods We will describe our experience with three cases of aggressive cutaneous M. marinum infection in patients taking anti-TNFα that presented to Abington Memorial Hospital in Pennsylvania between 2014 and 2017. Results Age, gender, diagnosis Age, gender, diagnosis Anti TNFα, duration and indication Exposure Delay in diagnosis Treatment Progression 47 y.o F Cellulitis/lymphangitis Etanercept, 5 years, for RA Municipal pool 2 weeks Clarithromycin+ etmabutol Cleared in 2 months 34 y.o M cellulitis Infliximab, 7 years, UC Salt water fish tank 10 weeks Clarithromycin+ etmabutol Cleared in 3 weeks 62 y.o F Cellulitis/lymphangitis Adalimumab, 8 months, RA Barnacle injury 4 weeks Clarithromycin+ Rifampin Cleared in 1 month Conclusion TNFα is not only linked to active TB, but also associated with other mycobacterial diseases including M. marinum. While CDC reports a delay of 17 months from time of onset of symptoms to establishing the diagnosis, our three cases were diagnosed much earlier. Early diagnosis relies probably on involvement of Infectious diseases specialists early in the course of the illness and the readiness in sampling of the lesions. The challenge to the clinicians remain in the safety and the timing of resuming anti TNFα treatment after M. marinum infection. Disclosures All authors: No reported disclosures.

Estimates suggest that between 10% and 25% of adolescents have experienced some form of physical violence within a dating relationship, and one in four college-age women experiences attempted or completed sexual violence on campus. Bystander programs focus on equipping young adults with the skills to safely intervene when they witness behaviors that can result in dating abuse. This approach is promoted for its capacity both to transform community norms that contribute to dating abuse and to foster more positive social interactions among youth, however, there has been limited review of the literature on the outcomes of bystander programs. Therefore, this article provides an in-depth systematic literature review, which describes the content and program components of bystander programs and summarizes what is currently known about the impact of bystander interventions on participants’ behaviors and attitudes. Results indicate that bystander programs are promising from the standpoint of increasing young adults’ willingness to intervene and confidence in their ability to intervene when they witness dating or sexual violence, however, the utilization of actual bystander behaviors was less straightforward. Implications for prevention practice and for future research are presented.

To examine trends in and correlates of fighting and violence among youths from the 3 largest racial/ethnic groups in the United States.We derived race/ethnicity-specific prevalence estimates for fighting, group fighting, and attacks with intent to harm from the National Survey on Drug Use and Health, a population-based study of youths aged 12 to 17 years.The prevalence of youth fighting and violence decreased significantly in all racial/ethnic groups over the study period (2002-2014), dropping from a high of 33.6% in 2003 to a low of 23.7% in 2014, reflecting a 29% decrease in the relative proportion of young people involved in these behaviors. However, there was also a clear severity gradient in which year-by-year point estimates for fighting and violence were consistently highest among non-Hispanic African American youths, followed by Hispanic and then non-Hispanic White youths.Although fighting and violence are on the decline among young people in general and across racial/ethnic subgroups, there is a stable pattern of disparities in youth involvement in these behaviors.

BACKGROUND The clinical learning model in medical education is driven by knowledge acquisition through direct patient-care experiences. Despite the emphasis on experiential learning, the ability of educators to quantify the clinical exposures of learners is limited. OBJECTIVE To utilize Veterans Affairs (VA) electronic medical record information through a data warehouse to quantify clinical exposures during an inpatient internal medicine rotation. METHODS We queried the VA clinical data warehouse for the patients encountered by each learner completing an acting internship rotation at the Cleveland VA Medical Center from July 2008 to November 2011. We then used discharge summary information to identify team exposures—patients seen by the learner's inpatient team who were not primarily assigned to the learner. Based on the learner and team exposures, we complied lists of past medical problems, medications prescribed, laboratory tests that resulted, radiology evaluated, and primary discharge diagnoses. RESULTS Primary learner and team-based clinical exposures were evaluated for a total of 128 acting internship students. The percentage of learners who had a primary exposure to a medication/lab value/imaging result/diagnosis was calculated. The percentage of learners with at least 1 primary or team-based exposure to an item was also calculated. The most common exposures in each category are presented. CONCLUSIONS Analysis of the clinical exposures during an inpatient rotation can augment the ability of educators to understand learners' experiences. These types of analyses could provide information to improve learner experience, implement novel curricula, and address educational gaps in clinical rotations. Journal of Hospital Medicine 2014;9:436–440. © 2014 Society of Hospital Medicine

Despite their medical training, record of military service, and the unmet needs within the health care sector, numerous challenges face veterans who seek to leverage their health care skills for employment after leaving the military. Creative solutions are necessary to successfully leverage these skills into jobs for returning medics that also meet the needs of health care systems. To achieve this goal, we created a novel ambulatory care health technician position on the basis of existing literature and modeled after a program which incorporates former military medics in emergency departments. Through a quality improvement approach, a position description, interview process, training program with clinical competencies, and team integration plan were developed and implemented. To date, two medics have been hired, successfully trained on relevant skill sets, and are currently caring for medical outpatients (under the supervision of licensed clinical personnel) as crucial interdisciplinary team members. Taken together, a multifaceted approach is required to effectively harness military medics' skills and experiences to meet identified health delivery needs.

The study of resilience in children who have been exposed to violence has led to three important conclusions: (1) That resilience is a complex, somewhat nebulous concept to which researchers have attached various meanings and definitions; (2) that these definitions are influenced to a certain extent by where hypotheses about resilience processes intersect with questions of more general interest to a researcher, such as how abused children or those otherwise exposed to violence keep from behaving poorly; (3) that resilience, defined as it is by a researcher, and studied developmentally, is malleable and responsive to the social environment (Herrenkohl, 2011; Klika & Herrenkohl, 2013; Ungar, 2013). As discussed in the articles of this special issue, questions about definitions, measurement, and data analytic strategies abound in the research literature on resilience. Authors of the five articles examine these issues by way of deep review and critique of published studies. The collection as a whole offers an important statement about the contributions and major advances in research that have occurred over the years, but also the gaps and inconsistencies that make interpretation of findings, at times, exceedingly difficult. Before attending specifically to the content of each review, I provide below a brief summary of just a few of the ‘‘big picture’’ issues that our contributors cover in their individual reports.

A number of cross-sectional and a few longitudinal studies have shown a developmental relationship between child abuse and adult physical and mental health. Published findings also suggest that social support can lessen the risk of adverse outcomes for some abused children. However, few studies have investigated whether social support mediates or moderates the relationship between child abuse and adult physical and mental health. Structural equation modeling was used to examine data on these topics from a longitudinal study of more than 30 years. While a latent construct of physical and emotional child abuse did not predict adult health outcomes directly, child abuse did predict outcomes indirectly through social support. A test of variable moderation for child abuse and social support was nonsignificant. Results suggest that social support may help explain the association between child abuse and health outcomes at midlife. Implications of the findings for prevention and treatment are discussed. (PsycINFO Database Record

This study examined the association between officially recorded child abuse and neglect and adult mental health, substance use, and physical health outcomes. Data are from a longitudinal study of more than 30 years in which individuals were interviewed most recently in their mid -30s. Analyses consisted of group comparisons using chi-square tests for categorical variables and independent samples t-tests for continuous measures. Logistic and linear regressions controlled for gender and childhood SES, adult age, marital status, and education. Adults maltreated in childhood reported more symptoms of adult depression, anxiety, and more impairment due to mental and physical health problems. A higher percentage of those with maltreatment histories reported lifetime alcohol problems and appear at greater risk for substance abuse. Most findings of these bivariate analyses remained significant after accounting for gender and childhood socioeconomic status. Somewhat fewer significant results were observed after controlling for adult age, marital status, and education.

School suspension is associated with school drop-out, crime, delinquency, and alcohol and other drug use for the suspended student. Important research questions are how academic and related factors are relevant to the school suspension process and the generality of the process in different sites. State representative samples of Grade 7 students (N = 1,945) in Washington State, United States and Victoria, Australia were followed from 2002 to 2004. In both states, Grade 7 school suspension was associated with higher rates of nonviolent antisocial behavior and suspension 24 months later, before Grade 8 factors were entered into the model. Relevant factors were Grade 8 low school grades and association with antisocial peers, as well as Grade 8 antisocial behavior in Washington State only. The implications of these findings for the ways in which suspension is used in schools are outlined.

Context: School suspension may have unintended consequences in contributing to problem behaviors, including dropping out from school, substance use, and antisocial behavior. Tobacco use is an early-onset problem behavior, but prospective studies of the effects of suspension on tobacco use are lacking. Method: Longitudinal school-based survey of students drawn as a two-stage cluster sample, administered in 2002 and 2003, in Washington State, United States, and Victoria, Australia. The study uses statewide representative samples of students in Grades 7 and 9 ( N = 3,599). Results: Rates of tobacco use were higher for Victorian than Washington State students. School suspension remained a predictor of current tobacco use at 12-month follow-up, after controlling for established risk factors including prior tobacco and other drug use for Grade 7 but not Grade 9 students. Conclusions: School suspension is associated with early adolescent tobacco use, itself an established predictor of adverse outcomes in young people. Findings suggest the need to explore process mechanisms and alternatives to school suspensions as a response to challenging student behavior in early adolescence.

Objective: This study examined concurrent and prospective relations between clinical depression, obesity and alcohol use disorders during young adulthood to better understand common etiology and the progression of co-occurrence. Method: Participants were 776 young adults (393 males and 383 females) who were interviewed at ages 24, 27 and 30 years with assessment of past-year major depressive episode, past-year alcohol abuse or dependence disorder, and obesity. Longitudinal path analyses were conducted separately for women and men, controlling for income and including stability of each of these outcomes. Results: Among women, depression was positively associated with later alcohol use disorders (ages 27 to 30: OR=3.11), and alcohol use disorders prospectively predicted obesity (ages 24 to 27: OR=3.84). Obesity predicted depression from ages 27 to 30 among women (OR=2.14), but was protective against depression for males (OR=0.31). Conclusions: Results show that depression, obesity and alcohol use disorders are interrelated conditions for women. A greater understanding of reasons underlying the co-occurrence of these conditions would benefit prevention and intervention efforts.

This review addresses research on the overlap in physical child abuse and domestic violence, the prediction of child outcomes, and resilience in children exposed to family violence. The authors explore current findings on the intersection of physical child abuse and domestic violence within the context of other risk factors, including community violence and related family and environmental stressors. Evidence from the studies reviewed suggests considerable overlap, compounding effects, and possible gender differences in outcomes of violence exposure. The data indicate a need to apply a broad conceptualization of risk to the study of family violence and its effects on children. Further testing of competing theoretical models will advance understanding of the pathways through which exposure leads to later problems in youth, as well as protective factors and processes through which resilience unfolds.

Purpose There have been few longitudinal studies of deliberate self-harm (DSH) in adolescents. This cross-national longitudinal study outlines risk and protective factors for DSH incidence and persistence. Methods Seventh and ninth grade students (average ages 13 and 15 years) were recruited as state-representative cohorts, surveyed, and then followed up 12 months later (N = 3,876), using the same methods in Washington State and Victoria, Australia. The retention rate was 99% in both states at follow-up. A range of risk and protective factors for DSH were examined using multivariate analyses. Results The prevalence of DSH in the past year was 1.53% in Grade 7 and .91% in Grade 9 for males and 4.12% and 1.34% for Grade 7 and Grade 9 females, respectively, with similar rates across states. In multivariate analyses, incident DSH was lower in Washington State (odds ratio [OR] = .67; 95% confidence interval [CI] = .45–1.00) relative to Victoria 12 months later. Risk factors for incident DSH included being female (OR = 1.93; CI = 1.35–2.76), high depressive symptoms (OR = 3.52; CI = 2.37–5.21), antisocial behavior (OR = 2.42; CI = 1.46–4.00), and lifetime (OR = 1.85; CI = 1.11–3.08) and past month (OR = 2.70; CI = 1.57–4.64) alcohol use relative to never using alcohol. Conclusions Much self-harm in adolescents resolves over the course of 12 months. Young people who self-harm have high rates of other health risk behaviors associated with family and peer risks that may all be targets for preventive intervention.

Earth systems science and technology are essential elements of a contemporary education. Remote sensing and GIS provide a valuable spatial framework for scientific inquiry, and are highly effective as a means to integrate Earth system science components. Drawing on the GLOBE Program's K-12 Earth science curriculum, we show how remote sensing and GIS can be used to integrate GLOBE's Land Cover-Biology and Hydrology investigations, emphasizing the Earth as a system. Our approach uses spatial thinking, geospatial technology, and the concept of watersheds to help students develop an understanding of the basic relationships between land cover and surface hydrology, two critically important and easily observed components of the Earth's surface. By starting with very simple exercises and analyses, students build upon a conceptual framework for understanding how land use pattern can influence the quantity and quality of one of the most critically important Earth resources, local fresh water. Ultimately, by understanding how terrestrial and aquatic systems interact, students begin to understand the link between science and land use policy.

In this paper we resurrect an idea originally proposed by Serafini[1] in 1992 for an RF photocathode gun capable of operating simultaneously at the fundamental frequency and a higher frequency harmonic. Driving the gun at two frequencies with the proper field ratio and relative phase produces a beam with essentially no rf emittance and a linear longitudinal phase space distribution. Such a gun allows a completely new range of operating parameters for controlling space charge emittance growth. In addition, the linear longitudinal phase space distribution aids in bunch compression. This paper will compare results of simulations for the two-frequency gun with the standard rf gun, and the unique properties of the two-frequency gun will be discussed.

Infrared spectroscopy using a Fourier Transform Infrared (FTIR) spectrometer is routine. These instruments are sophisticated and mature, and generally use a blackbody radiator as their infrared source. However, because the brightness of a thermal source is limited, the signal-to-noise ratio of these instruments begins to degrade at spatial resolutions not much better than 1 mm and they are rarely useful at resolutions smaller than 20 μm. Synchrotrons provide much brighter infrared beams than thermal sources, and Free-Electron Lasers (FELs) provide even brighter beams than synchrotrons. We will discuss the limitations of thermal sources, and show that a synchrotron is an excellent source for infrared spectroscopy at spatial resolutions on the order of the wavelength (λ). Even better spatial resolution, about λ/10, can be expected if an FEL is used as a source.

BACKGROUND: This article examines the effect of early adolescent alcohol use on mid-adolescent school suspension, truancy, commitment, and academic failure in Washington State, United States, and Victoria, Australia. Also of interest was whether associations remain after statistically controlling for other factors known to predict school outcomes. METHODS: State-representative student samples were surveyed in 2002 (grade 7; N = 1858) and followed up annually to 2004 (grade 9) in both sites. Students completed a modified version of the Communities That Care survey to report alcohol use, school outcomes, and risk and protective factors. Response rates were above 74% and retention rates exceeded 98% in both places. RESULTS: Controlling for grade 7 risk factors, grade 7 current alcohol use, and heavy episodic drinking were associated with grade 8 school suspension. Grade 7 current and frequent alcohol use and heavy episodic drinking were linked to grade 9 truancy. In fully adjusted analyses, associations between early alcohol use and academic failure and low school commitment did not remain. CONCLUSIONS: Although alcohol use is one factor influencing school performance and connection, there are other risk factors that need to be targeted to improve school outcomes. Language: en

We study experimentally and theoretically, the effects of desynchronism modulation on short pulse free-electron laser (FEL) oscillators. We find that the output power and the micropulse length of the FEL beam oscillate periodically at the modulation frequency and the minimum micropulse length can be significantly shorter than that obtained without modulation. The FEL can operate during part of the modulation cycle in the normally inaccessible portion of the output power curve where the FEL gain is less than the cavity loss.

Introduction: Liver disease is often marked by changes in hemostasis. Vitamin K is frequently administered to cirrhotic patients with an elevated INR to improve their coagulopathy, though strong evidence justifying this approach is lacking. Questions regarding the efficacy of vitamin K have been gathering based on an increased understanding of the rebalanced hemostasis of liver disease. This study evaluated the effect of vitamin K on the INR 24-72 hours after administration. Methods: This retrospective chart review used the VA Informatics and Computing Infrastructure (VINCI) database to identify 886 admissions for patients with liver disease who received vitamin K between January 1, 2001 and March 31, 2014. Patients were included if they had a coded diagnosis of cirrhosis, acute hepatitis, non-alcoholic steatohepatitis, hepatocellular carcinoma, or end stage liver disease. Charts for patients with one of those diagnoses who received vitamin K at the LSCDVAMC were included. All data was collected from the Computerized Patient Record System (CPRS). Medication route and dosing was determined from the pharmacy administration record. Patients were excluded if they received heparin, LMWH, FFP, or if they did not have an INR value before the administration of vitamin K or 24-72 hours after the dose was given. Results: A total 886 individual admissions were identified, 333 admissions met inclusion criteria for analysis. The mean INR on admission for the included encounters was 1.88 (95% CI 1.798 - 1.955) the lowest INR was 0.86 and the highest was 5.99. In the 333 admissions analyzed the mean decrease in the INR was 0.08 (95% CI 0.028 - 0.132). 180 encounters had a repeat INR during the hospitalization. The mean decrease in INR from admission to the second post-vitamin K INR was 0.123 (95% CI 0.058 - 0.187). Of the 333 included patient encounters 37 had a change in INR (increase or decrease) >0.4, of which in 11 the INR increased and in 24 the INR decreased (mean change in INR 0.313; 95% CI -0.139 to 0.765). The average INR of those 37 encounters was 2.83 (95% CI 2.497 - 3.171). There was no significant difference in albumin in encounters when the INR increased vs. decreased in response to vitamin K. There was a trend towards higher total bilirubin (TBILI) when the INR did not decrease in response to vitamin K. Mean TBILI was 5.9 in INR responders (95% CI 5.011 - 6.789) and was 6.66 (95% CI 5.219 - 8.101) in the encounters where the INR increased despite vitamin K. Conclusion: Vitamin K administration to improve the coagulopathy of patients with liver disease is common and often administered in response to an elevated INR. This is the largest retrospective review to date evaluating the effect of vitamin K on the INR of patients with liver disease. While a statistically significant decrease in INR of 0.08 was found, it is unclear if such a difference from vitamin K would be clinically significant. Moreover, only a very small portion of the patients included in this study (24/333) had an INR decrease of greater than 0.4. A limitation of our study is that patient centered outcomes, such as bleeding events, were not assessed. Future research should evaluate if there is a role for vitamin K in liver disease patients with a significantly elevated INR and low total bilirubin. Disclosures No relevant conflicts of interest to declare.

Near-field microscopy overcomes the diffraction limit through the partial conversion of the evanescent fields, formed around the subwavelength sources of light, into propagating waves by interactions between the probe and the sample. Contrast parameters in this imaging technique are quite different from those in conventional (far-field) optics. We study the mechanisms of image formation in the transmission mode of a near-field microscope in the mid-infrared part of the spectrum (6–10 μm). The amount of light propagating from a subwavelength aperture through a flat substrate (“allowed” light) is found to strongly increase as the tip approaches the sample, generating topographic artifacts in near-field images. Such artifacts can be eliminated by flat sample preparation techniques. The transmitted power is strongly influenced by the refraction index of the sample resulting in a substantial difference of the near-field spectrum from the far-field one. A model describing tunneling of light through a subwavelength aperture into the substrate has been developed and is in very good agreement with the experimental data. The model predicts that spectral sensitivity is enhanced with smaller tip diameters.

The detailed shape of picosecond optical pulses from a free-electron laser (FEL) oscillator has been studied for various cavity detunings. For large values of the cavity detuning the optical pulse develops an exponential leading edge, with a time constant proportional to the applied cavity detuning and the quality factor of the resonator. This behavior has been observed at two separate FELs that have completely different resonator layouts and electron beam characteristics, and using different methods of optical pulse length measurement. The optical pulses have a full width at half maximum time-bandwidth product Delta t(FWHM)Delta f(FWHM) of 0.2-0.3. The results presented here can be used to predict the optical pulse length and corresponding minimum spectral width that can be generated in a FEL pumped by short electron bunches. This is important for the design of new infrared free-electron laser user facilities, which need to make a balanced choice between short pulses for high temporal resolution and narrow bandwidth for linear and nonlinear spectroscopy.

At the Stanford FEL Center, magnetic longitudinal dispersion has been used to improve the well-known technique of measuring electron bunch time-profiles with off-phase acceleration and an energy spectrometer. This unambiguous direct method allowed us to measure, without extrapolation or the mathematical reconstructions of other high-resolution techniques, a variety of bunch profiles at approximately 100 fs resolution – including asymmetric bunches with a single extremely narrow peak. The sharply peaked bunches generated far-infrared undulator radiation two orders of magnitude brighter than bunches without such structure. A Fabry–Perot-type scan of the undulator radiation indicated nearly 100% coherence of the radiation from the brightest bunches, and provided optical evidence consistent with the bunch shape measurements.

This article discusses the application of a Lagrange multiplier-based fictitious domain method to the numerical simulation of incompressible viscous flow modeled by the Navier–Stokes equations around moving rigid bodies; the rigid body motions are due to hydrodynamical forces and gravity. The solution method combines finite element approximations, time discretization by operator splitting and conjugate gradient algorithms for the solution of the linearly constrained quadratic minimization problems coming from the splitting method. The study concludes with the presentation of numerical results concerning four test problems, namely the simulation of an incompressible viscous flow around a NACA0012 airfoil with a fixed center but free to rotate, then the sedimentation of 200 and 1008 cylinders in a two-dimensional channel, and finally the sedimentation of two spherical balls in a rectangular cylinder. Copyright © 1999 John Wiley & Sons, Ltd.

The graft-versus-host disease reaction is an immunologic consequence resulting from the grafting of immunocompetent cells from one individual to an immunocompromised host. The oral manifestations of this disease process include severe oral pain, xerostemia, ulcerative lesions, and mucositis. With appropriate history and diagnostic testing, these lesions can be differentiated from other oral diseases having similar clinical appearance.

We have implemented a control system for the free electron laser (FEL) and its linear accelerator which allows us to produce independently controlled FEL beams multiplexed on a macropulse time scale. In this paper, we discuss the generation of multiple beams at Stanford. We go on to describe FEL beam diagnostics, the separation of multiple optical beams when generated using a single undulator, and finally optical beam distribution.

The Stanford FEL Center was established in September 1990. In this paper, the FEL itself, the Center infrastructure, the interaction with experimenters and the educational mission are described.

We present a method for the remote generation of a transient near-field probe using conventional IR microscopy optics. Photo-induced reflectivity generated by picosecond pulses of visible light incident on the surface of a semiconductor substrate is used to create transient mirrors with dimensions determined by the spot size of the visible light. The IR light scattered by such sub-wavelength-size mirror is collected after propagating through the sample. As the sample is located on the semiconductor substrate, no near-field distance control is required, and the image can be taken at the speed of typical laser scanning microscope. And since the near-field probe is generated remotely – using light – the sample to be imaged can be covered by, or encased in, a transparent liquid or solid. The resolution of such an IR microscope is determined by the dimensions of the transient mirror, i.e., by the spot size of the visible light and its penetration depth into the substrate. To prevent resolution degradation due to diffusion of the photo-excited carriers in the substrate, the probe (IR) pulse duration should not exceed a few tens of picoseconds.

Requests for beam time at the Stanford Picosecond Free Electron Laser Center far exceed the amount available. We describe our efforts to increase the available beam time by interleaving pulse trains of different wavelengths and delivering these to different users, and present some of our results.

A physics experiment for laser-driven, electron acceleration in a structure-loaded vacuum is being carried out at Stanford University. The experiment is to demonstrate the linear dependence of the electron energy gain on the laser field strength. The accelerator structure, made of dielectric, is semi-open, with dimensions a few thousand times the laser wavelength. The electrons traverse the axis of two crossed laser beams to obtain acceleration within a coherence distance. We predict that the demonstration experiment will produce a single-stage, electron energy gain of 300 keV over a 2.5 mm distance. Ultimately, acceleration gradients of 1 GeV m−1 should be possible.

Although it is common for secondary schools to implement alcohol policies to reduce alcohol misuse, there has been little evaluation of the efficacy of these policies. The purpose of this study was to test the impact of the degree and type of alcohol policy enforcement in state representative samples of secondary students in Washington State, USA, and Victoria, Australia (n = 1848). Multivariate logistic regressions were used to examine the prospective association between student reports of school alcohol policy in Grade 8 and self-reported alcohol use in Grade 9, controlling for age, gender, state, family socio-economic status and Grade 8 alcohol use. The likelihood of students drinking on school grounds was increased when students perceived lax policy enforcement. Student perceptions of harm minimization alcohol messages, abstinence alcohol messages and counselling for alcohol policy violators predicted reduced likelihood of binge drinking. Students perceiving harm minimization messages and counselling for alcohol policy violators had a reduced likelihood of experiencing alcohol-related harms. Perceptions of harsh penalties were unrelated to drinking behaviour. These results suggest that perceived policy enforcement may lessen drinking at school 1 year later and that harm minimization messages and counselling approaches may also lessen harmful drinking behaviours as harm minimization advocates suggest.

BACKGROUND: Although previous studies have revealed that preschool-aged children imitate both aggression and prosocial behaviors on screen, there have been few population-based studies designed to reduce aggression in preschool-aged children by modifying what they watch. METHODS: We devised a media diet intervention wherein parents were assisted in substituting high quality prosocial and educational programming for aggression-laden programming without trying to reduce total screen time. We conducted a randomized controlled trial of 565 parents of preschool-aged children ages 3 to 5 years recruited from community pediatric practices. Outcomes were derived from the Social Competence and Behavior Evaluation at 6 and 12 months. RESULTS: At 6 months, the overall mean Social Competence and Behavior Evaluation score was 2.11 points better (95% confidence interval [CI]: 0.78–3.44) in the intervention group as compared with the controls, and similar effects were observed for the externalizing subscale (0.68 [95% CI: 0.06–1.30]) and the social competence subscale (1.04 [95% CI: 0.34–1.74]). The effect for the internalizing subscale was in a positive direction but was not statistically significant (0.42 [95% CI: −0.14 to 0.99]). Although the effect sizes did not noticeably decay at 12 months, the effect on the externalizing subscale was no longer statistically significant (P = .05). In a stratified analysis of the effect on the overall scores, low-income boys appeared to derive the greatest benefit (6.48 [95% CI: 1.60–11.37]). CONCLUSIONS: An intervention to reduce exposure to screen violence and increase exposure to prosocial programming can positively impact child behavior.

We have been able to measure the longitudinal phase space distribution of the Stanford Superconducting Accelerator's (SCA) electron beam by applying tomographic techniques to energy spectra taken as a function of the relative phase between the beam and the accelerating field. The temporal profile of the beam obtained by projecting the distribution onto the time axis is compared with that obtained from interferometric transition radiation measurements.