Revisiting the Performance of Firms Recognized for Creating a Healthy Culture.

OBJECTIVE: To augment several prior JOEM studies, which associated firms with recognized health and safety programs with outsized firm stock performance. METHODS: Stock performance of CHAA and C. Everett Koop National Health Award winners are analyzed using standard asset-pricing, risk-adjusted modeling to compare them against benchmark stock portfolios. RESULTS: While wellness programs are laudable, the firms did not universally outperform a market benchmark over extended periods when controlling for well-established measures of portfolio risk. CONCLUSIONS: Investors could have also expected to underperform the market based on the excess risk involved with these selected companies. Investors must recognize that adding these award-winning companies to their portfolios also increases the overall riskiness and volatility of their portfolios. The previously documented outsized returns could be the reward for bearing this additional risk.JEL categories: G11, G51, J26, J32.

Criminals Work from Home during Pandemics Too: a Public Health Approach to Respond to Fraud and Crimes against those 50 and above.

This paper uses the public health framework to address the apparent impact of the coronavirus on the victimization experiences with a specific focus given to those over the age of 50. The bulk of attention is given to fraud victimization, with consideration also given to parent abuse, partner violence, and patient abuse. A review of data from the Federal Trade Commission shows that reports of most types of fraud grew significantly in the first three months of 2020 in comparison to the same time period in 2019. Differences between fraud experiences based on age are considered. Older persons lost much more to fraud than younger persons, and far more in 2020 than 2019. In addition, they reported being targeted more often for certain types of cybercrime (i.e., tech support scams). While devastating to everyone, it is concluded that the coronavirus will potentially have a more significant impact on the financial health of older persons than younger persons. It is concluded that minimizing the consequences of all forms of crimes targeting older adults will be best achieved by using a public health approach.

Validity Evidence for a Serious Game to Assess Performance on Critical Pediatric Emergency Medicine Scenarios.

INTRODUCTION: We developed a first-person serious game, PediatricSim, to teach and assess performances on seven critical pediatric scenarios (anaphylaxis, bronchiolitis, diabetic ketoacidosis, respiratory failure, seizure, septic shock, and supraventricular tachycardia). In the game, players are placed in the role of a code leader and direct patient management by selecting from various assessment and treatment options. The objective of this study was to obtain supportive validity evidence for the PediatricSim game scores. METHODS: Game content was developed by 11 subject matter experts and followed the American Heart Association's 2011 Pediatric Advanced Life Support Provider Manual and other authoritative references. Sixty subjects with three different levels of experience were enrolled to play the game. Before game play, subjects completed a 40-item written pretest of knowledge. Game scores were compared between subject groups using scoring rubrics developed for the scenarios. Validity evidence was established and interpreted according to Messick's framework. RESULTS: Content validity was supported by a game development process that involved expert experience, focused literature review, and pilot testing. Subjects rated the game favorably for engagement, realism, and educational value. Interrater agreement on game scoring was excellent (intraclass correlation coefficient = 0.91, 95% confidence interval = 0.89-0.9). Game scores were higher for attendings followed by residents then medical students (Pc < 0.01) with large effect sizes (1.6-4.4) for each comparison. There was a very strong, positive correlation between game and written test scores (r = 0.84, P < 0.01). CONCLUSIONS: These findings contribute validity evidence for PediatricSim game scores to assess knowledge of pediatric emergency medicine resuscitation.

Effect of Maternal Antibody Transfer on Antibody Dynamics and Control of Porcine Circovirus Type 2 Infection in Offspring.

Sow immunity plays an important role in preventing viral infection and disease in newborn piglets. Vertical transmission of porcine circovirus type 2 (PCV2) may perpetuate porcine circovirus associated disease (PCVAD) in newborn and growing pigs. Hence, the immunological effects of maternal immunoglobulin transfer of PCV2-specific antibodies on PCV2 viremia and immune response in piglets in commercial swine herds were evaluated. Sow vaccination has been shown to reduce viral shedding and viremia, and increases the neutralizing antibody (NA) titers. Since NAs are important for control of PCVAD and mammary secretions may contain high anti-PCV2 NA levels, we examined the PCV2 NA levels in colostrum, milk, sow serum, and piglet serum over time to investigate an association between NA levels and protection against infection. NA titers were remarkably high (up to 10-6 50% neutralizing titer) in sow serum and colostrum on all farms regardless of viremia levels. In piglets vaccinated at 3 weeks of age, NA titers peaked at 10 weeks of age and continued to maintain high viral neutralizing titers to slaughter. The impact of maternally derived neutralizing activity was most evident during the suckling period. Although PCV2 was transmitted from sows to piglets in colostrum, piglets were largely nonviremic at weaning. Thus, NAs appear to control or suppress initial infection even though they are unable to clear or prevent infection later in life.

Iodine supplementation for women during the preconception, pregnancy and postpartum period.

BACKGROUND: Iodine is an essential nutrient required for the biosynthesis of thyroid hormones, which are responsible for regulating growth, development and metabolism. Iodine requirements increase substantially during pregnancy and breastfeeding. If requirements are not met during these periods, the production of thyroid hormones may decrease and be inadequate for maternal, fetal and infant needs. The provision of iodine supplements may help meet the increased iodine needs during pregnancy and the postpartum period and prevent or correct iodine deficiency and its consequences. OBJECTIVES: To assess the benefits and harms of supplementation with iodine, alone or in combination with other vitamins and minerals, for women in the preconceptional, pregnancy or postpartum period on their and their children's outcomes. SEARCH METHODS: We searched Cochrane Pregnancy and Childbirth's Trials Register (14 November 2016), and the WHO International Clinical Trials Registry Platform (ICTRP) (17 November 2016), contacted experts in the field and searched the reference lists of retrieved studies and other relevant papers. SELECTION CRITERIA: Randomized and quasi-randomized controlled trials with randomisation at either the individual or cluster level comparing injected or oral iodine supplementation (such as tablets, capsules, drops) during preconception, pregnancy or the postpartum period irrespective of iodine compound, dose, frequency or duration. DATA COLLECTION AND ANALYSIS: Two review authors independently assessed trial eligibility, risk of bias, extracted data and conducted checks for accuracy. We used the GRADE approach to assess the quality of the evidence for primary outcomes.We anticipated high heterogeneity among trials, and we pooled trial results using random-effects models and were cautious in our interpretation of the pooled results. MAIN RESULTS: We included 14 studies and excluded 48 studies. We identified five ongoing or unpublished studies and two studies are awaiting classification. Eleven trials involving over 2700 women contributed data for the comparisons in this review (in three trials, the primary or secondary outcomes were not reported). Maternal primary outcomesIodine supplementation decreased the likelihood of the adverse effect of postpartum hyperthyroidism by 68% (average risk ratio (RR) 0.32; 95% confidence interval (CI) 0.11 to 0.91, three trials in mild to moderate iodine deficiency settings, 543 women, no statistical heterogeneity, low-quality evidence) and increased the likelihood of the adverse effect of digestive intolerance in pregnancy by 15 times (average RR 15.33; 95% CI 2.07 to 113.70, one trial in a mild-deficiency setting, 76 women, very low-quality evidence).There were no clear differences between groups for hypothyroidism in pregnancy or postpartum (pregnancy: average RR 1.90; 95% CI 0.57 to 6.38, one trial, 365 women, low-quality evidence, and postpartum: average RR 0.44; 95% CI 0.06 to 3.42, three trials, 540 women, no statistical heterogeneity, low-quality evidence), preterm birth (average RR 0.71; 95% CI 0.30 to 1.66, two trials, 376 women, statistical heterogeneity, low-quality evidence) or the maternal adverse effects of elevated thyroid peroxidase antibodies (TPO-ab) in pregnancy or postpartum (average RR 0.95; 95% CI 0.44 to 2.07, one trial, 359 women, low-quality evidence, average RR 1.01; 95% CI 0.78 to 1.30, three trials, 397 women, no statistical heterogeneity, low-quality evidence), or hyperthyroidism in pregnancy (average RR 1.90; 95% CI 0.57 to 6.38, one trial, 365 women, low-quality evidence). All of the trials contributing data to these outcomes took place in settings with mild to moderate iodine deficiency. Infant/child primary outcomesCompared with those who did not receive iodine, those who received iodine supplements had a 34% lower likelihood of perinatal mortality, however this difference was not statistically significant (average RR 0.66; 95% CI 0.42 to 1.03, two trials, 457 assessments, low-quality evidence). All of the perinatal deaths occurred in one trial conducted in a severely iodine-deficient setting. There were no clear differences between groups for low birthweight (average RR 0.56; 95% CI 0.26 to 1.23, two trials, 377 infants, no statistical heterogeneity, low-quality evidence), neonatal hypothyroidism/elevated thyroid-stimulating hormone (TSH) (average RR 0.58; 95% CI 0.11 to 3.12, two trials, 260 infants, very low-quality evidence) or the adverse effect of elevated neonatal thyroid peroxidase antibodies (TPO-ab) (average RR 0.61; 95% CI 0.07 to 5.70, one trial, 108 infants, very low-quality evidence). All of the trials contributing data to these outcomes took place in areas with mild to moderate iodine deficiency. No trials reported on hypothyroidism/elevated TSH or any adverse effect beyond the neonatal period. AUTHORS' CONCLUSIONS: There were insufficient data to reach any meaningful conclusions on the benefits and harms of routine iodine supplementation in women before, during or after pregnancy. The available evidence suggested that iodine supplementation decreases the likelihood of postpartum hyperthyroidism and increases the likelihood of the adverse effect of digestive intolerance in pregnancy - both considered potential adverse effects. We considered evidence for these outcomes low or very low quality, however, because of study design limitations and wide confidence intervals. In addition, due to the small number of trials and included women in our meta-analyses, these findings must be interpreted with caution. There were no clear effects on other important maternal or child outcomes though these findings must also be interpreted cautiously due to limited data and low-quality trials. Additionally, almost all of the evidence came from settings with mild or moderate iodine deficiency and therefore may not be applicable to settings with severe deficiency.More high-quality randomised controlled trials are needed on iodine supplementation before, during and after pregnancy on maternal and infant/child outcomes. However, it may be unethical to compare iodine to placebo or no treatment in severe deficiency settings. Trials may also be unfeasible in settings where pregnant and lactating women commonly take prenatal supplements with iodine. Information is needed on optimal timing of initiation as well as supplementation regimen and dose. Future trials should consider the outcomes in this review and follow children beyond the neonatal period. Future trials should employ adequate sample sizes, assess potential adverse effects (including the nature and extent of digestive intolerance), and be reported in a way that allows assessment of risk of bias, full data extraction and analysis by the subgroups specified in this review.

Prevalence of Retinal Hemorrhages in Infants Presenting with Isolated Long Bone Fractures and Evaluation for Abuse.

BACKGROUND: Fractures are a frequent reason for emergency department visits and evaluation for abusive head trauma is an associated concern in infants. Recent guidelines have suggested that retinal examination may not be necessary in the absence of intracranial injury, but there is a lack of empirical evidence in infants < 1 year of age. OBJECTIVE: Our aim was to evaluate the prevalence of retinal hemorrhages in infants with isolated long bone fractures. METHODS: Retrospective chart review of infants < 1 year of age who presented to an urban, tertiary care pediatric hospital between January 2004 and April 2014 with the diagnosis of an acute long bone fracture or retinal hemorrhages. Patients were excluded for head injury, altered mental status, injury mechanism of motor vehicle accident, multiple fractures or injuries outside the fracture area. Patients were identified through trauma registry data and International Classification of Diseases codes. RESULTS: One hundred and forty-six patients had isolated long bone fractures, of which 68 patients did not undergo a retinal examination and 78 patients had dilated eye examinations, with no patients identified as having retinal hemorrhages. There were 46 patients identified with retinal hemorrhages concerning for abuse. No patients with retinal hemorrhages had isolated long bone fractures. CONCLUSIONS: In infants < 1 year of age presenting with isolated long bone fractures, a dilated eye examination to evaluate for retinal hemorrhages is not likely to yield additional information. Our results support recent studies that a subset of children and infants may not require dilated eye examinations in the evaluation of possible abuse.

Device Thrombosis During Destination Therapy.

BACKGROUND: Device thrombosis remains a complication of long-term mechanical circulatory support with HeartMate II. MATERIALS AND METHODS: Retrospective analysis of patients who underwent destination therapy (DT) with HeartMate II from January 2010-December 2013 at Tulane University Medical Center. RESULTS: Eighteen HeartMate II were implanted for DT. Survival rates were 72.2% at 1 year and 37% at 2 years. Device thrombosis in 7 of the 18 patients (39%) accounted for the low survival rate at 2 years. Known risk factors for device thrombosis were equally present in patients with and without device thrombosis. In contrast to patients without device thrombosis, all patients with device thrombosis had a pre-existing systemic inflammatory condition. CONCLUSIONS: Patients with pre-existing systemic inflammatory conditions are at risk of device thrombosis during DT.

A model to investigate the optimal seeder-to-naïve ratio for successful natural Mycoplasma hyopneumoniae gilt exposure prior to entering the breeding herd.

Due to the significance of Mycoplasma hyopneumoniae as a swine respiratory pathogen, acclimation measures are taken into consideration when obtaining replacement gilts from negative sources to be introduced to endemically infected herds. The aim of this study was to evaluate the optimum seeder-to-naïve gilt ratio in a 4-week period for successful natural exposure to M. hyopneumoniae. Sixty gilts were divided in two groups, 21 2-week old seeder gilts were inoculated with M. hyopneumoniae, and 39 aged-matched naïve gilts were exposed to the seeders during a 4-week period. The exposure was set by dividing the gilts into six groups of 10 with different ratios of seeder-to-naïve, from 1:9 until 6 seeders and 4 naïve gilts. Laryngeal swabs, oral fluids and blood samples were collected from all gilts prior to, during and after inoculation and exposure. Infection in seeders was confirmed by development of clinical signs, seroconversion post-inoculation, and detection of M. hyopneumoniae genetic material. Naïve were considered positive after 4 weeks if M. hyopneumoniae was detected on bronchial swab or fixed lung tissue. As result, 33% (3/9) naïve gilts were positive in the 1:9 ratio, 75% (6/8) in 2:8, 28% (2/7) in 3:7, 33% (2/6) in 4:6, 80% (4/5) in 5:5 and 100% (4/4) in the 6:4 ratio. The estimated transmission rate (ß) and expected probability of infection (ψ) were 1.28 per pig/week and 0.6, respectively. In this study, six seeders were required in a group of 10 gilts for successful exposure to M. hyopneumoniae in a 4-week exposure period.

Direct evidence of podocyte damage in cardiorenal syndrome type 2: preliminary evidence.

BACKGROUND: Renal structural alterations have been partially uncovered in cardiorenal syndrome (CRS). Patients with CRS may have evidence of tubular damage, but markers of glomerular damage other than proteinuria have not been thoroughly investigated. The nature of renal damage in CRS may have therapeutic implications, as glomerular damage requires tight blood pressure control and renin-angiotensin-aldosterone system (RAAS) inhibition. The present investigation evaluates patients with CRS type 2 (CRS-2) for direct evidence of glomerular damage as evidenced by the presence of urinary podocin. METHODS: The presence of glomerular damage was assessed in acutely decompensated patients with CRS-2 and healthy controls. Urinary podocin was determined by quantification of a tryptic peptide of podocin with high-performance liquid chromatography coupled to tandem mass spectrometry (LC-MS/MS). Morning urine samples were collected for podocin, creatinine (Cr), and protein. Urinary podocin was expressed in femtomoles of podocin/milligram of Cr. RESULTS: The urinary podocin/Cr ratio was greater in patients than in controls (0.37 ± 0.77 vs. 0.06 ± 0.05 fmol podocin/mg Cr, p = 0.04). A total of 40% of the patients had a urinary podocin/Cr ratio greater than the upper limit of normal (>0.2 fmol podocin/mg Cr). Patients with an elevated podocin/Cr ratio were more likely to have received ≤50% of the maximum dose of angiotensin-converting enzyme inhibitors or angiotensin receptor blockers (p = 0.04) than patients with a podocin/Cr ratio in the normal range. CONCLUSIONS: CRS-2 may be associated with glomerular damage as evidenced by an elevated urinary podocin/Cr ratio. Modulators of RAAS may have a protective effect on urinary podocin loss.

Bosnian and American students' attitudes toward electronic monitoring: is it about what we know or where we come from?

The use of community corrections continues to grow across the globe as alternatives to incarceration are sought. Little research attention, however, has been directed at correctional alternatives from a global orientation. The purpose of this research study is to compare the way that a sample of criminal justice students from the United States (n = 118) and Bosnia and Herzegovina (n = 133) perceive electronic monitoring. Because electronic monitoring is a newer sentencing alternative and it is used differently in Bosnia and Herzegovina than it is in the United States, it is predicted that Bosnian students will view electronic monitoring differently than will students from the United States. This study finds that while students are largely supportive of electronic monitoring sentences, support is affected by offender type and student nationality. For example, Bosnian students are more supportive of electronic monitoring sentences for drug offenders while American students are more supportive of electronic monitoring sentences for juvenile offenders. Differences were also found across student groups when attitudes toward electronic monitoring and the costs and pains associated with electronic monitoring were assessed. Specifically, American students were less likely to view electronic monitoring as meeting the goals of rehabilitation and more likely to view the conditions and restrictions associated with electronic monitoring as being punitive than Bosnian students were. Implications from these findings, as well as limitations and suggestions for further research are discussed.

Intra-farm risk factors for Mycoplasma hyopneumoniae colonization at weaning age.

The objective of this study was to identify intra-farm risk factors that affected the colonization with Mycoplasma hyopneumoniae at weaning age. Three farrow-to-wean farms were visited at least 5 times each. An average of 54 piglets were sampled at each visit and assayed by means of real-time PCR in nasal swabs. The proportion of PCR positive piglets was evaluated as a response to several variables including dam's PCR status, piglet serological status, and local climatic conditions during the lactation period, as well as other factors. All piglets at weaning age were negative to M. hyopneumoniae in 2 of the 3 farms. M. hyopneumoniae positive piglets were demonstrated in 5 of 7 weaning groups in 1 farm. The proportion of M. hyopneumoniae positive piglets in each weaning group at the positive farm was correlated with the proportion of positive dams in the group. The prevalence of M. hyopneumoniae at weaning increased with the piglet's age in the groups where at least one dam was positive. These results highlight the influence of the sow in the sow-to-piglet colonization process, as previously reported, and contribute to a more comprehensive understanding of the epidemiology of M. hyopneumoniae infections.

Assessing the level of elder abuse knowledge preprofessionals possess: implications for the further development of university curriculum.

Elder abuse is a multifaceted problemthat requires interdisciplinary prevention and intervention strategies. An important question that arises is whether professionals are adequately prepared to address elder abuse in this collaborative network. Unfortunately, no studies have been conducted to assess the varying levels of knowledge that preprofessionals enrolled in university courses possess with regard to elder abuse. To fill this void, this study assesses the levels of elder abuse awareness among social work, nursing, health professions, and criminal justice students. Specific attention is given to determining whether there are differences in the amount of exposure to elder abuse literature across the disciplines. The study involves the analysis of survey data collected from 202 students enrolled in health and human sciences classes at a large university. Results show that none of the preprofessional groups, on average, reported knowing enough about elder abuse. Implications for future practice and research are provided.

Elder abuse: what coroners know and need to know.

This article presents findings from a survey examining knowledge of elder abuse among Georgia's coroners. More than half of the 116 respondents indicated that they know "almost nothing" or "a little" about distinguishing signs of physical abuse from signs of aging (54%) and mandatory reporting laws and related elder abuse statutes (63%). When asked the frequency with which older adult cases were referred to the medical examiner, 49% indicated "rarely if ever." Study findings reveal specific opportunities for enhancing training efforts aimed at coroners, who play a critical role in the identification of elder abuse.

Factors contributing to perceptions about policies regarding the electronic monitoring of sex offenders: the role of demographic characteristics, victimization experiences, and social disorganization.

The purpose of this article is to explore factors contributing to perceptions about electronic monitoring policies governing sex offenders. Guided by Tannenbaum's theory of attribution and Shaw and McKay's theory of social disorganization, the authors examine the influence of demographic characteristics, victimization experiences, and neighborhood characteristics on perceptions about policies regarding the electronic monitoring of sex offenders. Ordinary least squares regression and logistic regression analyses of stratified telephone survey data reveal that factors associated with favorable views on the use of global positioning satellite monitoring for registered sex offenders appear to stem primarily from individuals' demographic characteristics. Experiential and neighborhood factors do provide some influence over individuals' views of electronic monitoring policies for sex offenders. Theoretical and policy implications are discussed.

Financial exploitation of older persons in adult care settings: comparisons to physical abuse and the justice system's response.

The current study uses a sample of 242 elder financial abuse cases and 314 elder physical abuse cases handled by fraud control units to shed some light on the dynamics of elder financial exploitation and the way the justice system processes these cases. Attention also is given to the way that the processing of elder financial exploitation cases can be distinguished from the processing of elder physical abuse cases. Results show that a wide range of elder financial exploitations cases are committed, and these cases should be broadly defined. Implications are provided.

A survey of georgia adult protective service staff: implications for older adult injury prevention and policy.

BACKGROUND: The aging population is a rapidly growing demographic. Isolation and limited autonomy render many of the elderly vulnerable to abuse, neglect and exploitation. As the population grows, so does the need for Adult Protective Services (APS). This study was conducted to examine current knowledge of older adult protection laws in Georgia among APS staff and to identify training opportunities to better prepare the APS workforce in case detection and intervention. METHODS: The Georgia State University Institute of Public Health faculty developed a primary survey in partnership with the Georgia Division of Aging Services' leadership to identify key training priority issues for APS caseworkers and investigators. A 47-item electronic questionnaire was delivered to all APS employees via work-issued email accounts. We conducted descriptive analyses, t-tests and chi-square analyses to determine APS employees' baseline knowledge of Georgia's elder abuse policies, laws and practices, as well as examine associations of age, ethnicity, and educational attainment with knowledge. We used a p-value of 0.05 and 95% confidence intervals to determine statistical significance of analyses performed. RESULT: Ninety-two out of 175 APS staff responded to the survey (53% response rate). The majority of respondents were Caucasian (56%) women (92%). For over half the survey items, paired sample t-tests revealed significant differences between what APS staff reported as known and what APS staff members indicated they needed to know more about in terms of elder abuse and current policies. Chi-square tests revealed that non-Caucasians significantly preferred video conferencing as a training format (44% compared to 18%), [χ(2)(1) = 7.102, p < .008], whereas Caucasians preferred asynchronous online learning formats (55% compared to 28%) [χ(2)(1) =5.951, p < .015]. CONCLUSION: Results from this study provide the Georgia Division of Aging with insight into specific policy areas that are not well understood by APS staff. Soliciting input from intended trainees allows public health educators to tailor and improve training sessions. Trainee input may result in optimization of policy implementation, which may result in greater injury prevention and protection of older adults vulnerable to abuse, neglect and exploitation.

Neighborhood disadvantage and refusal of formal services among cases reported to adult protection services.

Research suggests that certain factors influence the way caregivers of older adults experience the role of caretaker. Aspects of the caregiving experience that have been considered include factors influencing decisions to seek services, causes of caregiver burden, and the relationship between caregiver burden and maltreatment. Most of this research has focused on characteristics of caregivers and how these individual characteristics influence the caregiving experience and subsequent maltreatment. Very little research, however, has examined the influence of contextual factors on the caregiving experience. This study considers how neighborhood context influences decisions to reject formal services among cases reported to Adult Protective Services. A specific focus is given to caregivers of persons with Alzheimer's and related diseases.

Developing a citywide youth violence prevention plan: perceptions of various stakeholders.

Researchers suggest that violence prevention requires community-wide efforts and partnerships that demonstrate commitment to youth development. Missing from this research, however, are studies considering how these partnerships are formed and how members of various groups involved in these partnerships perceive youth violence prevention. This study sought to fill this void. A series of seven focus group interviews were conducted with 85 stakeholders involved in developing a youth violence prevention plan in one community. Results suggest that the stakeholders were optimistic about developing violence prevention strategies and forging partnerships between various groups. Participants pointed to specific themes that provide a framework for understanding youth violence prevention planning efforts. Implications are provided.

Elder abuse coverage in newspapers: regional differences and its comparison to child-abuse coverage.

Dozens of studies have examined how the press portrays crime. Most of these studies focus on some aspect of the criminal or the response to the event. Few have considered the portrayal of victims and even fewer have examined the way the media portrays older victims. To fill this void, this study examines (1) whether elder abuse coverage varies across newspapers and (2) how the extent of elder abuse coverage compares to child-abuse coverage. Results indicate that regional differences appear to exist and child abuse receives far more coverage than elder abuse. Implications are provided.

Training adult protective services workers about domestic violence: training needs and strategies.

Many cases of elder abuse involve instances of partner abuse. In this study, attention is given to whether adult protective services supervisors think their workers know enough about specific aspects of domestic violence. Attention is also given to the strategies that the supervisors think would be most useful to teach about domestic violence. According to the supervisors, workers need to know more about intervening with perpetrators, planning for their own safety, and dealing with frustrations. The supervisors rated the importance of understanding theoretical perspectives as low. Results also show that agencies with domestic violence training policies participate in domestic violence training programs more often.