Risk Of Serious Harm Research Articles

Challenging Vavřička: Questioning Compatibility of the Mandatory Tetanus Vaccination with ECHR.

The compatibility of mandatory vaccinations with human rights has become a very current issue with the COVID-19 pandemic and the Vavřicka ruling by the European Court of Human Rights. This ruling has faced criticism for not conducting examinations related to disease and vaccines based on direct scientific evidence. In this analysis, an assessment will be made based on direct scientific evidence about tetanus and its vaccine. The prevailing reason for mandatory tetanus vaccination is to protect the health of the vaccinated individual. Competent adults have the right to refuse treatment. This rule also applies to preventive medical interventions, including tetanus vaccination. As a rule, parents are entitled to give consent for medical interventions on their children. If an immediate and serious threat permanently endangers the minor’s life, medical intervention can be carried out against the parents’ will. The limitation of parental autonomy is more disputed when the minor’s life is not immediately threatened. With respect to tetanus vaccination as a preventive medical intervention, it does not eliminate an immediate and serious risk of harm. As a result, interference with the parent’s discretion on tetanus vaccination as a preventive medical intervention should be evaluated for its compatibility with the current legal approach to medical interventions on minors and patient rights. Keywords: best interest, mandatory vaccination, preventive medical intervention, right to reject a medical intervention, vaccine refusal, tetanus Acknowledgments: Z.T. wrote Part II: Information on Tetanus, M.S.P. wrote the rest of the paper. Elif Akdag was involved in formatting the footnotes. Funding: The authors were leading and core researchers in the project named “GETTING READY FOR THE NEXT PAN- DEMIC: Questioning Vaccine Mandates over COVID-19 and Childhood Vaccinations.” This project was funded by a grant from The Scientific and Technological Research Council of Türkiye (Grant Number: 122K378) and Altinbas University (Grant Number: PB2021-HUKUK-1). Conflicts of Interest: none

Radicalisation in adolescents: mental health considerations for violent extremism.

To outline current understanding and recommended mental health and psychiatric considerations for radicalisation and violent extremism among adolescents. Overview of recent research regarding violent extremism in adolescents and relationships with mental illness and other psychosocial determinants. Relevant international and Australasian research is outlined, with an emphasis on adolescents. Psychiatric considerations, intervention and policy implications will be explored. Adolescents who become radicalised form a heterogenous group with complex, multifaceted needs from mental disorder, familial, societal and/or environmental contributions. Thus, assessment and management need to be individualised. Mental health clinicians working with at-risk and radicalised adolescents should maintain a high index of suspicion for mental illness (particularly psychosis and depressive disorder) and neurodevelopmental disorder. Identified psychiatric conditions warrant prioritised mental health treatment. There may be a relationship between specific psychopathology and certain ideological beliefs and behaviours. Radicalised adolescents pose challenges with risk of serious harm to others, presentation complexity, multifactorial contributors and associations with varied psychopathology. All adolescents at risk of radicalisation or who are radicalised, should receive comprehensive mental health assessment and prompt assertive treatment of identified psychiatric conditions.

The Role of Deliberation in Correcting and Validating Intuition: A Holy Grail for Child-care Professionals or a False Dawn?

Abstract The role of deliberation in correcting and validating the more error prone intuition is subject to much interest and debate across a range of professions and disciplines. For child-care professionals, the opportunity to correct errors in their reasoning is crucial, especially where serious consequences can arise from mistakes. This study examines the way deliberation corrects and validates intuition when professionals discuss vulnerable children who have experience of secure care and present a serious risk of harm to other people. Data from twenty-one consultation meetings involving eighty-one professionals are collected and coded. Findings suggest that professionals engage in deliberative thinking to validate intuitive ideas, which is important in providing explanations and justifications. However, deliberation is rarely used to correct errors in intuitive thinking and this gives some cause for concern about the quality of professionals’ reasoning in complex child-care cases. Child-care professionals should give greater consideration to their reasoning, especially the role of deliberative thinking in complex cases and where serious risks exist for children. This requires professionals to value errors in, and challenges to their own thinking and recognise the additional cognitive effort necessary for deliberation.

Antipsychotics Linked to Increased Risk of Adverse Outcomes in Patients with Dementia.

According to this study: Use of antipsychotics in patients with dementia is associated with an increased risk of a wide range of serious adverse outcomes, particularly soon after the initiation of treatment.Antipsychotics are associated with a wider range of risks than previously known, and any potential benefits must be weighed against the risk of serious harm.

The benefits of using a Shared Lives type community response to support survivors of domestic abuse with disabilities and older survivors

PurposeThis paper aims to introduce the concept of using the well-established Shared Lives approach to support survivors of domestic abuse with complex needs including those with learning and physical disabilities, older people and carers.Design/methodology/approachSurvivors with complex needs are often excluded from traditional domestic abuse support services thus increasing their risk and making recovery impossible. Using the Shared Lives approach in suitable cases could address gaps in provision and improve the outcomes for survivors with disabilities, older survivors and carers.FindingsThe paper draws on evidence from reports and research about the experiences of these cohorts of survivors to explain how the Shared Lives approach could increase support options for specific categories of survivors.Practical implicationsUsing the Shared Lives approach to support cohorts of victims/survivors who experience barriers to accessing support could improve outcomes for these people, reduce risk of serious harm and improve quality of life.Originality/valueWith the recent recommendation from Association of Directors of Adult Social Services around increasing use of Shared Lives, this paper provides one potential way to meet this recommendation.

A qualitative study exploring how undergraduate pharmacy students undertake a drug allergy history

Abstract Introduction If antimicrobial resistance (AMR) is not controlled, a post-antibiotic era could result in common infections and minor injuries becoming fatal. One way to combat AMR is the ‘de-labelling’ or removal of incorrect antibiotic allergy labels. At least 92% of labels corresponding to penicillin allergy are incorrect when tested.[1] This means that patients may not be receiving the correct antibiotic treatment and take longer to recover. Therefore, taking an accurate allergy history is important. Pharmacists routinely take drug allergy histories. From 2026, pharmacy students in England will graduate as prescribers, highlighting the importance of drug allergy knowledge and skills. Aim To explore how undergraduate pharmacy students undertake a drug allergy history. Methods A qualitative study utilising a constructivist approach involving a low-fidelity simulation followed by a one-to-one face-to-face semi-structured interview was conducted. Final year undergraduate Master of Pharmacy students of an English school of pharmacy were recruited via email and word-of-mouth to take part in this study. Following informed consent, participants simulated taking a drug allergy history with a student researcher. The simulation was audio-recorded and then played back to the participant as a cue for a subsequent audio-recorded semi-structured interview that explored their thought-process when taking a drug allergy history. All audio-recordings were transcribed verbatim. Transcripts were analysed using reflexive thematic analysis.[2] Results Nine participants took part in the study. The simulation and interview lasted seven minutes on average. Four themes were generated through the analysis. Theme 1: taking drug allergy history is learnt mainly through practice-based learning. Theme 2: nature, type and severity of allergic reactions information were deemed important for making clinical judgements. Theme 3: skills for taking drug allergy history are underdeveloped despite having knowledge. Theme 4: real patient contact exposure is needed to translate learning into practice. Most participants remembered learning about taking drug allergy history through practice-based learning sessions such as workshops, objective structured clinical examinations (OSCEs) and hospital placements. Participants seemed to follow a set of ‘rules’ when undertaking the simulation. For example, they stopped asking questions about allergies and decide not to dispense penicillin when they were informed that the patient was allergic to penicillin. Most participants recognised the risk of serious harm to patients if they made a mistake about patient allergies, and the need to have more real-world experiences to help translate their learning into practice. Conclusion Pharmacy students appeared to have the theoretical knowledge about drug allergies, but they were not yet able to make an appropriate clinical judgement in real-world situations. An increase in real-world clinical experience such as patient consultations in work-based placements can provide pharmacy students with valuable opportunities. By knowing how to undertake an accurate allergy history, fewer people will be inaccurately labelled as allergic, promoting antimicrobial stewardship. To our knowledge, this is the first study investigating how United Kingdom undergraduate pharmacy students undertake a drug allergy history. Our participants studied in one pharmacy school and undergraduate pharmacy students studying in other pharmacy schools may have different experiences around drug allergy history taking.

Hyperkinetic disorder in children: principles of diagnosis and therapy

This pathology includes disorders of neuropsychological development, the leading clinical sign of which is constant persistent patterns (models) of behavior with impaired attention and/or increased motor activity and impulsivity, leading to maladjustment in several areas of the child’s social functioning. Attention disorders manifest themselves in the form of the following behavioral patterns: distractibility with disorganization of behavior and problems with stable focus on a task, which are not associated with a decrease in intelligence and lack of understanding of the proposed tasks. Hyperactivity is understood as excessive motor activity, fussiness, restlessness, or verbosity that is not adequate to accepted norms. Impulsive behavior involves quick, hasty, thoughtless, hurried actions that carry a high risk of serious harm and injury. Due to the great heterogeneity in the severity of clinical manifestations, this pathology tends to be diagnosed late, often with the start of schooling.

The cost of implementing the COVID-19 shielding policy in Wales

BackgroundThe EVITE Immunity study investigated the effects of shielding Clinically Extremely Vulnerable (CEV) people during the COVID-19 pandemic on health outcomes and healthcare costs in Wales, United Kingdom, to help prepare for future pandemics. Shielding was intended to protect those at highest risk of serious harm from COVID-19. We report the cost of implementing shielding in Wales.MethodsThe number of people shielding was extracted from the Secure Anonymised Information Linkage Databank. Resources supporting shielding between March and June 2020 were mapped using published reports, web pages, freedom of information requests to Welsh Government and personal communications (e.g. with the office of the Chief Medical Officer for Wales).ResultsAt the beginning of shielding, 117,415 people were on the shielding list. The total additional cost to support those advised to stay home during the initial 14 weeks of the pandemic was £13,307,654 (£113 per person shielded). This included the new resources required to compile the shielding list, inform CEV people of the shielding intervention and provide medicine and food deliveries. The list was adjusted weekly over the 3-month period (130,000 people identified by June 2020). Therefore the cost per person shielded lies between £102 and £113 per person.ConclusionThis is the first evaluation of the cost of the measures put in place to support those identified to shield in Wales. However, no data on opportunity cost was available. The true costs of shielding including its budget impact and opportunity costs need to be investigated to decide whether shielding is a worthwhile policy for future health emergencies.

Development of the internal family systems model: Honoring contributions from family systems therapies.

We describe Richard Schwartz's development of the Internal Family Systems model (IFS) from his position as a Structural/Strategic family therapist. Four decades ago, Schwartz struggled to help clients who exhibited serious risk of harm to self and others. Through a process of inquiry, he began to work with the positive intentions behind his most challenging clients' harmful thoughts and behaviors. He applied foundational ideas from family systems thinking to patterns of internal experiences. As he experimented with ways of applying these ideas, he created an approach to healing. We summarize the IFS model delineating ways a range of family systems theory and practice inform its development and contribute to its best practice. Our purposes are to inform IFS practitioners who are not trained in foundational family systems models as well as to acknowledge the significant contributions family therapy theories made in the development and best practice of the IFS model.

Elderly Abuse in Rural and Urban Areas of Guntur District - A Comparative Study

Beautiful old people are works of art!". There is still time for us to help the 'art' that is our beautiful elders” said by Eleanor Roosevelt. Elder abuse is a term referring to any knowing, intentional, or negligent act by a care-given or any other person that causes harm or a serious risk of harm to a vulnerable adult. Therefore, we can say that mistreatment by the care given to the elderly is a normal thing or phenomenon as the family structure is changed from a joint to a nuclear family. There is no space for elderly people in the family. They are considered a burden and useless, which results, in ignorance of the elderly. According to the 2011 Census, there are 104 million elderly persons (aged 60 years or above) in India. The proportion of the elderly was 8.6% in 2011 and is rising. Also, the average Indian can expect to live at least 18 years beyond the age of 60, which means the dependency ratio is also rising. In this connection since the elderly abuse is a burning topic there is a great need in studying and knowing the problems of elderly, types of elderly abuse and features of elderly abuse etc. An attempt is made in this paper to Examining the socioeconomic and demographic profiles of respondents of the age of abuse and analysis of responses of elderly people on different types of abuse faced in the study area.

Mechanisms by which the cystic fibrosis transmembrane conductance regulator may influence SARS-CoV-2 infection and COVID-19 disease severity.

Patients with cystic fibrosis (CF) exhibit pronounced respiratory damage and were initially considered among those at highest risk for serious harm from SARS-CoV-2 infection. Numerous clinical studies have subsequently reported that individuals with CF in North America and Europe-while susceptible to severe COVID-19-are often spared from the highest levels of virus-associated mortality. To understand features that might influence COVID-19 among patients with cystic fibrosis, we studied relationships between SARS-CoV-2 and the gene responsible for CF (i.e., the cystic fibrosis transmembrane conductance regulator, CFTR). In contrast to previous reports, we found no association between CFTR carrier status (mutation heterozygosity) and more severe COVID-19 clinical outcomes. We did observe an unexpected trend toward higher mortality among control individuals compared with silent carriers of the common F508del CFTR variant-a finding that will require further study. We next performed experiments to test the influence of homozygous CFTR deficiency on viral propagation and showed that SARS-CoV-2 production in primary airway cells was not altered by the absence of functional CFTR using two independent protocols. On the contrary, experiments performed in vitro strongly indicated that virus proliferation depended on features of the mucosal fluid layer known to be disrupted by absent CFTR in patients with CF, including both low pH and increased viscosity. These results point to the acidic, viscous, and mucus-obstructed airways in patients with cystic fibrosis as unfavorable for the establishment of coronaviral infection. Our findings provide new and important information concerning relationships between the CF clinical phenotype and severity of COVID-19.

High plasma nesfatin-1 level in Chinese adolescents with depression

Depression is a common psychiatric disorder with high prevalence and mortality rates as well as high risk of serious harm in adolescents that have significant negative impact on families and society. The feeding inhibitor Nesfatin-1 contributes to the regulation of stress and emotion. The purpose of this project was to compare the differences in the levels of Nesfatin-1 between adolescents with depression and healthy adolescents, and verify the association between the levels of Nesfatin-1 and severity of depression in adolescents. Adolescents with depression (n = 61) and healthy adolescents (n = 30) were evaluated. The Hamilton Depression Rating Scale (HAMD-17) was used to classify the adolescents with depression. Thirty-one and thirty-two was assigned to the mild-to-moderate (HAMD-17 ≤ 24) depression group and severe group (HAMD-17 > 24). Plasma Levels of Nesfatin-1 were measured by human ELISA Kit and differences among groups evaluated. Data were analyzed using the statistical software SPSS 23. HAMD-17 score was significantly higher in adolescents with depression than that in the healthy adolescents (P < 0.001). Median plasma Nesfatin-1 levels in adolescents with depression and healthy adolescents differed significantly at 37.3 pg/ml (22.1 pg/ml, 63.6 pg/ml) and 18.1 pg/ml (10.0 pg/ml, 25.7 pg/ml) (p < 0.001). A multivariate logistic regression analysis showed high plasma Nesfatin-1 concentrations were associated with increased risk of depression (OR = 0.914, 95% CI 0.87–0.96, P < 0.001). The receiver operating characteristic curve showed that the area under curve were 0.808 (95% CI 0.722–0.894, P < 0.001). Plasma Nesfatin-1 cut-off point of 32.45 pg/mL showed 59% sensitivity and 100% specificity. Median plasma Nesfatin-1 levels in the severe depression group (n = 30), mild-to-moderate depression group (n = 31), and control group (n = 30) were 53.4 pg/ml (28.2 pg/ml, 149.1 pg/ml), 29.9 pg/ml (14.5 pg/ml, 48.5 pg/ml) and 18.1 pg/ml (10.0 pg/ml, 25.7 pg/ml), and differed significantly among the three groups (P < 0.001). Median plasma level of Nesfatin-1 in males (n = 20) was 38.6 pg/ml (23.5 pg/ml, 70.1 pg/ml), while that in females (n = 41) was 37.3 pg/ml (22.0 pg/ml, 63.6 pg/ml), which was not a significant difference (P > 0.05). Plasma levels of Nesfatin-1 increased with severity of depression in adolescents and may be useful as a biomarker of depression severity. Further studies are needed in future projects.

Moderate to Vigorous Intensity Locomotor Training After Stroke: A Systematic Review and Meta-analysis of Mean Effects and Response Variability.

This meta-analysis quantified mean effects of moderate to vigorous intensity locomotor training (LT mv ) on walking outcomes in subacute and chronic stroke, and the magnitude of variability in LT mv response. Databases were searched for randomized trials comparing LT mv with no intervention, nongait intervention, or low-intensity gait training. Comfortable gait speed (CGS), fastest gait speed (FGS), 6-minute walk test (6MWT), walking activity (steps per day), and adverse effect/event (AE) data were extracted. Pooled estimates were calculated for mean changes, AE relative risks, and the standard deviation of response (SD response ) to LT mv versus control groups, stratified by study chronicity where possible. There were 19 eligible studies (total N = 1096): 14 in chronic stroke (N = 839) and 5 in subacute stroke (N = 257). Compared with control interventions, LT mv yielded significantly greater increases in CGS (chronic, +0.06 m/s [95% confidence interval (CI), 0.01-0.10]; subacute, +0.16 [0.12-0.19]; subacute vs chronic, P = 0.03), FGS (chronic, +0.07 m/s [0.02-0.13]; subacute, +0.21 [0.01, 0.41]; P = 0.04), and 6MWT (chronic, +33 m [24-42]; subacute, +51 [26-77]; P = 0.054) but not steps/day (+260 [-1159 to 1679]). There were no treatment-related serious AEs among 398 LT mv participants in 14 AE-reporting studies. SD response estimates indicated substantial response variability: CGS, 0.11 m/s [0.00-0.15]; FGS, 0.14 m/s [-0.00 to 0.20]; and 6MWT, 41 m [27-51]. LT mv improves mean walking capacity outcomes in subacute and chronic stroke and does not appear to have high risk of serious harm. Response magnitude varies within and between chronicity subgroups, and few studies have tested effects on daily walking activity or non-serious AEs.Video Abstract available for more insights from the authors (see the Video, Supplemental Digital Content 1 available at: http://links.lww.com/JNPT/A452 ).

Illegal edible cannabis products: risk of serious harm if accidentally ingested by children

Illegal edible cannabis products: risk of serious harm if accidentally ingested by children

The ESA Active Dosimeter (EAD) system onboard the International Space Station (ISS)

Ionizing radiation in general and mixed fields of space radiation in particular pose a risk of serious harm to human health. The risk of such adverse effects increases with the duration of the mission, and for all missions outside the protective properties of the Earth’s magnetic field and atmosphere. Accordingly, radiation protection is of central importance for all human spaceflight, which is recognized by all international space agencies. To date various systems, analyze and determine the exposure to ionizing radiation within the environment and to the crew onboard the International Space Station (ISS). In addition to this operational monitoring, experiments and technology demonstrations are carried out. This to further enhance systems capabilities, to prepare for exploratory missions, to the Deep Space Gateway and/or to enable for human presence at other celestial bodies. Subsequently the European Space Agency (ESA) decided early to support the development of an active personal dosimeter. Under the auspices of the European Space Research and Technology Center (ESTEC) together with the European Astronaut Center's (EAC) Medical Operations and Space Medicine (HRE-OM) team, a European industrial consortium was formed to develop, build, and test this system. To complete the ESA Active Dosimeter (EAD) Technology Demonstration in space, EAD components were delivered to ISS with the ESA’s space missions ‘iriss’ and ‘proxima’ in 2015 and 2016. This marked Phase 1 (2015) and 2 (2016–2017) of the EAD Technology Demonstration to which focus is given in this publication. All EAD systems and their functionalities, the different radiation detector, their properties, and calibrations procedures are described. Emphasis is first on the “iriss” mission of September 2015, that provided a complete set of data for an entire space mission from launch to landing, for the first time. Data obtained during Phase 2 in 2016–2017 are discussed thereafter. Measurements with the active radiation detectors of the EAD system provided data of the absorbed dose, dose equivalent, quality factor as well as the various dose contributions during the crossings of the South Atlantic Anomaly (SAA) and/or resulting from galactic cosmic radiation (GCR). Results of the in-flight cross-calibrations among the internal sensors of the EAD systems are discussed and alternative usage of the EAD Mobile Units as area monitors at various different locations inside the ISS is described.

Emergency examination authorities in Queensland, Australia.

In Queensland, where a person experiences a major disturbance in their mental capacity, and is at risk of serious harm to self and others, an emergency examination authority (EEA) authorises Queensland Police Service (QPS) and Queensland Ambulance Service (QAS) to detain and transport the person to an ED. In the ED, further detention for up to 12 h is authorised to allow the examination to be completed. Little published information describes these critical patient encounters. Queensland's Public Health Act (2005), amended in 2017, mandates the use of the approved EEA form. Data were extracted from a convenience sample of 942 EEAs including: (i) patient age, sex, address; (ii) free text descriptions by QPS and QAS officers of the person's behaviour and any serious risk of harm requiring urgent care; (iii) time examination period commenced; and (iv) outcome upon examination. Of 942 EEA forms, 640 (68%) were retrieved at three 'larger central' hospitals and 302 (32%) at two 'smaller regional' hospitals in non-metropolitan Queensland. QPS initiated 342 (36%) and QAS 600 (64%) EEAs for 486 (52%) males, 453 (48%) females and two intersexes (<1%), aged from 9 to 85 years (median29 years, 17% aged <18 years). EEAs commonly occurred on weekends (32%) and between 2300 and midnight (8%), characterised by 'drug and/or alcohol issues' (53%), 'self-harm' (40%), 'patient aggression' (25%) and multiple prior EEAs (23%). Although information was incomplete, most patients (78%, n =419/534) required no inpatient admission. EEAs furnish unique records for evaluating the impacts of Queensland's novel legislative reforms.

Altruism in medical education: assessing attitudes of hospital in-patients towards face-to-face contact with medical students during the COVID-19 pandemic

BackgroundLimited research indicated patients were largely amenable to seeing medical students pre-pandemic. However, the COVID-19 pandemic has highlighted the potential risk of nosocomial transmission and harm to patients from students. Patient opinions regarding these risks remain unexplored, which impacts elicitation of informed consent. We aim to identify these, and explore whether reflection on the risks and benefits of direct student interaction influenced patients’ attitudes. For guidance, we further explored measures to reduce perceived infection risk.MethodWe designed an original questionnaire for a cross-sectional study, completed by 200 inpatients from 25 wards between 18/02 and 16/03/2022 at Derriford Hospital, Plymouth. Patients in intensive care, with active COVID-19 infection or unable to comprehend the study information were excluded. The responses of a guardian were recorded for inpatients under 16. 17 questions were included - the initial question, reporting willingness to talk with and be examined by students, was repeated following nine questions exploring risks and benefits of student interaction. A further four questions addressed reducing the perceived infection risk. Data is summarised using frequencies and percentages, and with Wilcoxon signed-rank and rank-sum tests of association.Results85.4% (169/198) of participants gave an initial positive response to seeing medical students, and despite a third of participants changing their response 87.9% (174/197) remained willing after the survey resulting in no significant change. Furthermore, 87.2% (41/47) of those who perceived themselves at severe risk of harm from COVID-19 remained happy to see students. Participants reported reassurance knowing students were: fully vaccinated (76.0%); wearing masks (71.5%); lateral flow test negative within the last week (68.0%) and wearing gloves and gown (63.5%).ConclusionThis study demonstrated the willingness of patients to engage in medical education despite recognised risks. Patient reflection on the risks and benefits of student interaction did not significantly reduce numbers willing to see students. Even those perceiving a risk of serious harm remained happy to have direct student contact – a demonstration of altruism in medical education. This suggests informed consent should include discussion of infection control measures, risks and benefits to patients and students, and offer alternatives to direct inpatient contact.

Galápagos and the plastic problem

Plastic pollution (PP) is an ongoing, pervasive global problem that represents a risk to the Galápagos archipelago, despite it being one of the world's most pristine and well-protected regions. By working closely with citizen scientists, we aimed to quantify and map the magnitude and biological effects of PP. With macroplastic abundance ranging from 0.003 to 2.87 items/m2, our research indicates that all five sampled Galápagos bioregions are contaminated with PP along their coastlines. The distribution of this debris is not uniform, with macroplastics significantly higher on the windward shores. Based on the identification information found on the examined items, Polyethylene terephthalate (PET) was the most predominant type of plastic originating from both consumer and fisheries-based products deriving primarily from Perú, China, and Ecuador. The top three manufacturers were AjeCroup, Coca-Cola, and Tingy Holding Corporation. Through citizen science, we documented PP exposure in 52 species (20 endemic) in Galápagos terrestrial and marine environments, with exposure occurring in two ways: entanglement and ingestion. These included reptiles (8 species), birds (13 species), mammals (4 species), cartilaginous fish (7 species), bony fish (14 species), and invertebrates (6 species). The top five species with the greatest risk of serious harm due to entanglement (in decreasing order) were identified as green sea turtles, marine iguanas, whale sharks, spine-tail mobulas, and medium-ground finches. In contrast, Santa Cruz tortoises, green sea turtles, marine iguanas, black-striped salemas, and Galápagos sea lions were at the highest risk of harm due to the ingestion of plastics. Our research indicates that PP is a growing problem in the Galápagos archipelago and that additional work is necessary to mitigate its impact now and in the future.

Public elementary schools' handling of student neglect and adjustment problems

The challenge of being able to respond to student adjustment needs in elementary schools is a problem worldwide. In this manuscript, we offer one example from Indonesia. Using data from 15 public elementary schools from three small regions in Indonesia: Semarang, Surabaya, and Jakarta, we analyze conditions that result in neglect. Student neglect is any inappropriate action by an incompetent person that results in serious physical or emotional harm, or abuse, which presents a serious risk of harm to the student. The data were collected through documentation, interview, and observation. The study results showed no specific handling adjustment problems regulations and mechanisms, specialized professional staff handling adjustment, and specific room for handling adjustment problems within the public elementary school due to the unawareness, misunderstanding, ignorance, the less-caring educational system, and also the disconnection of the relationship between the educational institution and the community. The study suggests that student neglect on adjustment problems at public elementary schools should not be taken lightly because this can threaten the psychological condition of students in the future.

Reconceptualizing protective factors in response to risk with vulnerable children

The quality and robustness of childcare professionals’ thinking about protective factors is crucial to interventions with vulnerable children. Yet, protective factors in childcare are under-conceptualized in policy and practice and have been overshadowed by the concept of risk. This study uses discourse analysis to examine how childcare professionals discuss protective factors in response to risk and in a way that demonstrates critical thinking. Findings Data was collected from 30 consultation meetings, which involve a total of 109 professionals. The consultation meetings focus on the assessment of a child who presents a serious risk of harm to others and who are themselves at risk. The findings suggest that professionals do discuss protective factors in response to risk, however, it occurs on a ratio of approximately one to nine, which suggests a level of separation in the way these terms are conceptualized in practice. Application It is suggested that a professional construct of “protective factors versus risk,” which is applied with critical thinking, will offer a more robust way of conceptualizing the support provided to vulnerable children. While professionals have to analyze risk in terms of what is wrong, it is equally crucial to include protective factors in a strategy for it to work. A starting point is for professionals to re-construct protective factors and risk and apply it with critical thinking to core elements of social work practice, such as assessments, multi-disciplinary meetings and the verbal communications with service users.