Intensive Family Reunification Services: A Conceptual Framework and Case Example

Recent federal mandates require child welfare agencies to make reasonable efforts to reunify families after out-of-home placement. Consistent with those mandates, agencies are increasingly employing techniques from family preservation services intended initially to prevent out-of-home placement. The purpose of this article is to articulate a conceptual framework and practice guidelines for family reunification services and to describe an experimental reunification program based on a family preservation model. A case example illustrates the way in which the services affected one family that participated in the experiment.

Hypofibrinolysis in type 2 diabetes: the role of the inflammatory pathway and complement C3

AIMS/HYPOTHESIS Plasminogen activator inhibitor-1 (PAI-1) has been regarded as the main antifibrinolytic protein in diabetes, but recent work indicates that complement C3 (C3), an inflammatory protein, directly compromises fibrinolysis in type 1 diabetes. The aim of the current project was to investigate associations between C3 and fibrinolysis in a large cohort of individuals with type 2 diabetes. METHODS Plasma levels of C3, C-reactive protein (CRP), PAI-1 and fibrinogen were analysed by ELISA in 837 patients enrolled in the Edinburgh Type 2 Diabetes Study. Fibrin clot lysis was analysed using a validated turbidimetric assay. RESULTS Clot lysis time correlated with C3 and PAI-1 plasma levels (r = 0.24, p < 0.001 and r = 0.22, p < 0.001, respectively). In a multivariable regression model involving age, sex, BMI, C3, PAI-1, CRP and fibrinogen, and using log-transformed data as appropriate, C3 was associated with clot lysis time (regression coefficient 0.227 [95% CI 0.161, 0.292], p < 0.001), as was PAI-1 (regression coefficient 0.033 [95% CI 0.020, 0.064], p < 0.05) but not fibrinogen (regression coefficient 0.003 [95% CI -0.046, 0.051], p = 0.92) or CRP (regression coefficient 0.024 [95% CI -0.008, 0.056], p = 0.14). No correlation was demonstrated between plasma levels of C3 and PAI-1 (r = -0.03, p = 0.44), consistent with previous observations that the two proteins affect different pathways in the fibrinolytic system. CONCLUSIONS/INTERPRETATION Similarly to PAI-1, C3 plasma levels are independently associated with fibrin clot lysis in individuals with type 2 diabetes. Therefore, future studies should analyse C3 plasma levels as a surrogate marker of fibrinolysis potential in this population.

Do clinicians understand the size of treatment effects? A randomized survey across 8 countries.

BACKGROUND Meta-analyses of continuous outcomes typically provide enough information for decision-makers to evaluate the extent to which chance can explain apparent differences between interventions. The interpretation of the magnitude of these differences - from trivial to large - can, however, be challenging. We investigated clinicians' understanding and perceptions of usefulness of 6 statistical formats for presenting continuous outcomes from meta-analyses (standardized mean difference, minimal important difference units, mean difference in natural units, ratio of means, relative risk and risk difference). METHODS We invited 610 staff and trainees in internal medicine and family medicine programs in 8 countries to participate. Paper-based, self-administered questionnaires presented summary estimates of hypothetical interventions versus placebo for chronic pain. The estimates showed either a small or a large effect for each of the 6 statistical formats for presenting continuous outcomes. Questions addressed participants' understanding of the magnitude of treatment effects and their perception of the usefulness of the presentation format. We randomly assigned participants 1 of 4 versions of the questionnaire, each with a different effect size (large or small) and presentation order for the 6 formats (1 to 6, or 6 to 1). RESULTS Overall, 531 (87.0%) of the clinicians responded. Respondents best understood risk difference, followed by relative risk and ratio of means. Similarly, they perceived the dichotomous presentation of continuous outcomes (relative risk and risk difference) to be most useful. Presenting results as a standardized mean difference, the longest standing and most widely used approach, was poorly understood and perceived as least useful. INTERPRETATION None of the presentation formats were well understood or perceived as extremely useful. Clinicians best understood the dichotomous presentations of continuous outcomes and perceived them to be the most useful. Further initiatives to help clinicians better grasp the magnitude of the treatment effect are needed.

Family Preservation Journal, Summer 1995, Volume 1. (Entire issue)

Entire issue (large pdf file) Articles include: Family Preservation and Support: Past, Present, and Future. Katharine Hooper-Briar,C. Anne Broussard, John Ronnau, and Alvin Sallee An Examination of Treatment Fidelity in an Intensive Family Preservation Program. Marianne Berry Intensive Family Reunification Services: A Conceptual Framework and Case Example. Elaine Walton, Mark W. Fraser, Catherin Harlin, and Robert E. Lewis Intensive Family Preservation Services: Do They Have Any Impact on Family Functioning? Roy W. Rodenhiser, Joseph Chandy, Kazi Ahmed Institutionalizing Intensive Family Preservation Services: A Strategy for Creating Staffing Standards Based on Projections of At-Risk Children from Referral sources. Robert E. Lewis

Consolidation and permeability characteristics at DSDP Sites 87-582, 87-583, and 87-584

The results of nine consolidation and permeability tests are presented for sediment samples from the Japan Trench and Nankai Trough sites of Leg 87. Coring and degassing disturbance results in an underconsolidated state for most Site 582 samples; however, the compressional effects of the subduction zone and high sediment accumulation rates may also play a role in causing underconsolidation. Samples collected at Site 583 exhibit similar evidence of disturbance but are slightly overconsolidated, confirming the possibility of sediment erosion at this site. The highly diatomaceous sediments at Site 584 are all overconsolidated, but the trend of overconsolidation decreases with depth. Disturbances of the diatom clay structure may increase the sediment compressibility and create this apparent overconsolidation

Magnetic susceptibility stratigraphy for Pleistocene and Pliocene sediments of ODP Leg 110 samples

Whole-core magnetic susceptibility measurements define a detailed stratigraphy that enables correlation between the various Pleistocene, Pliocene, and upper Miocene sections cored on ODP Leg 110, near the Tiburon Rise. The magnetic susceptibility in these sections is primarily related to the content of volcanic ash, rich in titanomagnetite, and also inversely related to calcium carbonate content. The high resolution of the susceptibility record enables correlations with a resolution of about 0.3 m of sediment thickness, and the identification of minor faults not definable by biostratigraphic means. Reverse and normal faults identified in Hole 672A are probably a result of normal oceanic sediment dewatering and compaction processes. This work indicates some of the problems of using visible ash layers as time-stratigraphic markers.

Magnetic susceptibility anisotropy in deformed sediments of ODP Leg 110

The anisotropy of magnetic susceptibility documents the generation of tectonically produced fabrics in sediments that macroscopically show no evidence of this disruption. The fabric observed in initial accretion is largely produced by overprinting of the original sedimentary susceptibility anisotropy by an E-W horizontal tectonic shortening and vertical extension. The response of the sediments to stress during initial accretion is variable, particularly near the sediment surface, and appears to reflect the inhomogeneous distribution of strain rate in the overthrust sequence. The susceptibility anisotropy of sediments possessing scaly fabric is consistent with the strong orientation of Phyllosilicates seen in thin section, producing a Kmin normal to the scalyness. The slope sediments deposited on the accreted sequence are also affected by tectonic shortening. The accreted sequences at Sites 673 and 674 show a complex history of fabric modification, with previous tectonic fabrics overprinted by later fabric modifications, pointing to continued tectonic shortening during the accretion process. The form of the susceptibility anisotropy axes at Sites 673 and 674 is consistent with NESW shortening, probably reflected in the NW-SE surface expression of the out-of-sequence thrusts. The susceptibility anisotropy appears to document a downhole change in the trend of shortening from E to W at the surface to more NESW at depth, probably as a result of the obliquely trending basement ridge, the Tiburon Rise.

Fly-through movie for the reconstructed folds in the onset region of the Petermann Glacier, North Greenland

The increasing catalogue of high-quality ice-penetrating radar data provides a unique insight in the internal layering architecture of the Greenland ice sheet. The stratigraphy, an indicator of past deformation, highlights irregularities in ice flow and reveals large perturbations without obvious links to bedrock shape. In this work, to establish a new conceptual model for the formation process, we analysed the radar data at the onset of the Petermann Glacier, North Greenland, and created a three-dimensional model of several distinct stratigraphic layers. We demonstrate that the dominant structures are cylindrical folds sub-parallel to the ice flow. By numerical modelling, we show that these folds can be formed by lateral compression of mechanically anisotropic ice, while a general viscosity contrast between layers would not lead to folding for the same boundary conditions. We conclude that the folds primarily form by converging flow as the mechanically anisotropic ice is channelled towards the glacier.

Physical properties of sediments at DSDP Sites 93-603, 93-604, and 93-605

On Leg 93, physical properties measurements were made of vertical and horizontal sonic velocity, acoustic impedance, vane shear strength, and penetrometer strength, using procedures discussed in Boyce (1973, 1976, 1984). Gravimetric procedures were used to determine wet-bulk density, grain density, porosity, and water content, using either the chunk method or the cylinder method. Calcium carbonate content of Leg 93 sediments was determined by the carbonate.