bluuebunny/crossref_metadata_2025 huggingface dataset:
Harnessing Technology to Improve Clinical Trials: Study of Real-Time Informatics to Collect Data, Toxicities, Image Response Assessments, and Patient-Reported Outcomes in a Phase II Clinical Trial
Authors: Pietanza M. Catherine , Basch Ethan M. , Lash Alex , Schwartz Lawrence H. , Ginsberg Michelle S. , Zhao Binsheng , Shouery Marwan , Shaw Mary , Rogak Lauren J. , Wilson Manda , Gabow Aaron , Latif Marcia , Lin Kai-Hsiung , Wu Qinfei , Kass Samantha L. , Miller Claire P. , Tyson Leslie , Sumner Dyana K. , Berkowitz-Hergianto Alison , Sima Camelia S. , Kris Mark G.
Published: April 2013

Purpose

In clinical trials, traditional monitoring methods, paper documentation, and outdated collection systems lead to inaccuracies of study information and inefficiencies in the process. Integrated electronic systems offer an opportunity to collect data in real time.

Patients and Methods

We created a computer software system to collect 13 patient-reported symptomatic adverse events and patient-reported Karnofsky performance status, semi-automated RECIST measurements, and laboratory data, and we made this information available to investigators in real time at the point of care during a phase II lung cancer trial. We assessed data completeness within 48 hours of each visit. Clinician satisfaction was measured.

Results

Forty-four patients were enrolled, for 721 total visits. At each visit, patient-reported outcomes (PROs) reflecting toxicity and disease-related symptoms were completed using a dedicated wireless laptop. All PROs were distributed in batch throughout the system within 24 hours of the visit, and abnormal laboratory data were available for review within a median of 6 hours from the time of sample collection. Manual attribution of laboratory toxicities took a median of 1 day from the time they were accessible online. Semi-automated RECIST measurements were available to clinicians online within a median of 2 days from the time of imaging. All clinicians and 88% of data managers felt there was greater accuracy using this system.

Conclusion

Existing data management systems can be harnessed to enable real-time collection and review of clinical information during trials. This approach facilitates reporting of information closer to the time of events, and improves efficiency, and the ability to make earlier clinical decisions.
Cediranib for Metastatic Alveolar Soft Part Sarcoma
Authors: Kummar Shivaani , Allen Deborah , Monks Anne , Polley Eric C. , Hose Curtis D. , Ivy S. Percy , Turkbey Ismail B. , Lawrence Scott , Kinders Robert J. , Choyke Peter , Simon Richard , Steinberg Seth M. , Doroshow James H. , Helman Lee
Published: April 2013

Purpose

Alveolar soft part sarcoma (ASPS) is a rare, highly vascular tumor, for which no effective standard systemic treatment exists for patients with unresectable disease. Cediranib is a potent, oral small-molecule inhibitor of all three vascular endothelial growth factor receptors (VEGFRs).

Patients and Methods

We conducted a phase II trial of once-daily cediranib (30 mg) given in 28-day cycles for patients with metastatic, unresectable ASPS to determine the objective response rate (ORR). We also compared gene expression profiles in pre- and post-treatment tumor biopsies and evaluated the effect of cediranib on tumor proliferation and angiogenesis using positron emission tomography and dynamic contrast-enhanced magnetic resonance imaging.

Results

Of 46 patients enrolled, 43 were evaluable for response at the time of analysis. The ORR was 35%, with 15 of 43 patients achieving a partial response. Twenty-six patients (60%) had stable disease as the best response, with a disease control rate (partial response + stable disease) at 24 weeks of 84%. Microarray analysis with validation by quantitative real-time polymerase chain reaction on paired tumor biopsies from eight patients demonstrated downregulation of genes related to vasculogenesis.

Conclusion

In this largest prospective trial to date of systemic therapy for metastatic ASPS, we observed that cediranib has substantial single-agent activity, producing an ORR of 35% and a disease control rate of 84% at 24 weeks. On the basis of these results, an open-label, multicenter, randomized phase II registration trial is currently being conducted for patients with metastatic ASPS comparing cediranib with another VEGFR inhibitor, sunitinib.
Mechanisms of tentacle morphogenesis in the sea anemoneNematostella vectensis
Authors: Fritz Ashleigh E. , Ikmi Aissam , Seidel Christopher , Paulson Ariel , Gibson Matthew C.
Published: April 2013

Evolution of the capacity to form secondary outgrowths from the principal embryonic axes was a crucial innovation that potentiated the diversification of animal body plans. Precisely how such outgrowths develop in early-branching metazoan species remains poorly understood. Here we demonstrate that three fundamental processes contribute to embryonic tentacle development in the cnidarian Nematostella vectensis. First, a pseudostratified ectodermal placode forms at the oral pole of developing larvae and is transcriptionally patterned into four tentacle buds. Subsequently, Notch signaling-dependent changes in apicobasal epithelial thickness drive elongation of these primordia. In parallel, oriented cell rearrangements revealed by clonal analysis correlate with shaping of the elongating tentacles. Taken together, our results define the mechanism of embryonic appendage development in an early-branching metazoan, and thereby provide a novel foundation for understanding the diversification of body plans during animal evolution.
Trust, Reciprocity, and Favors in Cooperative Relationships
Authors: Abdulkadiroğlu Atila , Bagwell Kyle
Published: April 2013

We study trust, reciprocity, and favors in a repeated trust game with private information. In our main analysis, players are willing to exhibit trust and thereby facilitate cooperative gains only if such behavior is regarded as a favor that must be reciprocated, either immediately or in the future. The size of a favor owed may decline over time, following neutral periods. Indeed, a favor-exchange relationship with this feature improves on a simple favor-exchange relationship. In some settings, an infrequent and symmetric punishment sustains greater cooperation. A honeymoon period followed by favor-exchange or symmetric punishment can also offer scope for improvement. (JEL C73, D82, Z13)
Development and prevalence of femoroacetabular impingement-associated morphology in a paediatric and adolescent population
Authors: Monazzam S. , Bomar J. D. , Dwek J. R. , Hosalkar H. S. , Pennock A. T.
Published: April 2013

We investigated the development of CT-based bony radiological parameters associated with femoroacetabular impingement (FAI) in a paediatric and adolescent population with no known orthopaedic hip complaints. We retrospectively reformatted and reoriented 225 abdominal CTs into standardised CT pelvic images with neutral pelvic tilt and inclination (244 female and 206 male hips) in patients ranging from two to 19 years of age (mean 10.4 years). The Tönnis angle, acetabular depth ratio, lateral centre–edge angle, acetabular version and α-angle were assessed.

Acetabular measurements demonstrated increased acetabular coverage with age and/or progressive ossification of the acetabulum. The α-angle decreased with age and/or progressive cortical bone development and resultant narrowing of the femoral neck. Cam and pincer morphology occurred as early as ten and 12 years of age, respectively, and their prevalence in the adolescent patient population is similar to that reported in the adult literature. Future aetiological studies of FAI will need to focus on the early adolescent population.

Cite this article: Bone Joint J 2013;95-B:598–604.
Reduction of blood loss with the use of a new combined intra-operative and post-operative autologous blood transfusion system compared with no drainage in primary total hip replacement
Authors: Horstmann W. G. , Swierstra M. J. , Ohanis D. , Castelein R. M. , Kollen B. J. , Verheyen C. C. P. M.
Published: April 2013

Autologous retransfusion and no-drainage are both blood-saving measures in total hip replacement (THR). A new combined intra- and post-operative autotransfusion filter system has been developed especially for primary THR, and we conducted a randomised controlled blinded study comparing this with no-drainage.

A total of 204 THR patients were randomised to autologous blood transfusion (ABT) (n = 102) or no-drainage (n = 102). In the ABT group, a mean of 488 ml (sd 252) of blood was retransfused. The mean lowest post-operative haemoglobin level during the hospital stay was higher in the autotransfusion group (10.6 g/dl (7.8 to 13.9) vs 10.2 g/dl (7.5 to 13.3); p = 0.01). The mean haemoglobin levels for the ABT and no-drainage groups were not significantly different on the first day (11.3 g/dl (7.8 to 13.9) vs 11.0 g/dl (8.1 to 13.4); p = 0.07), the second day (11.1 g/dl (8.2 to 13.8) vs 10.8 g/dl (7.5 to 13.3); p = 0.09) or the third day (10.8 g/dl (8.0 to 13.0) vs 10.6 g/dl (7.5 to 14.1); p = 0.15). The mean total peri-operative net blood loss was 1464 ml (sd 505) in the ABT group and 1654 ml (sd 553) in the no-drainage group (p = 0.01). Homologous blood transfusions were needed in four patients (3.9%) in the ABT group and nine (8.8%) in the no-drainage group (p = 0.15). No statistically significant difference in adverse events was found between the groups.

The use of a new intra- and post-operative autologous blood transfusion filter system results in less total blood loss and a smaller maximum decrease in haemoglobin levels than no-drainage following primary THR.

Cite this article: Bone Joint J 2013;95-B:616–22.
The cost of outpatient venous thromboembolism prophylaxis following lower limb injuries
Authors: Menakaya C. U. , Pennington N. , Muthukumar N. , Joel J. , Ramirez Jimenez A. J. , Shaw C. J. , Mohsen A.
Published: April 2013

This paper reports the cost of outpatient venous thromboembolism (VTE) prophylaxis following 388 injuries of the lower limb requiring immobilisation in our institution, from a total of 7408 new patients presenting between May and November 2011. Prophylaxis was by either self-administered subcutaneous dalteparin (n = 128) or oral dabigatran (n = 260). The mean duration of prophylaxis per patient was 46 days (6 to 168). The total cost (pay and non-pay) for prophylaxis with dalteparin was £107.54 and with dabigatran was £143.99. However, five patients in the dalteparin group required nurse administration (£23 per home visit), increasing the cost of dalteparin to £1142.54 per patient. The annual cost of VTE prophylaxis in a busy trauma clinic treating 12 700 new patients (2010/11), would be £92 526.33 in the context of an income for trauma of £1.82 million, which represents 5.3% of the outpatient tariff.

Outpatient prophylaxis in a busy trauma clinic is achievable and affordable in the context of the clinical and financial risks involved.

Cite this article: Bone Joint J 2013;95-B:673–7.
Season-induced variation in lipid composition is associated with semen quality in Holstein bulls
Authors: Argov-Argaman N , Mahgrefthe K , Zeron Y , Roth Z
Published: April 2013

Season-induced variation in fatty acid and cholesterol composition in bovine semen has been associated with semen quality. Given the specific roles of the various semen compartments (seminal fluids, sperm head, and sperm tail) in fertilization, we hypothesized that environmental-stress-induced alterations in the lipid composition of a specific compartment might impair semen quality and sperm function. Semen samples were collected from five mature Holstein–Friesian bulls during the summer (August to September) and winter (December to January). Semen was evaluated by computerized sperm-quality analyzer, calibrated for bulls' semen, and centrifuged to separate the spermatozoa from the seminal fluids. The spermatozoal fraction was sonicated to separate the sperm head and tail compartments. Cold lipid extraction was performed with chloroform:methanol (2:1, vol/vol). Lipids were identified and quantified by gas chromatography. Seasonal variation was found in both physiological and structural parameters. The proportion of spermatozoa defined as morphologically normal was higher in the winter, with higher motility, progressive motility, and velocity relative to summer samples. Lipid composition within fractions varied between seasons with prominent impairment in the tail compartment, characterized by high saturated fatty acid, low polyunsaturated fatty acid, and low cholesterol concentrations during the summer. Given the association between alterations in lipid composition and reduced sperm motility and velocity during the summer, it is suggested that lipid composition might serve to predict sperm quality.
An Organelle Gatekeeper Function forCaenorhabditis elegansUNC-16 (JIP3) at the Axon Initial Segment
Authors: Edwards Stacey L , Yu Szi-chieh , Hoover Christopher M , Phillips Barret C , Richmond Janet E , Miller Kenneth G
Published: April 2013

Neurons must cope with extreme membrane trafficking demands to produce axons with organelle compositions that differ dramatically from those of the cell soma and dendrites; however, the mechanism by which they accomplish this is not understood. Here we use electron microscopy and quantitative imaging of tagged organelles to show that Caenorhabditis elegans axons lacking UNC-16 (JIP3/Sunday Driver) accumulate Golgi, endosomes, and lysosomes at levels up to 10-fold higher than wild type, while ER membranes are largely unaffected. Time lapse microscopy of tagged lysosomes in living animals and an analysis of lysosome distributions in various regions of unc-16 mutant axons revealed that UNC-16 inhibits organelles from escaping the axon initial segment (AIS) and moving to the distal synaptic part of the axon. Immunostaining of native UNC-16 in C. elegans neurons revealed a localized concentration of UNC-16 at the initial segment, although UNC-16 is also sparsely distributed in distal regions of axons, including the synaptic region. Organelles that escape the AIS in unc-16 mutants show bidirectional active transport within the axon commissure that occasionally deposits them in the synaptic region, where their mobility decreases and they accumulate. These results argue against the long-standing, untested hypothesis that JIP3/Sunday Driver promotes anterograde organelle transport in axons and instead suggest an organelle gatekeeper model in which UNC-16 (JIP3/Sunday Driver) selectively inhibits the escape of Golgi and endosomal organelles from the AIS. This is the first evidence for an organelle gatekeeper function at the AIS, which could provide a regulatory node for controlling axon organelle composition.
New Roles for Old Characters: An Educational Primer for Use with “Vps Factors Are Required for Efficient Transcription Elongation in Budding Yeast”
Authors: Duina Andrea A
Published: April 2013

An article from Alan Hinnebusch’s laboratory in the March 2013 issue of GENETICS establishes an exciting new link between proteins with well-established roles in the endomembrane system and the process of transcription elongation. This Primer article provides tools needed for students to fully appreciate, analyze, and critically evaluate the experiments and interpretations of Gaur et al. (2013). The primer includes detailed descriptions of techniques used in the study, such as the chromatin immunoprecipitation assay and assays for transcription elongation, and it provides a framework to facilitate an understanding of how a combination of genetic, biochemical, and cell microscopy experimental approaches were used by the authors to converge on a single major conclusion. Suggestions for using this Primer article in an undergraduate or graduate-level course in conjunction with the original article to promote student learning are also presented.

Related article in GENETICS: Gaur, N. A., J. Hasek, D. G. Brickner, H. Qiu, F. Zhang et al., 2013 Vps factors are required for efficient transcription elongation in budding yeast. Genetics 193: 829–851.
Treatment of Severe Pulmonary Hypertension in the Setting of the Large Patent Ductus Arteriosus
Authors: Niu Mary C. , Mallory George B. , Justino Henri , Ruiz Fadel E. , Petit Christopher J.
Published: April 2013

Treatment of the large patent ductus arteriosus (PDA) in the setting of pulmonary hypertension (PH) is challenging. Left patent, the large PDA can result in irreversible pulmonary vascular disease. Occlusion, however, may lead to right ventricular failure for certain patients with severe PH. Our center has adopted a staged management strategy using medical management, noninvasive imaging, and invasive cardiac catheterization to treat PH in the presence of a large PDA. This approach determines the safety of ductal closure but also leverages medical therapy to create an opportunity for safe PDA occlusion. We reviewed our experience with this approach. Patients with both severe PH and PDAs were studied. PH treatment history and hemodynamic data obtained during catheterizations were reviewed. Repeat catheterizations, echocardiograms, and clinical status at latest follow-up were also reviewed. Seven patients had both PH and large, unrestrictive PDAs. At baseline, all patients had near-systemic right ventricular pressures. Nine catheterizations were performed. Two patients underwent 2 catheterizations each due to poor initial response to balloon test occlusion. Six of 7 patients exhibited subsystemic pulmonary pressures during test occlusion and underwent successful PDA occlusion. One patient did not undergo PDA occlusion. In follow-up, 2 additional catheterizations were performed after successful PDA occlusion for subsequent hemodynamic assessment. At the latest follow-up, the 6 patients who underwent PDA occlusion are well, with continued improvement in PH. Five patients remain on PH treatment. A staged approach to PDA closure for patients with severe PH is an effective treatment paradigm. Aggressive treatment of PH creates a window of opportunity for PDA occlusion, echocardiography assists in identifying the timing for closure, and balloon test occlusion during cardiac catheterization is critical in determining safety of closure. By safely eliminating the large PDA, this treatment algorithm can halt the perilous combination of the large shunting from the PDA and PH in a population at high risk of morbidity and mortality.
Association of Procalcitonin With Acute Pyelonephritis and Renal Scars in Pediatric UTI
Authors: Leroy Sandrine , Fernandez-Lopez Anna , Nikfar Roya , Romanello Carla , Bouissou François , Gervaix Alain , Gurgoze Metin K. , Bressan Silvia , Smolkin Vladislav , Tuerlinckx David , Stefanidis Constantinos J. , Vaos Georgos , Leblond Pierre , Gungor Firat , Gendrel Dominique , Chalumeau Martin
Published: April 2013

BACKGROUND AND OBJECTIVE:

Urinary tract infections (UTIs) are common childhood bacterial infections that may involve renal parenchymal infection (acute pyelonephritis [APN]) followed by late scarring. Prompt, high-quality diagnosis of APN and later identification of children with scarring are important for preventing future complications. Examination via dimercaptosuccinic acid scanning is the current clinical gold standard but is not routinely performed. A more accessible assay could therefore prove useful. Our goal was to study procalcitonin as a predictor for both APN and scarring in children with UTI.

METHODS:

A systematic review and meta-analysis of individual patient data were performed; all data were gathered from children with UTIs who had undergone both procalcitonin measurement and dimercaptosuccinic acid scanning.

RESULTS:

A total of 1011 patients (APN in 60.6%, late scarring in 25.7%) were included from 18 studies. Procalcitonin as a continuous, class, and binary variable was associated with APN and scarring (P < .001) and demonstrated a significantly higher (P < .05) area under the receiver operating characteristic curve than either C-reactive protein or white blood cell count for both pathologies. Procalcitonin ≥0.5 ng/mL yielded an adjusted odds ratio of 7.9 (95% confidence interval [CI]: 5.8–10.9) with 71% sensitivity (95% CI: 67–74) and 72% specificity (95% CI: 67–76) for APN. Procalcitonin ≥0.5 ng/mL was significantly associated with late scarring (adjusted odds ratio: 3.4 [95% CI: 2.1–5.7]) with 79% sensitivity (95% CI: 71–85) and 50% specificity (95% CI: 45–54).

CONCLUSIONS:

Procalcitonin was a more robust predictor compared with C-reactive protein or white blood cell count for selectively identifying children who had APN during the early stages of UTI, as well as those with late scarring.
Ethical Controversies in Organ Donation After Circulatory Death
Authors:   COMMITTEE ON BIOETHICS, Antommaria Armand H. Matheny , Fallat Mary E. , Katz Aviva L. , Mercurio Mark R. , Moon Margaret R. , Okun Alexander L. , Webb Sally A. , Weise Kathryn L.
Published: April 2013

The persistent mismatch between the supply of and need for transplantable organs has led to efforts to increase the supply, including controlled donation after circulatory death (DCD). Controlled DCD involves organ recovery after the planned withdrawal of life-sustaining treatment and the declaration of death according to the cardiorespiratory criteria. Two central ethical issues in DCD are when organ recovery can begin and how to manage conflicts of interests. The “dead donor rule” should be maintained, and donors in cases of DCD should only be declared dead after the permanent cessation of circulatory function. Permanence is generally established by a 2- to 5-minute waiting period. Given ongoing controversy over whether the cessation must also be irreversible, physicians should not be required to participate in DCD. Because the preparation for organ recovery in DCD begins before the declaration of death, there are potential conflicts between the donor’s and recipient’s interests. These conflicts can be managed in a variety of ways, including informed consent and separating the various participants’ roles. For example, informed consent should be sought for premortem interventions to improve organ viability, and organ procurement organization personnel and members of the transplant team should not be involved in the discontinuation of life-sustaining treatment or the declaration of death. It is also important to emphasize that potential donors in cases of DCD should receive integrated interdisciplinary palliative care, including sedation and analgesia.
Cognitive functions in type 1 and type 2 diabetes. Metaanalysis
Authors: Kálcza-Jánosi Kinga , Lukács Andrea , Barkai László , Szamosközi István
Published: April 2013

Introduction: Diabetes has been repeatedly associated with a wide variety of cognitive impairments. Aim: To clarify the differences in cognitive dysfunctions between the two types of diabetes. Method: Metaanalysis was performed using databases of Medline, PubMed and ScienceDirect (3 studies with type 1 and 6 with type 2 diabetes). Results: Adults with type 1 diabetes showed lower performance than control subjects in all fields. The effect size had the highest value in psychomotor activity (D = –0.69). The effect size was small for delayed verbal memory (D = –0.48), attention (D = –0.47), language (D = –0.44), visual processing (D = –0.35), immediate verbal memory (D = –0.30), working memory (D = –0.27) and executive functions (D = –0.26). Adults with type 2 diabetes showed lower performance than control subjects in all cognitive domains, except for working memory (D = +0.03). The effect size had the highest value in immediate verbal memory (D = –1.12), psychomotor activity (D = –0.82) and delayed verbal memory (D = –0.81). The effect size was moderate for general intellectual abilities (D = –0.68) and small for general memory (D = –0.37), attention (D = –0.35), language (D = –0.35), visual processing (D = –0.33) and executive functions (D = –0.33). Conclusion: Both types of diabetes are associated with reduced performance in numerous cognitive domains. Orv. Hetil., 2013, 154, 694–699.
Using Mediation to Achieve Permanency for Children and Families
Authors: Landsman Miriam J. , Thompson Kathy , Barber Gail
Published: April 2013

The Iowa Mediation for Permanency Project (IMPP), a nonadversarial mediation-based approach founded on the principles of attachment and empowerment, is a promising way to achieve permanency for children, a national priority in child welfare established by The Adoption and Safe Families Act of 1997. The IMPP broadens the concept of permanency to include reunification and guardianship. The authors discuss its implementation, including qualifications and requirements of mediators, examine an independent evaluation of the results, and present two case histories.
Education for Ethical Dilemmas in Social Work Practice
Authors: Goldstein Howard
Published: April 2013

Ethical and moral conflicts are bound to arise in the problems of living that social workers confront in practice. This personal essay proposes an approach to education for practice that includes both theoretical knowledge and the development of experiential wisdom. The analogy of practice as a performing art suggests that the narrative and the literature of the humanities offer fertile sources for learning how to be and how to help in instances of such conflicts.
When Moms Are Incarcerated: The Needs of Children, Mothers, and Caregivers
Authors: Young Diane S. , Smith Carrie Jefferson
Published: April 2013

Maternal incarceration increasingly contributes to the number of children placed in kinship care arrangements. The needs of incarcerated women, their children, and the children's caregivers have historically been dealt with in isolation. Practitioners across substantive areas of corrections, child welfare, and aging must think creatively and collaboratively about ways to positively assist these families. This paper examines the needs of children, imprisoned women, and the children's kinship caregivers from an ecological theoretical perspective. Key findings from evaluation studies of programs designed to strengthen families affected by maternal incarceration are discussed. Finally, interventions that increase adaptive exchanges between incarcerated women, their children, and the children's caregivers are suggested.
Helping Substance-Abusing Mothers in the Child-Welfare System: Turning Crisis into Opportunity
Authors: Sun An-Pyng
Published: April 2013

This paper integrates in-depth interviews with eight mothers and existing relative literature, explaining the recovery journey of substance-abusing mothers in the child-welfare system. The results show that these mothers longed for a mainstream dream (a better life, meaningful relationships, and self-actualization), perhaps because of, as well as for the sake of, their children. However, for them to achieve their dreams, the support of various external systems is necessary—treating mothers and children as one unit, facilitating nonusing social networks, and providing case-management and life-skills training. Child protective service caseworkers can serve as key persons to help these mothers turn crisis into opportunity.
A Strengths-Based Practice Model: Psychology of Mind and Health Realization
Authors: Wartel Stephen G.
Published: April 2013

The author discusses the tenets and applications of the psychology of mind/health realization theory (POM/HR), stating that, although used for the past 27 years, it is still unfamiliar to many in the helping professions. This therapeutic model has been best described by Roger Mills and George Pransky. It fits in well with the trend toward strengths-based practice, focusing on the client's resources and resilience, on self-empowerment and self-help, effectiveness and efficiency. It can be taught and implemented easily, and, among other advantages, allows here-and-now focus on feelings of well-being rather than on painful thoughts and disturbing memories.
The Secret in Supervision: An Integral Part of the Social Worker's Professional Development
Authors: Itzhaky Haya
Published: April 2013

The implications of social workers keeping secrets and hiding information from their supervisors in the course of the supervision process are discussed. Based on Winnicot's (1965) approach, the secret is discussed as a way to create space for growth and independence. A comparison is made between the relationship in supervision and the process of the supervisee's professional development and parent–child relationships. Cases are presented in which a secret was hidden in the course of supervision, and these demonstrate the interplay among three elements: the quality of the content of the secret; the professional maturity of the supervisee; and the professional maturity of the supervisor. The events described demonstrate the role of the secret in the professional growth of social workers, as well as the supervisor's need to exercise judgment about whether and when to “open up” the secret.
Child and Family Well-Being in States with Different Political Cultures
Authors: Zimmerman Shirley L.
Published: April 2013

Taking the perspective of political culture theory, this paper focuses on findings on child and family well-being in 13 states using information from the National Survey of America's Families reported by Child Trends and the Urban Institute. The four states on which this discussion focuses are California, Florida, Minnesota, and New York. These states, with the exception of Minnesota, represent states with mixed political cultures. The present discussion is based on the assumption that just as states' political culture can be a source of variation in states' policy approaches to families; it also can be a source of state variation in child and family well-being. Political culture appears to have some bearing on family well-being. At the very least, the data suggest the need for social work practice and research that contextualize family functioning and well-being in terms of states' political cultures. Because most states represent a mix of political cultures, social workers are likely to find the most support for their efforts among like-minded groups in states with a strong moralistic strain. In other states, they will require the help and support of their national organizations to counter state and local tendencies that are likely to compromise the well-being of children and families as well as social work's goals and values.
Children who Have Witnessed Community Homicide: Incorporating Risk and Resilience in Clinical Work
Authors: Levy Alan J. , Wall Jack C.
Published: April 2013

New research and theory on developmental risk and resiliency in childhood are presented and are applied to clinical practice with children who have witnessed violence. This material expands the mental-health services with this population by contextualizing the phenomenon and incorporating a strengths perspective in clinical interventions.
Coming Out to Families in a Multicultural Context
Authors: Merighi Joseph R. , Grimes Marty D.
Published: April 2013

This article examines how young gay men disclose their sexual identity to family members and how their family members respond to this disclosure. Qualitative data were collected from a nonrandom sample of 57 African-, European-, Mexican-, and Vietnamese-American gay males, ages 18 to 24. Findings revealed similarities across racial and ethnic groups in how these young gay men came out to family members and the responses they received after their initial self-disclosure. Implications for practice are discussed.
A Transtheoretical Model for Assessing Organizational Change: A Study of Family Service Agencies' Movement to Time-Limited Therapy
Authors: Prochaska Janice M.
Published: April 2013

This research examined how well a leading model of intentional change, the Transtheoretical Model, captures the dynamics of organizational change. Within a total population of family service agencies in the United States providing counseling, the stages, pros and cons, and processes of planned change to time-limited therapy (TLT) were assessed. Measurement development occurred in the design of staging, decisional balance, and processes measures for changing to TLT. A series of MANOVAs were run comparing groups representing five stages of change. Follow-up Tukey tests determined which specific stages differed from each other. Each of the study's dimensions was found to have systematic relationships predicted by the Transtheoretical Model of change.
A Solution-Focused Approach to Cross-Cultural Clinical Social Work Practice Utilizing Cultural Strengths
Authors: Lee Mo Yee
Published: April 2013

A major challenge faced by clinical social work practice today is how to apply clinical social work knowledge and practice theories to ethnic and racial groups who have diverse cultural values and practices. A solution-focused approach that incorporates the premises and techniques of social constructivism, empowerment-based practice, and a strengths perspective is well suited for responding to the needs of these groups with respect for their values and practices. With its focus on pragmatic change and encouraging clients to create solutions for themselves, in addition to avoiding the shame that clients in these enthnic and racial populations feel in seeking professional help, this approach fits cultural approval to seek support and advice.
A Social Worker's Use of the Diagnostic and Statistical Manual
Authors: McQuaide Sharon
Published: April 2013

The relationship between social work and the Diagnostic and Statistical Manual (DSM) has never been simple. The social worker would be empowered in using the DSM by using it flexibly and malleably. After summarizing some pros and cons regarding the use of the DSM, recommendations for social workers to view the DSM through a postmodern lens are made. These include remembering that the DSM syndromes are actually social constructions, not scientific facts free from a political agenda; remaining always cognizant of the individualís uniqueness; recognizing that the DSM, while privileging certain knowledge, subjugates other knowledge; and remembering that the person is not the problem, the problem is the problem. In these days of managed care and short-term treatments, the DSM is used more than ever, so it is important for social workers to approach this potentially useful and potentially dangerous tool with a perspective compatible with social work values. To demonstrate a social worker's use of the DSM, early work with a client is presented.
Peer Victimization: The Case for Social Work Intervention
Authors: Mishna Faye
Published: April 2013

In this article, the author summarizes the research on bullying and discusses implications for practice. Children involved in peer victimization or bullying are at greater risk of having adjustment problems that may persist into adulthood. Because bullying unfolds in the context of the peer group, the school, and the community, a comprehensive framework is needed to address the factors influencing bullying and the interactions among them. This perspective is consistent with social work's mission and with the person-in-environment framework. Social workers are uniquely situated to help children, youth, and their families affected by bullying and to address peer victimization at all levels of intervention.
Reclaiming a Stress Focus: The Hassles of Rural, Poor Single Mothers
Authors: Wijnberg Marion H. , Reding Kathleen M.
Published: April 2013

Models of stress in the psychological literature have moved beyond a concentration on acute life events to smaller more chronic stresssors, commonly called “hassles.” The authors review of research suggests that the hassles of women have not been fully differentiated from the hassles of men. Rural women are a sadly neglected group. The authors interviewed thirty-three rural, poor single mothers to identify the hassles in their daily lives. The findings indicate the centrality of their mothering role. Chronic hassles included: children that overwhelm them, children with chronic illness, disciplining children, fathers of the children, negative social network members, and the hassles of finding, keeping, and paying baby-sitters. By exploring the hassles in the lives of rural single mothers, one uncovers the specific environmental conditions of living that tax and at times erode the mothers capacity to cope. Over the past twenty years, chronic stress factors alone or in combination with life events have been found to have major consequences for individual and family well-being. As Moos and Swindle (1990) indicate, interventions addressed to alleviate chronic hassles have the capacity to improve daily functioning and to reduce the potential for depressive disorders in the targeted population (Moos & Swindle, 1990, pp. 176–177).
The Sea Change in Nonprofit Human Services: A Critical Assessment of Outcomes Measurement
Authors: Fischer Robert L.
Published: April 2013

Outcomes assessment or program evaluation has historically been an infrequent activity within nonprofit agencies. Direct-service agencies have routinely focused on measures of output as indicators of impact rather than on measures related to outcomes and effectiveness. Funders of program services (e.g., United Way, foundations, government agencies) exercise substantial influence over the use of evaluation by recipient programs and agencies. The essential task of identifying outcomes and implementing the processes associated with the outcome measurement enterprise, however, fall squarely on the nonprofits themselves. This paper discusses and critiques the outcome measurement approach from the perspective of a direct service agency and suggests how the available methods can be adopted most successfully.
Expanding the Conceptual Basis of Outcomes and Their Use in the Human Services
Authors: Moxley David P. , Manela Roger W.
Published: April 2013

Despite the broad-based endorsement of outcomes as appropriate yardsticks by which to measure the merit and worth of human services in a variety of fields of social welfare, the selection, specification, and use of outcomes involve complex social and organizational forces. This paper seeks to expand the conceptual basis of outcomes and their use in human services by first considering these forces, and then discussing how outcomes evolve out of the expectations of the powerful, reflect the aspirations of the dispossessed and their advocates, and embody moral perspectives.
The Capabilities Perspective: A Framework for Social Justice
Authors: Morris Patricia McGrath
Published: April 2013

The concept of social justice is deeply rooted in social work. The theoretical framework most often embraced by the profession is John Rawls' A Theory of Justice. However, like most frameworks it has limitations. This paper examines Rawls' social justice framework as interpreted by social work and offers an alternative, called the “capabilities” perspective, that emerged nearly a decade after Rawls' 1971 seminal work. Developed by welfare economist Amartya Sen and further articulated by political philosopher Martha Nussbaum, this perspective builds on Rawls' distributive justice approach and adds the dimensions of human dignity, self-determination, and well-being to its justice framework.
Applying Child Support Guidelines: Users versus Nonusers of Child Support Enforcement Services
Authors: Ellis Walter L.
Published: April 2013

This study ascertained which of 371 fathers (either court-ordered to pay child support directly to the custodial parent or through a child support enforcement services agency) benefited from decisions regarding the use of presumptive child support guidelines. Chi-square tests and a logistic regression show that former fathers with higher incomes ($3,000+ monthly) were granted a downward departure from the guidelines. However, for the courts to let these fathers “off the hook” by reducing their child support obligations, they had to be willing to make up for the lower payments by increasing the post-divorce quality of life of their children and, when financially warranted, former spouses in other more meaningful ways. Mothers in these cases were at a greater financial disadvantage than their counterparts who had court orders to go through the agency for their child support payments.
The Impact of Job Loss on Professional and Managerial Employees and Their Families
Authors: Straussner Shulamith Lala Ashenberg , Phillips Norma Kolko
Published: April 2013

Despite the recent economic boom, layoffs of professional and managerial employees in the United States continue to affect millions of individuals and their family members. This paper presents the findings of an exploratory study of the impact of unemployment on ten displaced professionals and managers and their families. A seven-stage typology describing reactions of the unemployed and their families to long-term unemployment is presented. Impact on the family, differences in reactions to loss of employment based on gender and on age, and information regarding re-employment status of these individuals are discussed. Implications for work-based programs, clinical services, and policy are provided.
Family Preservation Services and Special Populations: The Invisible Target
Authors: Denby Ramona W. , Curtis Carla M. , Alford Keith A.
Published: April 2013

Children of color are especially vulnerable for a devastating outcome as a result of their living environment and are disproportionately represented within the child welfare system. Social workers, who are trained to mitigate the effects of social injustice and societal inconsistencies, particularly among minorities and oppressed populations, perpetuate the injustices associated with the child welfare system by ignoring the special needs of children of color when administering family preservation services. The authors present results from a national study that examined the attitudes, beliefs, and behaviors of family preservation workers regarding the service criterion based on whether a family is part of a special population. Results indicate a significant bias against targeting family preservation services to children of color.
Perceptions and Utilization of a Police–Social Work Crisis Intervention Approach to Domestic Violence
Authors: Corcoran Jacqueline , Stephenson Margaret , Perryman Derrelyn , Allen Shannon
Published: April 2013

This study reports survey findings of police officer perceptions and utilization of a domestic violence response team, which involved social workers and trained volunteers providing crisis intervention at the scene of domestic violence crimes. The majority of the 219 police officer respondents perceived the domestic violence response team as helpful. Other feedback provided in the survey was used to expand services and to make them more efficient and effective.
Communication about Sexual Behavior among Adolescent Women, Their Family, and Peers
Authors: Pistella Christine L. Young , Bonati Frank A.
Published: April 2013

Adolescent pregnancy and sexually transmitted disease rates in the United States are among the highest among developed nations. A survey of female adolescent family planning patients (N = 249) indicated that teens 13 to 16 years of age were more likely than teens 17 to 1 9 years of age to discuss sexual behavior with adult, nonparental relatives (43% vs. 26%, p = .007). Teens with a prior pregnancy were more likely than never-pregnant teens to report parental discussion of contraception choices (83% vs. 53%, p = .004) and of sites for contraceptive care (61% vs. 37%, p = .0023). Adolescents rely on a complex network of family and peers for communication about sexuality. Social work clinical and community skills facilitate family-centered reproductive health training and counseling for improved reproductive health of U.S. adolescents.
Social Support for Changes in Adoption Practice: Gay Adoption, Open Adoption, Birth Reunions, and the Release of Confidential Identifying Information
Authors: Miall Charlene E. , March Karen
Published: April 2013

The authors report on a Canada-wide survey examining support for changes in adoption as a kinship form and relate their findings to relevant survey research conducted in the United States. Half of the survey respondents in Canada and the United States support same-sex adoption. There is also strong support for some form of open adoption and birth reunions for adult adoptees. In the Canadian survey, over three quarters of respondents support the unconditional release of confidential identifying information to adult adoptees. The authors discuss the disjuncture between changing social values and policy and practice in adoption.
Correlates of Change in Marital Relationships under Stress: The Case of Childhood Cancer
Authors: Lavee Yoav
Published: April 2013

This study focuses on the factors associated with positive and negative change in the marital relationship among parents of children with cancer. Data were gathered from both parents in 35 couples whose children had been treated for cancer. Measures included perception of the situation and personal, system, and community resources. Change in the marital relationship was primarily associated with mothers' social support and fathers' sense of coherence, as well as with duration of the illness. Additionally, change was associated with psychological distress of the fathers, but not of the mothers. Whereas women's psychological distress is buffered by social support, men achieve their primary support within the marriage and therefore experience less distress when the marital relationship is stronger.
The Life Course Perspective: A Promising Approach for Bridging the Micro and Macro Worlds for Social Workers
Authors: Hutchison Elizabeth D.
Published: April 2013

The life course perspective, an emerging interdisciplinary perspective, has potential for helping social workers bridge their micro and macro worlds. This article provides an overview of the empirical and theoretical roots of the life course perspective and its basic concepts and major themes. Five basic concepts are defined and discussed: cohorts, transitions, trajectories, life events, and turning points. Six major themes that are emerging from interdisciplinary research are examined: interplay of human lives and historical time, timing of lives, linked or interdependent lives, human agency in making choices, diversity in life course trajectories, and developmental risk and protection. Strengths and limitations of the perspective for use by social workers are discussed and connections are made to narrative approaches to practice.
The Spiritual Dimension in Clinical Social Work Practice: A Client Perspective
Authors: Gotterer Rebecca
Published: April 2013

Based on input from a range of clients, this article focuses on the relationship between spirituality, religion, and mental health. Spirituality and religion are rich areas for discussion with clients, and are often a hidden source of both problems and inspiration. Included here are some basic principles for practitioners to think about regarding spirituality and religion: supporting spirituality as a client strength, examining religious and spiritual struggles as a source of conflict and constraint, being cognizant of the relationship between social work values and religious values, and being culturally sensitive about spirituality as it affects client assessment. There is also a discussion of the challenges for practitioners that hinder such work. As the dialogue grows about the place of spirituality in social work, this article affirms the significance of exploring this subject with clients.