The joint paediatric–forensic examination in child abuse

The investigation of alleged child abuse should be multi-professional and coordinated to minimize distress to the child and family. Much attention has focused on the joint interview process, with less prominence being given to the medical component of the initial investigation. No standard practice exists in the United Kingdom regarding the conduct of the medical examination or in the training requirements of the doctors who perform the examination. We present a model of practice which has evolved in Edinburgh and the Lothians, drawing on the combined expertise and experience of paediatricians and police surgeons, which has operated for over 2 years; and propose a formal accreditation process for doctors who wish to specialize in the field of child abuse. © 1998 John Wiley & Sons, Ltd.     

Organizational Learning in Global Purchasing: A Model and Test of Internal Users and Corporate Buyers*

This research examines a model centered on organizational learning in purchasing. Two different studies are conducted to test the hypotheses among purchasing users (Study 1) and buyers (Study 2). The user sample consists of users representing 355 strategic business units of a Fortune 500 multinational corporation. The buyer sample consists of corporate buyers of 200 multinational corporations drawn from the membership directory of the National Association of Purchasing Management (NAPM). In each study, the focus is on the learning relationships between corporate buyers and internal users in the purchasing organization. Based on the two studies, the results suggest that organizational learning in the purchasing process is influenced by the organizational culture factors of localness, transformational leadership, and openness. Organizational learning has a positive effect on information processing in the purchasing system, which, in turn, has a positive influence on the cycle time of the purchasing process.     

On three and four vicious walkers

We establish a reflection principle for three lattice walkers and use this principle to reduce the enumeration of configurations of three vicious walkers to the enumeration of configurations of two vicious walkers. More precisely, the reflection principle leads to a bijection between three walks (L₁, L₂, L₃) such that L₂ intersects both L₁ and L₃ and three walks (L₁, L₂, L₃) such that L₁ intersects L₃. Hence we find a combinatorial interpretation of the formula for the generating function for the number of configurations of three vicious walkers, originally derived by Bousquet-Mélou by using the kernel method, and independently by Gessel by using tableaux and symmetric functions. This answers a question posed by Gessel and Bousquet-Mélou. We also find a reflection principle for four vicious walks that leads to a combinatorial interpretation of a formula derived from Gessel's theorem.     

Unmet home care service needs of rural older adults with Alzheimer's disease: a perspective of informal caregivers

This study assessed unmet service needs of rural older adults with Alzheimer's disease (AD) and identified factors that were related to these needs. Data were collected from 109 informal caregivers of AD patients. Over half of the patients experienced unmet service needs in 1 or more areas of activities of daily functioning. Informal caregiver burden and patient's gender and functional status were significantly related to patients' unmet service needs. Patients' use of formal services was marginally related to their unmet service needs. To better address patients' service needs, a comprehensive needs assessment should be conducted with both patients and their caregivers.     

A Hybrid Geometric Phase II/III Clinical Trial Design based on Treatment Failure Time and Toxicity

The problem of comparing several experimental treatments to a standard arises frequently in medical research. Various multi-stage randomized phase II/III designs have been proposed that select one or more promising experimental treatments and compare them to the standard while controlling overall Type I and Type II error rates. This paper addresses phase II/III settings where the joint goals are to increase the average time to treatment failure and control the probability of toxicity while accounting for patient heterogeneity. We are motivated by the desire to construct a feasible design for a trial of four chemotherapy combinations for treating a family of rare pediatric brain tumors. We present a hybrid two-stage design based on two-dimensional treatment effect parameters. A targeted parameter set is constructed from elicited parameter pairs considered to be equally desirable. Bayesian regression models for failure time and the probability of toxicity as functions of treatment and prognostic covariates are used to define two-dimensional covariate-adjusted treatment effect parameter sets. Decisions at each stage of the trial are based on the ratio of posterior probabilities of the alternative and null covariate-adjusted parameter sets. Design parameters are chosen to minimize expected sample size subject to frequentist error constraints. The design is illustrated by application to the brain tumor trial.     

“Disagreeable Echoes … Reached Me for Many Years After”: (An Excerpt from Free Associations)

This essay offers a comment on Bringing the Plague: Toward a Postmodern Psychoanalysis from the perspective of British object-relations psychoanalysis. It reviews the different histories of psychoanalysis in Britain and the United States, noting the continuing clinical focus of the field in Britain, in both the public sector and in private practice, as a source of continuing strength. Psychoanalysis does not face the scale of crisis in the United Kingdom that it now does in the United States, possibly because it has never achieved the same degree of influence. I argue that a more important difference than that between “modernist” and “postmodernist” approaches to psychoanalysis lies between all psychoanalytic psychotherapies and the behavioural and pharmacological approaches to psychic distress that are becoming so invasive. A positive aspect of psychoanalytic modernism was its assertion of a shared human nature and of the right of all individuals to be treated as autonomous subjects.     

Citizenship for Some: Heteronormativity as Cloaked Bullying

SUMMARY

The average student of diverse sexuality hears eight homophobic insults per day with one third from faculty and staff. Through a lens of citizenship education, we elucidate heteronormative undercurrents obstructing the acceptance of sexual diversity; in-depth analysis of two such barriers, the public man and the ethics of marriage, are provided and suggest that heteronormativity, with roots in the Enlightenment discourse, is overpowering instrumental curricula promoting the acceptance of sexual diversity. Further, the perpetuation of such heteronormative undercurrents can and should be seen as a form of violence: cloaked bullying. The article challenges the use of “It's Ok to be Gay” kits and other modes of essentializing sexual diversity, and petitions educators to remain cognizant of heteronormative undercurrents in their teaching practice. By laboring to dislodge heteronormative underpinnings educators are enabled to model genuine open-minded and accepting citizenship and effect meaningful progress in the acceptance of sexual diversity.     

Remeasuring ageing in Hong Kong SAR; or ‘keeping the demographic window open’

Hong Kong SAR has among both the lowest fertility rates and highest life expectancy in the world. Under the current calculation of the Old Age Dependency Ratio (OADR), Hong Kong is, understandably, ageing extremely rapidly. This is a cause of significant concern among policy makers. However, OADR assumes that the entire population aged above 65 is both ‘old’ and ‘dependent’, neither of which is clearly defined, and that all aged below 65 are active in the labour force. Furthermore, because the rate is fundamentally based upon a European/North American model of pension and retirement it is arguably less appropriate to areas of the world where retirement ages are more fluid and pension systems less developed. We apply and extend a method for Hong Kong, designed by Sanderson and Scherbov, to ‘remeasure ageing’ by taking remaining life expectancy as the constant, rather than years lived by using projected life tables and 1 × 1 population projections. In doing so, we show that Sanderson and Scherbov’s new ‘prospective’ measurements of ageing more accurately reflect the increased longevity and vitality of Hong Kong’s population. Rather than passively accepting fate as a ‘rapidly ageing’ population, East Asian economies can be active in rethinking society’s relationship to work and other activities across the life-cycle. By adapting existing measurements to take into account the different welfare regimes in East Asia, we can radically alter the timeframe in which population ageing becomes ‘critical’. This allows more time to develop a more holistic life-course view of the relationship between work, longevity and fertility and to actively tackle ageing in an optimistic way.