Non‐accidental injury and bone fragility disorders: the need for a multidisciplinary perspective

A case is presented of a child who was initially diagnosed with osteogenesis imperfecta following a skull fracture. However, she later presented with multiple fractures and soft tissue injuries which were considered to be due to non‐accidental injury. It can be perplexing distinguishing accidental and non‐accidental injury in children where a bone fragility disorder has been suspected. A combination of a careful review of the history, a thorough examination and expert review of the radiology is imperative. DNA testing can be helpful. Multidisciplinary case review, taking into account the social history and any concerns professionals have about the family, is invaluable in informing a difficult diagnosis. In this context, there is a definite role for other agencies in challenging the diagnosis or exclusion of non‐accidental injury. Professionals should be willing to challenge the exclusion of non‐accidental injury when such exclusion is not evidence based. Copyright © 2009 John Wiley & Sons, Ltd.     

Report on the implementation and evaluation of an interprofessional learning programme for inter‐agency child protection teams

Effective collaborative working between the different professions and agencies working to safeguard children is essential. Lack of knowledge of others' roles, perceived differences in status and expertise, and negative stereotypes are examples of why this can be difficult to achieve. A facilitated interprofessional learning (IPL) programme was implemented to assess if such an intervention could overcome some of the barriers to effective interprofessional and inter‐agency team working. Six teams based in primary and secondary care trusts took part with participants from health, education, police and social services. Quantitative and qualitative data were collected from individual participants using a pre‐validated team climate inventory and reflective statements. Findings from this study demonstrate statistically significant changes in five out of six categories in the inventory. Reflective statements suggested that overall the programme offered a positive learning experience at both an individual and team level. The importance of outside facilitation to maintain the team's momentum was acknowledged, as was the difficulty of maintaining a good level of activity once the programme had ended. Nevertheless, the IPL programme provided a timely opportunity to reflect upon the interprofessional and inter‐agency team working needed within Children's Trusts and the implications for staff involved with regard to skills development. Copyright © 2009 John Wiley & Sons, Ltd.     

Family Therapy for Kids Without Families: Working Systemically With Children and Young People in Residential Care

A significant proportion (4%, Australian Institute of Health and Welfare, 2008) of children and young people in Australia live in some form of residential care, usually in small group‐homes staffed by residential care workers in shifts. However, as Hawkins‐Rodgers (2007) points out, these placements are often not resourced to heal the effects of trauma and multiple attachment disruptions in their residents. The lack of an archetypal ‘family’ has led in the past to family therapists considering that there is little work to be done with such clients. This leaves such placements to be supported most frequently by clinicians who specialise in behaviour management and other linearly founded models of practice. The Alternate Care Clinic (ACC) is the first mental health service in New South Wales dedicated entirely to children and young people in out of home care with a high level of complex needs. This article examines the systemic therapeutic model the clinic has developed in the last two years. In particular, the article seeks to explore the importance of ‘meaning making’ in a diffuse parental system, particularly with regards to the term ‘family’. The complexities of working in this area and possible ways forward are illustrated with a closely worked case study.     

Ethnic‐Controlled Economy or Segregation? Exploring Inequality in Latina/o Co‐Ethnic Jobsites1

Recent research has increasingly focused on how ethnicity operates within labor markets. Due to perceptions of intragroup homogeneity and assumptions that inequality only occurs between majority whites and people of color, most research has neglected intragroup economic inequality. This study examines how skin color, immigration/nativity status, and gender influence wage differentials in Latina/o co‐ethnic jobsites (where workers are the same ethnicity). Using data from the Los Angeles Study of Urban Inequality (LASUI), it is found that there are skin color, immigration/nativity status, and sex wage gaps among Latina/os working in co‐ethnic jobsites. Moreover, illustrating intersectionality, immigrant women and dark‐skinned immigrants suffer from wage gaps in co‐ethnic jobsites. Unexpectedly, some Latinas experience a wage advantage, in comparison with Latinos, which is associated with lighter skin. The author suggests that Latinas are subjected to multiple‐jeopardy situations in which they experience an intersection of inequalities in jobsites saturated by co‐ethnics but that lightness of skin color functions as a form of social capital. Thus, research on the benefits or costs associated with working with co‐ethnics cannot be extended to the entire ethnic group. The conclusion is that for Central Americans and Mexicans, co‐ethnic jobsites are generally forms of segregated employment with limited protection from discrimination.     

Parental involvement in the development of a culture‐based school curriculum

This study focuses on parental involvement in Sámi schools when developing a culturally sensitive school curriculum. The research recognizes a number of competing and complementary interests that play a role when constructing structures and policies in curriculum development. Two Sámi schools in Sweden with 115 pupils, their parents and 27 teachers were included in a longitudinal three‐year study. Interviews, school visits, videotapes and document analysis were used to gather information. The results indicate the invisible existence of culture‐based school practice and curriculum texts. The lack of contact among homes, schools and community culture was obvious. Parents and teachers expressed an interest in developing a culture‐based local curriculum through a process of reflecting on and creating an education incorporating the past, the present and the future. The study showed that parents, pupils and teachers experienced increased awareness in culture‐based schoolwork. The study pointed to a desire for cooperation between home and school in the development of a culture‐based school curriculum and a school practice supported by a culturally responsible teacher.     

Low‐Income Mothers’ Private Safety Nets and Children’s Socioemotional Well‐Being

Using longitudinal data from the Fragile Families and Child Well‐being Study (N = 1,162) and the National Evaluation of Welfare‐to‐Work Strategies (N = 1,308), we estimate associations between material and instrumental support available to low‐income mothers and young children’s socioemotional well‐being. In multivariate OLS models, we find mothers’ available support is negatively associated with children’s behavior problems and positively associated with prosocial behavior in both data sets; associations between available support and children’s internalizing and prosocial behaviors attenuate but remain robust in residualized change models. Overall, results support the hypothesis that the availability of a private safety net is positively associated with children’s socioemotional adjustment.     

Improving and measuring transparency in NGOs: A disclosure index for activities and projects

Nongovernmental organizations (NGOs) are established not with the aim of making profits but rather to provide social values by implementing different projects and activities. Transmitting complete information about these projects to society is a key element of transparency, as they operate within an atmosphere of public trust. Although there is a large body of literature on transparency in NGOs from a global perspective, very little research has been conducted on transparency within the area of projects and activities. This study takes a deeper look at this line and contributes to the literature on transparency in NGOs by proposing an index to measure the information transparency of the projects implemented by these organizations. The index captures three dimensions of the information about the projects (technical, financial, and scope) and makes it possible to: analyze the level of transparency of the portfolio of projects, detect the specific aspects that could be improved in each organization, and carry out comparisons among organizations.     

The time‐dependent “cure‐death” model investigating two equally important endpoints simultaneously in trials treating high‐risk patients with resistant pathogens

A variety of primary endpoints are used in clinical trials treating patients with severe infectious diseases, and existing guidelines do not provide a consistent recommendation. We propose to study simultaneously two primary endpoints, cure and death, in a comprehensive multistate cure‐death model as starting point for a treatment comparison. This technique enables us to study the temporal dynamic of the patient‐relevant probability to be cured and alive. We describe and compare traditional and innovative methods suitable for a treatment comparison based on this model. Traditional analyses using risk differences focus on one prespecified timepoint only. A restricted logrank‐based test of treatment effect is sensitive to ordered categories of responses and integrates information on duration of response. The pseudo‐value regression provides a direct regression model for examination of treatment effect via difference in transition probabilities. Applied to a topical real data example and simulation scenarios, we demonstrate advantages and limitations and provide an insight into how these methods can handle different kinds of treatment imbalances. The cure‐death model provides a suitable framework to gain a better understanding of how a new treatment influences the time‐dynamic cure and death process. This might help the future planning of randomised clinical trials, sample size calculations, and data analyses.     

Enabling robust assessment of QTc prolongation in early phase clinical trials

Since the implementation of the International Conference on Harmonization (ICH) E14 guideline in 2005, regulators have required a “thorough QTc” (TQT) study for evaluating the effects of investigational drugs on delayed cardiac repolarization as manifested by a prolonged QTc interval. However, TQT studies have increasingly been viewed unfavorably because of their low cost effectiveness. Several researchers have noted that a robust drug concentration‐QTc (conc‐QTc) modeling assessment in early phase development should, in most cases, obviate the need for a subsequent TQT study. In December 2015, ICH released an “E14 Q&As (R3)” document supporting the use of conc‐QTc modeling for regulatory decisions. In this article, we propose a simple improvement of two popular conc‐QTc assessment methods for typical first‐in‐human crossover‐like single ascending dose clinical pharmacology trials. The improvement is achieved, in part, by leveraging routinely encountered (and expected) intrasubject correlation patterns encountered in such trials. A real example involving a single ascending dose and corresponding TQT trial, along with results from a simulation study, illustrate the strong performance of the proposed method. The improved conc‐QTc assessment will further enable highly reliable go/no‐go decisions in early phase clinical development and deliver results that support subsequent TQT study waivers by regulators.     

A Bayesian sequential design with binary outcome

Several researchers have proposed solutions to control type I error rate in sequential designs. The use of Bayesian sequential design becomes more common; however, these designs are subject to inflation of the type I error rate. We propose a Bayesian sequential design for binary outcome using an alpha‐spending function to control the overall type I error rate. Algorithms are presented for calculating critical values and power for the proposed designs. We also propose a new stopping rule for futility. Sensitivity analysis is implemented for assessing the effects of varying the parameters of the prior distribution and maximum total sample size on critical values. Alpha‐spending functions are compared using power and actual sample size through simulations. Further simulations show that, when total sample size is fixed, the proposed design has greater power than the traditional Bayesian sequential design, which sets equal stopping bounds at all interim analyses. We also find that the proposed design with the new stopping for futility rule results in greater power and can stop earlier with a smaller actual sample size, compared with the traditional stopping rule for futility when all other conditions are held constant. Finally, we apply the proposed method to a real data set and compare the results with traditional designs.