Vulnerabilities to CSE.
\\n\\n
More than half of the publishers listed alongside IntechOpen (18 out of 30) are Social Science and Humanities publishers. IntechOpen is an exception to this as a leader in not only Open Access content but Open Access content across all scientific disciplines, including Physical Sciences, Engineering and Technology, Health Sciences, Life Science, and Social Sciences and Humanities.
\\n\\nOur breakdown of titles published demonstrates this with 47% PET, 31% HS, 18% LS, and 4% SSH books published.
\\n\\n“Even though ItechOpen has shown the potential of sci-tech books using an OA approach,” other publishers “have shown little interest in OA books.”
\\n\\nAdditionally, each book published by IntechOpen contains original content and research findings.
\\n\\nWe are honored to be among such prestigious publishers and we hope to continue to spearhead that growth in our quest to promote Open Access as a true pioneer in OA book publishing.
\\n\\n\\n\\n
\\n"}]',published:!0,mainMedia:null},components:[{type:"htmlEditorComponent",content:'
Simba Information has released its Open Access Book Publishing 2020 - 2024 report and has again identified IntechOpen as the world’s largest Open Access book publisher by title count.
\n\nSimba Information is a leading provider for market intelligence and forecasts in the media and publishing industry. The report, published every year, provides an overview and financial outlook for the global professional e-book publishing market.
\n\nIntechOpen, De Gruyter, and Frontiers are the largest OA book publishers by title count, with IntechOpen coming in at first place with 5,101 OA books published, a good 1,782 titles ahead of the nearest competitor.
\n\nSince the first Open Access Book Publishing report published in 2016, IntechOpen has held the top stop each year.
\n\n\n\nMore than half of the publishers listed alongside IntechOpen (18 out of 30) are Social Science and Humanities publishers. IntechOpen is an exception to this as a leader in not only Open Access content but Open Access content across all scientific disciplines, including Physical Sciences, Engineering and Technology, Health Sciences, Life Science, and Social Sciences and Humanities.
\n\nOur breakdown of titles published demonstrates this with 47% PET, 31% HS, 18% LS, and 4% SSH books published.
\n\n“Even though ItechOpen has shown the potential of sci-tech books using an OA approach,” other publishers “have shown little interest in OA books.”
\n\nAdditionally, each book published by IntechOpen contains original content and research findings.
\n\nWe are honored to be among such prestigious publishers and we hope to continue to spearhead that growth in our quest to promote Open Access as a true pioneer in OA book publishing.
\n\n\n\n
\n'}],latestNews:[{slug:"stanford-university-identifies-top-2-scientists-over-1-000-are-intechopen-authors-and-editors-20210122",title:"Stanford University Identifies Top 2% Scientists, Over 1,000 are IntechOpen Authors and Editors"},{slug:"intechopen-authors-included-in-the-highly-cited-researchers-list-for-2020-20210121",title:"IntechOpen Authors Included in the Highly Cited Researchers List for 2020"},{slug:"intechopen-maintains-position-as-the-world-s-largest-oa-book-publisher-20201218",title:"IntechOpen Maintains Position as the World’s Largest OA Book Publisher"},{slug:"all-intechopen-books-available-on-perlego-20201215",title:"All IntechOpen Books Available on Perlego"},{slug:"oiv-awards-recognizes-intechopen-s-editors-20201127",title:"OIV Awards Recognizes IntechOpen's Editors"},{slug:"intechopen-joins-crossref-s-initiative-for-open-abstracts-i4oa-to-boost-the-discovery-of-research-20201005",title:"IntechOpen joins Crossref's Initiative for Open Abstracts (I4OA) to Boost the Discovery of Research"},{slug:"intechopen-hits-milestone-5-000-open-access-books-published-20200908",title:"IntechOpen hits milestone: 5,000 Open Access books published!"},{slug:"intechopen-books-hosted-on-the-mathworks-book-program-20200819",title:"IntechOpen Books Hosted on the MathWorks Book Program"}]},book:{item:{type:"book",id:"960",leadTitle:null,fullTitle:"Cancer of the Uterine Endometrium - Advances and Controversies",title:"Cancer of the Uterine Endometrium",subtitle:"Advances and Controversies",reviewType:"peer-reviewed",abstract:"The book Cancer of the Uterine Endometrium - Advances and Controversies brings together an international collaboration of authors who share their contributions for the management of endometrial carcinoma. 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\r\n\tIn recent years, epidemiological studies, paired with genomic analyses have shed light on specific interactions of Helicobacter pylori and the increased risk of development of digestive and extradigestive outcomes. Genomic tools such as genome sequencing, restriction fragment length polymorphism genome mapping and analytical methods are enhancing the molecular epidemiological methods currently used to study H. pylori pathogenesis. Besides, new drugs and different combinations of them have been suggested to eradicate the microorganism and scientists around the world have discussed the management of the infection, considering the host characteristics.
\r\n\r\n\tThis book is an invitation for having a different look at Helicobacter pylori infection, since its first isolation by Warren and Marshall in the 80´s until nowadays.
",isbn:"978-1-83968-292-6",printIsbn:"978-1-83968-291-9",pdfIsbn:"978-1-83968-293-3",doi:null,price:0,priceEur:0,priceUsd:0,slug:null,numberOfPages:0,isOpenForSubmission:!1,hash:"f90afe88d326a6554b6e094e93f0f0e7",bookSignature:"Dr. Bruna Maria Roesler",publishedDate:null,coverURL:"https://cdn.intechopen.com/books/images_new/10141.jpg",keywords:"Virulence Factors, Genotyping, Pathogenicity, Host-Pathogen Interaction, Gastritis, Peptic Ulcer Disease, Gastric Cancer, Development of Gastrointestinal Disorders, Management of Antimicrobial Resistance, New Drugs, Antibiotics, Helicobacter pylori and Extradigestive diseases",numberOfDownloads:null,numberOfWosCitations:0,numberOfCrossrefCitations:null,numberOfDimensionsCitations:null,numberOfTotalCitations:null,isAvailableForWebshopOrdering:!0,dateEndFirstStepPublish:"September 1st 2020",dateEndSecondStepPublish:"September 29th 2020",dateEndThirdStepPublish:"November 28th 2020",dateEndFourthStepPublish:"February 16th 2021",dateEndFifthStepPublish:"April 17th 2021",remainingDaysToSecondStep:"4 months",secondStepPassed:!0,currentStepOfPublishingProcess:4,editedByType:null,kuFlag:!1,biosketch:"Dr. Roesler is a pharmacist biochemist and holds a Master’s degree in Pharmacology and a Doctoral degree in Basic Sciences - Internal Medicine from the State University of Campinas. Her research includes the etiology, epidemiology, and physiopathology of gastrointestinal diseases.",coeditorOneBiosketch:null,coeditorTwoBiosketch:null,coeditorThreeBiosketch:null,coeditorFourBiosketch:null,coeditorFiveBiosketch:null,editors:[{id:"54995",title:"Dr.",name:"Bruna Maria",middleName:null,surname:"Roesler",slug:"bruna-maria-roesler",fullName:"Bruna Maria Roesler",profilePictureURL:"https://mts.intechopen.com/storage/users/54995/images/system/54995.jpg",biography:"Dr. Bruna Maria Roesler is a pharmacist biochemist and holds\r\na Master’s degree in Pharmacology and a Doctoral degree in\r\nBasic Sciences—Internal Medicine from the State University of\r\nCampinas (Campinas, SP, Brazil) where she has identified the\r\nprincipal genotypes of Helicobacter pylori strains in patients with\r\nchronic gastritis, peptic ulcer disease, and gastric cancer (early\r\nand advanced stages) through molecular biology techniques. 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From chapter submission and review, to approval and revision, copyediting and design, until final publication, I work closely with authors and editors to ensure a simple and easy publishing process. I maintain constant and effective communication with authors, editors and reviewers, which allows for a level of personal support that enables contributors to fully commit and concentrate on the chapters they are writing, editing, or reviewing. I assist authors in the preparation of their full chapter submissions and track important deadlines and ensure they are met. I help to coordinate internal processes such as linguistic review, and monitor the technical aspects of the process. As an ASM I am also involved in the acquisition of editors. 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by"}},{type:"book",id:"1373",title:"Ionic Liquids",subtitle:"Applications and Perspectives",isOpenForSubmission:!1,hash:"5e9ae5ae9167cde4b344e499a792c41c",slug:"ionic-liquids-applications-and-perspectives",bookSignature:"Alexander Kokorin",coverURL:"https://cdn.intechopen.com/books/images_new/1373.jpg",editedByType:"Edited by",editors:[{id:"19816",title:"Prof.",name:"Alexander",surname:"Kokorin",slug:"alexander-kokorin",fullName:"Alexander Kokorin"}],productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"57",title:"Physics and Applications of Graphene",subtitle:"Experiments",isOpenForSubmission:!1,hash:"0e6622a71cf4f02f45bfdd5691e1189a",slug:"physics-and-applications-of-graphene-experiments",bookSignature:"Sergey Mikhailov",coverURL:"https://cdn.intechopen.com/books/images_new/57.jpg",editedByType:"Edited by",editors:[{id:"16042",title:"Dr.",name:"Sergey",surname:"Mikhailov",slug:"sergey-mikhailov",fullName:"Sergey Mikhailov"}],productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}}]},chapter:{item:{type:"chapter",id:"57686",title:"Children and Young People’s Vulnerabilities to Grooming",doi:"10.5772/intechopen.71672",slug:"children-and-young-people-s-vulnerabilities-to-grooming",body:'\nWhile many children across the globe experience happy, secure childhoods, amassing the skills to help them thrive into adulthood, many are abused in the most horrific and sustained ways possible. UNICEF in a report from 2014 [1] estimate that around 120 million girls worldwide (about 1 in 10) will have experienced forced intercourse or other forced sexual acts at some time in their lives; a shocking almost incomprehensible amount. Child abuse is an evolving, pervasive contemporary social problem for humanity, but for some it is a multi-million pound business with transactions carried out on the ‘dark web’ via the internet as well as face-to-face in contact abuse. Some young people are born into this type of abuse in families or community circumstances or latterly in the form of trafficking and modern day slavery, others are groomed into being abused. ‘Stop the traffik’ [2] estimate that 600,000–800,000 men, women and children are trafficked across international borders each year with an approximation of 80% women and girls. Up to 50% are estimated to be minors. A recent report by The Children’s Society [3] estimates that ‘The scale of child trafficking, as officially monitored, has increased by 55% between 2012 and 2014 and the numbers of boys and young men trafficked has more than doubled in the same period’—though the recorded levels are widely regarded as underestimating the issue.
\nGrooming children and young people into abuse in the form of CSE, to be trafficked into becoming slaves and victims of multiple abuse as well as for radicalisation and terrorism, is now a well-documented ‘process’ [4]. Vulnerable young people are targeted, often online, and groomed via different social media, as well as face-to-face, to become victims of abuse or to commit or contribute to terrorist offences. Serious Case Reviews in the UK on CSE [5–8] and radicalisation [9] clearly document the consequences of this for the victim, professionals and policy makers.
\nGrooming is currently defined in the UK by the NSPCC as: ‘when someone builds an emotional connection with a child to gain their trust for the purposes of sexual abuse, sexual exploitation or trafficking. Children and young people can be groomed online or face-to-face, by a stranger or by someone they know - for example a family member, friend or professional. Groomers may be male or female. They could be any age. Many children and young people don’t understand that they have been groomed or that what has happened is abuse’ [10].
\nMany children and young people are consequently at risk of being groomed. In the UK Ofsted, the Office for Standards in Education, Children’s Services and Skills, who inspect and regulate services that care for and educate children and young people, require organisations to teach children and young people about being groomed: ‘…how to keep themselves safe from relevant risks such as abuse, sexual exploitation and extremism, including when using the internet and social media’ [11].
\nHowever, this is a difficult and complex task, often requiring specialist knowledge. Research suggests that many professionals do not feel equipped to tackle these issues, particularly in relation to radicalisation, where lack of appropriate training impacts on practitioner confidence [12, 13]. Brighton and Hove SCR on siblings W and X indicates how the social workers in this case lacked the knowledge, experience and training to deal with radicalisation [9].
\nRisk factors for being particularly vulnerable to CSE are identified in literature and SCRs and include those listed in \nTable 1\n.
\nHaving a prior experience of neglect, physical and/or sexual abuse; | \n
Lack of a safe/stable home environment, now or in the past (domestic violence or parental substance misuse, mental health issues or criminality); | \n
Recent bereavement or loss; | \n
Social isolation or social difficulties; | \n
Absence of a safe environment to explore sexuality; | \n
Economic vulnerability; | \n
Homelessness or insecure accommodation status; | \n
Connections with other children and young people who are being sexually exploited; | \n
Family members or other connections involved in adult sex work; | \n
Having a physical or learning disability; | \n
Being in care (particularly those in residential care and those with interrupted care histories); | \n
Sexual identity. | \n
Vulnerabilities to CSE.
CSE has been identified as being widespread in some areas of the UK, with several cases highlighted in the local and national press following court appearances of perpetrators, often gangs of men, and subsequent serious case reviews [5–8]. CSE can affect all ages and is described as happening when:
\n\n‘\n…an individual or group takes advantage of an imbalance of power to coerce, manipulate or deceive a child or young person under the age of 18 into sexual activity (a) in exchange for something the victim needs or wants, and/or (b) for the financial advantage or increased status of the perpetrator or facilitator. The victim may have been sexually exploited even if the sexual activity appears consensual. Child sexual exploitation does not always involve physical contact; it can also occur through the use of technology’ [13].
\nThe consequences of being groomed for CSE are considerable for each young person (\nTable 2\n) and some extreme cases have resulted in young people being murdered (see for example the cases of Breck Bednar [14] and Kayleigh Haywood [15]), suffering long term physical and psychological trauma [13] and being groomed into gangs [16] a life of crime, drug and alcohol related activities [17].
\n‘It all began when I was about 12. They gave us more than my mum could’ | \n
‘It was exciting – Asian boys with flash cars. They made me trust them for months. I was their friend\n’. | \n
‘When the grooming started they were so kind and nice. They were a lot older. It was flattering. Then things started to change’ | \n
‘They took us to a field where there were other men who came to have sex with us. I tried not to do it. There were five of them’ | \n
‘They threatened to blow my house up with my mum in it. I was expected to do things: if I did not they said they would come to my house and burn me alive’ | \n
‘I turned up at the police station at 2/3 am, blood all over me soaked through my trousers to the crotch. They dismissed me as being naughty, a nuisance’ | \n
Oxford Gang rape victims [7] | \n
CSE: why do young people get drawn in?.
In terms of understanding grooming in the context of radicalisation in the UK, schools, colleges, Universities and health and social care organisations are obligated under the Prevent Duty to address radicalisation with children, young people and young adults:
\n‘In order for schools and childcare providers to fulfil the Prevent duty, it is essential that staff are able to identify children who may be vulnerable to radicalisation, and know what to do when they are identified. Protecting children from the risk of radicalisation should be seen as part of schools’ and childcare providers’ wider safeguarding duties, and is similar in nature to protecting children from other harms (e.g. drugs, gangs, neglect, sexual exploitation), whether these come from within their family or are the product of outside influences’ [18, 19].
\nThe Channel vulnerability assessment framework [20] outlines 22 factors that may cause someone to engage with a terrorist group, cause or ideology. The list is designed to assess whether individuals need support to safeguard them from the risk of being targeted by terrorists and radicalisers. These factors have been contested, including human rights groups who claim that the assessment framework is divisive and stigmatises and alienates segments of the population [21].
\nIt has also been recently argued [13] that the way harm manifests in radicalisation can be quite different to CSE. Young people targeted do not have to be ‘vulnerable’ in the CSE sense (for example being in care) they can be well educated and well cared for as in the case of the three Bethnal Green girls (\nTable 3\n). As a consequence, some young people may not have overt signs of being groomed; for example, they often do not go missing for extended periods of time, as with grooming for CSE. Detection of this type of grooming may well require a detailed examination of their social media profiles and online activity.
\n\nOn Tuesday February 17th 2015, CCTV cameras at Gatwick airport captured Amira Abase, Shamima Begum and Khadiza Sultana, clearing security checks before a flight. The three young girls (aged between 15 and 16 years old) boarded a Turkish airline’s flight to Istanbul, on the first phase of their journey to join ISIS. This collection of images of the three girls has become synonymous with the phenomenon of female migrants to ISIS territory, particularly within British consciousness [22]. | \n
The girls travelled to Isis Syrian stronghold of Raqqa and all three girls were reported to have become ‘jihadi brides’. All contact with the girls was lost in mid-December—around the time British, American and Russian warplanes stepped up their bombardment of Raqqa and Kadiza Sultana is believed to have died in May 2016, raising fears for her two classmates—whose fate remains unknown. | \n
The girls attended Bethnal Green Academy and were hardworking, straight A’ students who formed a close-knit friendship group. It is well-documented that Isis has specifically targeted western women (at least 100 of the more than 800 people who have travelled from Britain to Syria are female), using female propagandists to offer practical advice and sell a utopian vision of the sisterhood on offer in Islamic State. The online recruiters are prolific and online grooming played a role with the Bethnal Green girls. However the group psychology of this close-knit friendship was also crucial. One of the reasons the case made such an impact was that it was the first widely known example of a group of women radicalising together offline. | \n
The number of Britons joining Isis has slowed, thanks to better policing in the UK and the loss of Isis caliphate. They no longer place such emphasis on convincing people to travel to Syria, but have changed their strategy to encourage radicalised cells at home. | \n
The case of the Bethnal Green girls.
‘Today, online grooming has a whole new use. Radicalising young, impressionable minds by extremists. If you’re young and struggling to find your place in the world, and someone appears to understand you, that makes you vulnerable. Many children and young people are unaware they are being controlled. Groomers will hide their true intentions, often spending a long time gaining a young person’s trust, slowly manipulating their thoughts so they can begin introducing their twisted ideologies’ [23].
\nYoung people are naturally inquisitive and keen to explore new avenues and ideas. When ideas are shared on-line, and an apparent likeminded person replies reiterating their beliefs and opinions, this can increase vulnerability to grooming. Grooming for radicalisation in particular does not necessitate face-to face meetings, highlighting the power of the internet and social media in covert grooming. Five hypotheses identified in the literature [24] links the internet with increased opportunities to become radicalised; it acts as an ‘echo chamber’ to find like-minded individuals, accelerates the process of radicalisation, increases opportunities for self-radicalisation and allows radicalisation to occur without physical contact. In the case of Breck Bednar there were several months of grooming activity via online gaming sites prior to meeting his attacker Lewis Daynes. During this time Daynes groomed Breck to be anti-establishment and anti-government. Breck was told by Daynes that he has contributed to Daesh through making money from his computing business. Just months after the grooming started Daynes lured Breck to his address and murdered him in a sexual motivated attack. This is thought to be the only time the two had met in person. Links between the sexual exploitation process and that of radicalisation can clearly be seen in this case [14].
\nSuch is the power of grooming, in cases of CSE, victims may be coerced into initially sending indecent images or making videos while radicalisers can convince someone to create a homemade device without directly meeting them. The internet acts as a place where individuals find their ideas supported and echoed by others, giving them a misplaced sense of empowerment and belonging.
\nBecause the outcomes of being groomed for CSE or radicalisation are often very serious, resulting in serious injury trauma and death, it is often assumed that the process of grooming is therefore aggravated or aggressive. Groomers, however, are often quite sophisticated in their approaches, often unknowingly adopting techniques more usually associated with attachment; providing a ‘secure base’ or a ‘safe haven’ for individuals while they flatter, accept and ‘nurture’ them. Young people are often drawn to groomers’ because of a need for ‘attachment or affection’ [25, 26]. While the threats and fear do materialise, as indicated by the quotes from the Oxford Serious Case Review in \nTable 2\n, the initial approaches, whether face-to face or online will often be enticing and flattering, often accompanied by gifts, in order to facilitate trust and confidence.
\nIt is often argued that grooming is a ‘process’ with clearly defined stages leading to the ultimate end goals of sexual abuse or radicalisation, however face- to-face and online grooming often have different starting points and consequently variables may be different. Moreover, a process suggests a linear route and this may not necessarily be the case as one or more grooming techniques can be occurring at the same time. Consequently, rather than a ‘process’ grooming can be visualised as more of a matrix (\nFigure 1\n) with some, many or all of the following features slotting together and overlapping in time and context:
\nThe grooming matrix [4, 13, 20, 24, 26–29].
Because grooming is such a serious and widespread social problem on and offline, educational resources from a variety of sources have been produced to work with children and young people on the topic (see \nTable 4\n).
\nCSE | \nWeb Links | \n
---|---|
Thinkyouknow | \n\n | \n
NSPCC | \n\n | \n
Childline | \n\n | \n
\n | \n\n | \n
Blast project for boys | \n\n | \n
See me hear me! | \n\n | \n
\nRadicalisation\n | \n\nWeb Links\n | \n
Educate against hate | \n\n | \n
Let us talk about it | \n\n | \n
FAST | \n\n | \n
Addressing extremism and radicalisation lesson plans | \n\n | \n
\nPrevent Education for Schools\n | \n\n | \n
\nStop It Now\n | \n\n | \n
Kayleigh Haywood story | \n\n | \n
Breck Foundation | \n\n | \n
Resources on CSE and radicalisation in the UK for use with young people.
Many of these resources are used as part of personal, health and social education (PHSE) in schools in the UK and some are very impactful, delivering clear messages via a popular medium of film. However, because some are often film based they are essentially ‘passive’ tools for young people. Film based approaches, while popular with students and teachers alike may also have drawbacks [30] and may not involve learners in the development of critical thinking and analytical skills so important for evaluating the myriad of information often inundating young people in their daily lives through social media [31]. A clear example of this is the current trend towards ‘fake’ news, often celebrity related which can be hard to evaluate truth from fiction.
\nSimulated learning is used in many different contexts with adults and with children and young people. Simulation can, however, mean different things in different contexts. From a simulated suite of learning at UWE, which is in fact a physical learning ward, to using actors with young people in mental health, as well as attending a school in Second Life [33], these are all considered simulations [32].
\nHowever, using simulations in child protection are in their infancy [12, 34]. The Centre for Child Protection at the University of Kent is at the forefront of this development and has now created, by working in partnership with health & social care, law enforcement and education organisations, seven simulations on different aspects of child protection, designed for use with both professionals and young people.
\nSimulated learning is associated with a tranche of associated benefits; they are engaging [35]; promote good discussion [36]; offer opportunities for immersion & interaction in a ‘safe’ space [37] allowing individuals to take risks safely. Perhaps of most significance however, is that they offer experiential learning [38] which many people thrive on and they are learner centred rather than teacher led: the ‘teacher’ becomes the facilitator rather than disseminator. With young people in particular it is argued that ‘virtual role play allows students to develop ‘embodied empathy’ for complex social systems’ [39].
\nDrawing on social constructionist educational theory, it can be argued that in order for children and young people to develop into individuals who can reflect and evaluate knowledge, they need to be active learners and develop skills of critical self-reflection, which they are prepared to apply to their worlds and themselves [39]. Learners do this at different rates and times and some may not have opportunities to develop these skills at all. It is suggested by Barnett [40] that to become critical beings young people have to ‘think collaboratively’ and this must be sustained through shared activity and discourse around collective standards in a community’. Wass [41] argues that Vygotsky (1896–1934) conceptualised the zone of proximal development (ZPD) [42] to help teachers assist people to develop skills beyond their immediate reach, and this can include critical thinking. He argued that ZPD is the difference between what a learner can do on their own and what he or she can achieve with help. Put simply teachers, peers, activities and some learning environments can help develop critical skill via scaffolding: structuring an issue clearly and problematizing it.
\nIn terms of answering the question posed by this chapter what can be done to prevent children and young people being groomed? Part of the answer may lie in designing interactive content on grooming for young people which is just beyond their reach which, as a consequence, then stimulates them to interrogate the issue. It is often easy to develop \npassive\n learning information on radicalisation and CSE, including films, listening to visiting speakers, and watching actors. These resources can be positive as they can simplify key information on these complex and emotive topics which then leads to discussion. However, these type of activities often provide a ‘structure’ through radicalisation or CSE where the \nsolutions are often provided\n in the film or by the presenter or actors. An alternative model could be to scaffold an issue, including the complexities & problems, (which may be just outside of a learners reach) and with help allow the learner to work through the scaffolding to develop their critical thinking, reasoning and evaluation skills on the topic. As Wass [41] suggests ‘Scaffolding allows students to identify and solve the educative problems, while structuring removes these problems for the student’.
\nIn the simulation ‘Looking Out for Lottie’ on grooming and CSE, we follow the life of 14 year old Lottie through four different social media site, including a vlog. We have access to her social media and her private ‘phone messages, allowing learners to interrogate her life, build rapport with her and evaluate events in her life as they unfold. The simulation is split into separate scenes and in each scene the learner (preferably in small groups to promote community thinking mentioned earlier) completes a set of questions reflecting on the social media content and on their own experiences. Using the ‘boyfriend’ model of grooming, set out in \nFigure 1\n, users find and are exposed to indicators of grooming and how manipulative and focussed groomers can be to achieve what they want. The final scene is, uniquely, from the groomers’ perspective so learners are able to understand the motivating factors and consequences for Jake as a groomer.
\nIn the simulation ‘Maryam and Joe: Behind Closed Doors’ learners follow BBC and Sky news clips on radicalisation and are able to follow two storylines to analyse how different characters respond to the same news events and evaluate, through the characters social media sites and private messages, how these events impact on their lives. Again learners are interrogating information via social media, looking for the groomers and critically evaluating how the characters react to this grooming. The social media format is the ‘scaffolding’ and engages the learner by making the way they receive information current and young person focused. Learners are ‘forensically’ searching for signs of grooming for radicalisation in a format that is familiar to them, therefore encouraging them to engage with the simulation subject matter. Clues are hidden in popular social media formats (‘Wetube’ ‘Hashtagged’ ‘whatchat’ ‘snappit’ etc.) (\nFigure 2\n) and young people have to evaluate this content to identify the groomers and evaluate the effects this has on the young people being groomed (\nTable 5\n).
\nScreen shots ‘Maryam and Joe – Behind Closed Doors’ (top) and ‘Looking out for Lottie’ (bottom).
Learners have to solve a \nchallenge\n (‘who is the groomer’ & ‘why?’) | \n
It involves them in making choices, in ‘\nforensic\n’ \nanalysis of evidence\n for example interrogating Lottie’s phone conversations with the groomer, Jake, so learners can evaluate the different evidence before them and come to their own reasoned conclusions | \n
They can see, weigh up & evaluate the different consequences of certain actions via various social media (which are familiar to them). | \n
If young people work in small groups they observe and have the opportunity to learn from their peers critical evaluation skills | \n
Radicalisation and CSE are \nstructured\n as a topic; social media, however, is the \nscaffolding\n. The issues and complexities are buried in the stories and narratives of the simulation and have to be found: thus developing critical evaluation skills | \n
We have provided tools to \nactivate\n thinking, \ninterrogate\n evidence for themselves and see the \nconsequences of different\n actions and behaviour | \n
How do we do this in our child protection simulations?.
Research [43] into the effectiveness of child protection simulations [12, 26, 34] has only just begun and is ongoing. However, by embedding teaching and learning techniques into a simulation which require young people to ‘forensically’ interrogate a story via ‘scaffolding’ in a format which they use in their everyday lives, namely social media platforms, appears to have encouraging results (\nTable 5\n).
\nIn a small scale pilot of ‘Behind Closed Doors’ conducted in a College of Further Education, 39 students were divided into five sessions. After a brief introduction to the simulation, each student was asked to complete a consent form and then asked to ‘play’ scene 1 of the Maryam or Joe story. After playing the game, either in pairs or individually, each student filled in a feedback form of 13 questions rating the simulation, the story and the simulation features. The questionnaire elicited the following results: on the 1–10 rating scale, 85% of students rated the game as ‘Good to Excellent’ (39% males: 46% females) and 15% of student rated the game as ‘Ok to Not useful’ (0–6 on the rating scale) (7.5% male, 7.5% female).
\nWhile it is encouraging to have the simulation rated overall as good to excellent, what is noteworthy for future research is that 82% of students said that they had increased their knowledge about the topics of radicalization and grooming after playing the game. Additionally and of significance is that 61.5% of students said they would change their online behaviour after playing the game. Although this is only a very small scale pilot study, what these results give an insight into, and can be followed up in future studies, is that young people state that they are willing to change their online behaviour after going through an active process of learning whereby they have followed and interrogated the lives of young people who have been groomed and analysed how this happened. The features embedded in the simulation have allowed them to be active learners, constructing their own knowledge, being given a degree of control over how they learn and in what order, in a context which is meaningful to them and they have been given space and encouragement to reflect on a complex and difficult topic. Those students who said the simulation would not change their online behaviour often qualified this with a comment such as ‘because I am careful anyway’ or ‘because I already am safe online but this keeps me aware’.
\nResearch reviewed clearly states that grooming is a serious contemporary threat to global childhoods. The research reviewed has shown that there are young people who are particularly vulnerable to being groomed and that policy and the law has moved to try to protect them. However, recent serious cases reviews in the UK clearly show that on-line and face-to-face groomers have a sophisticated modus operandi for entrapping children and exploiting them sexually and for radicalization. Children need to understand what these techniques and approaches are so that they can protect themselves and each other and keep safe online. Parents need to have an ongoing dialogue with their children on online and face-to-face grooming and promote regular conversations between their children and with them, in order to understand online behaviour. Additionally, they need to know what approaches schools are adopting on the topics of grooming, CSE and radicalisation to teach their children to be critical thinkers on these issues in order to protect themselves and their friends. Schools need to share the resources they are using and clearly signpost parents to them to enhance their knowledge and understanding on these complex topics.
\nExisting research on simulations indicates that simulated environments offer a safe way for young people to evaluate situations and take risks safely. This chapter has reviewed innovative simulations currently being developed to help children and young people learn to protect themselves online in the form of simulations. These tools follow the lives of young people who are themselves groomed, giving young people the scaffolding through which to develop their evaluative skills in a way that is significant to them. A small scale pilot study has revealed that this approach to learning about grooming for child protection is encouraging and has the potential to change online behaviour.
\nThe word “migraine” comes from the
Migraine is self-limiting, usually presenting as recurrent severe
The best solutions to medical conditions come only from understanding the pathophysiology of the disease state. As per Wolff’s vascular theory, vascular constriction leading to hypoperfusion of the cortex later followed by vascular dilation was put forward as the main pathophysiological mechanism. Currently neurovascular hypothesis involving the trigeminovascular system is considered. Another hypothesis includes mutations of neuronal calcium channels, leading to hypersensitivity, resulting in migraine attacks. It is also postulated that increased dopaminergic activity in the thalamus/hypothalamus causing modulation in central pain pathways also plays a role in migraine attacks. Other mechanisms put forward include cortical spreading depression; release of vasoactive peptides like substance P, calcitonin gene-related peptide (CGRP) from trigeminal neural endings, nitric oxide, and serotonin; excess activation of N-methyl-
It can be divided into treatment of acute attacks and treatment of chronic migraine. As per the US consortium (2000), recommended guidelines [13] for treatment of acute migraine include pharmacological and non-pharmacological modalities as shown in Table 1.
|
Treatment of acute migraine attacks.
Triptans are selective agonists of 5-HT1B and 5-HT1D receptors. The mechanism of action includes intracranial vessel vasoconstriction (5-HT1B), peripheral neuronal inhibition (5-HT1D), and presynaptic dorsal horn stimulation (5-HT1D), producing second-order brain stem neuronal inhibition. Triptans influence the function of 5-hydroxytryptamine 1F (5-HT1F) receptors and enhance descending inhibitory pain pathways. Triptans reduce—to a considerable extent—pain severity in 2 h as per randomized controlled trials. Oral formulations are usually preferred over other formulations, but 6 mg subcutaneous injection of sumatriptan appears to be the most efficacious. As per current evidence, all oral formulations have equal efficacy except for frovatriptan which is less efficacious but has longer duration action. Parenteral preparations are more useful than oral ones, but the choice of medications depends on the clinician as well as the patient. Triptans are the first-line drugs used in acute treatment of moderate-to-severe migraine with the best pain relief occurring if it is taken within 30 min of attack, and a second dose is usually recommended after 2–4 h of initial dose. It is best used in combination with antiemetics and NSAIDs. Adverse effects include serotonin syndrome when used in combination with selective serotonin reuptake inhibitors (SSRIs), and it should be used with caution in patients having ischemic heart disease [14, 15, 16, 17, 18, 19, 20, 21, 22]. Characteristics of triptans are summarized in Table 2.
Drugs | Half life | Maximum daily dose |
---|---|---|
Group 1: fast-acting triptans | ||
Sumatriptan | 3 h | 200 mg oral 40 mg intranasal 12 mg subcutaneous |
Rizatriptan | 2–3 h | 30 mg (15 mg if on propranolol) |
Almotriptan | 3–4 h | 25 mg |
Zolmitriptan | 3 h | Two tablets or 10 mg maximum oral daily dose. Two sprays or 10 mg intranasal |
Eletriptan | 4 h | 80 mg |
Group 2: slow-acting triptans | ||
Frovatriptan | 26 h | 7.5 mg |
Naratriptan | 6 h | 5 mg |
Triptan characteristics.
Ergots act on multiple receptors including the 5-HT ones, and these account for a robust side effect profile. It is used in acute management of migraine. Side effect includes nausea as well as severe vasoconstriction. It is contraindicated in patients with vascular disease, hepatic problems, renal dysfunction, and hypertension. It is avoided in pregnancy. Dihydroergotamine (DHE) is the only preparation available and is used both parentally and intranasally. Repeated administration of DHE is very effective in refractory cases as well as status migrainosus. It is relatively safe and effective but it requires hospital administration [23, 24, 25].
Good quality evidence supports the use of NSAIDs alone or in combination with specific agents. These drugs in combination with antiemetics are comparable to lower doses of oral triptans. Recently, powdered preparation of diclofenac sodium is approved for treatment of acute attack. Ketorolac, administrated IV, can be used for emergency management of migraine. NSAIDs need to be used with caution in patients with renal toxicity [26, 27, 28, 29]. Characteristics of different drugs in this group are summarized in Table 3.
Drugs | Formulation | Dose used (the dose wording should be mg’) |
---|---|---|
Aspirin | Tablet/oral solution | 650–1000 mg |
Ketorolac | Tablet | 10 mg |
Ketoprofen | Capsule | 50–75 mg |
Ketoprofen-extended release | Capsule | 200 mg |
Diclofenac potassium | Tablet/powder | 50 mg |
Meclofenamate | Capsule | 50 mg, 100 mg |
Ibuprofen | Capsule, tablet, oral suspension | 400–1, 0 g |
Etodolac | Tablet/capsule | 200–500 mg |
Naproxen | Tablet | 120–550 mg |
Naproxen-controlled release | Tablet | 750–850 mg maximum |
NSAID characteristics.
Dopamine D2 receptor antagonists can be used alone or in combination to treat headache as well as nausea. It is mostly used in emergency settings and is available in oral, parenteral, and suppository forms, but concerns over extrapyramidal side effects, tardive dyskinesia, and lack of familiarity in their effect on migraine attacks restrict their use to a great extent [30, 31, 32, 33]. Characteristics of antiemetics are summarized in Table 4.
Drug | Formulation | Dose of migraine |
---|---|---|
Prochlorperazine | Tablet, suppository | 5–10 mg 25 mg |
Metoclopramide | Tablet | 10 mg |
Chlorpromazine | Tablet | 10–25 mg |
Promethazine | Tablet | 25–50 mg |
Ondansetron | Tablet, oral disintegrating tablet | 4 mg 8 mg |
Antiemetic characteristics.
Steroids are suggested for acute treatment as well as for status migrainosus [34]. They act by reducing the neurogenic inflammation and vasogenic edema and also play an important role in central serotonergic pathways [35]. One study showed that addition of dexamethasone 4 mg per oral to triptans plus NSAID reduces recurrence and is well tolerated in patients with frequent attacks [36, 37].
Opioids are the most prescribed drug for acute and rescue therapy in migraine in America. Recent studies have discouraged the use of opioids mainly because it decreases gray matter, increases CGRP release, releases pro-inflammatory peptides, and also causes glutamate receptor activation. It also results in degranulation of mast cells and causes vasodilation. There are many side effects, such as overuse headache and disease progression [38, 39].
Based on migraine pathology theories, trigeminal ganglion activation causes the activation of nociceptive neurons which leads to subsequent release of CGRP. Increased CGRP levels cause plasma protein extrusion, vasodilation, and mast cell degranulation, ultimately leading to neurogenic inflammation. Drugs which antagonize CGRP include olcegepant, telcagepant, and latest approved monoclonal antibodies, namely, erenumab, fremanezumab, and galcanezumab [40]. They prevent binding of endogenous CGRP on its receptors and suppress the stimulation of CGRP on trigeminal ganglion neurons. They inhibit cortical spreading depression [40]. They lack vasoconstrictive effect. Olcegepant is as effective as oral triptans with less cardiovascular side effects such as blood pressure increase and tachycardia. But one major limitation is intravenous dosing. Telcagepant was initially claimed to be as potent as rizatriptan, causing pain relief in 2 h and also sustained pain relief at 24 h and relief of migraine-associated symptoms with overall good tolerability profile, but later the phase II trial was terminated, claiming the drug showed increase in liver transaminases [40]. Eptinezumab is a new drug in this class under trial and is not yet approved by the Food and Drug Administration (FDA).
It is a 5-HT1F receptor agonist. In experimental model, it blocks neurogenic inflammation, decreases c-fos expression, and lacks vasoconstriction. The main postulated mechanisms include inhibition of protein leakage, blockage of secondary trigeminal neuronal activation, and inhibition of neuropeptide release like glutamate. In a double-blind placebo-controlled parallel group study in 512 patients, the oral form and dose of 50, 100, 200, and 400 mg in moderate-to-severe migraine attacks proved that it is as effective as sumatriptan without causing vasoconstriction, but the significant drawback is its major side effects in the central nervous system. Studies also show a great improvement in headache response in 2 h but also show high 24-h headache recurrence rate [41].
Tezampanel acts as a competitive antagonist of the α-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid (AMPA) and kainate receptor (subtype GluR5) of the ionotropic glutamate receptor family. A randomized triple-blind parallel group double-dummy, multicenter trial showed 1.2 mg tezampanel had 69% headache response rate when compared to 6 mg s.c. sumatriptan which had a response rate of 86%. It is effective and well tolerated in migraine. It can be used only via intravenous route. Dasolampanel is an orally bioavailable analog of tezampanel. Both drugs were never marketed [42]. Other newer agents are summarized in Table 5.
Newer targets and drugs | Current status |
---|---|
1. Adenosine receptor agonists [43] |
|
2. NXN-188 [44] |
|
3. LY2951742 [45] |
|
4. Orexin receptor antagonism [46] (filorexant) | Orexin: trigeminal nociceptive and CSD RCT: failed efficacy |
5. TRPV1 antagonism (SB-705498) [47] |
|
6. Melatonin [48] |
|
7. P2Y purinergic receptors [49] |
|
Newer targets and drugs.
It is indicated when a patient meets the following criteria [50]:
Four or more migraine days per month.
Recurring migraines significantly interfere with daily activity.
Contraindication/failure/overuse—acute therapies.
Overwhelming costs of acute therapies.
Uncommon migraine conditions—hemiplegic and basilar migraine.
Various beta blockers used are summarized in Table 6. The mechanisms by which they act include inhibition of central beta receptors and antagonism of 5-HT1A and 5-HT1B receptors, thereby reducing neuronal excitability. It inhibits nitric oxide (NO) production by blocking inducible nitric oxide synthase and inhibits excitatory activity of glutamate, thereby reducing neuronal activity. They also inhibit kainate-induced currents (synergistic with NMDA blockers) and reduce neuronal activity and also have additional membrane-stabilizing action [51, 52].
Drugs | Daily doses |
---|---|
Propranolol | 40–400 mg |
Nadolol | 20–160 mg |
Metoprolol | 100–200 mg |
Atenolol | 50–200 mg |
Timolol | 20–60 mg |
Beta blockers and dosage.
In an open-label trial of 76 patients, a dose of 3.125–6.25 mg twice a week was used, and it was found that 60% of patients had 50% reduction in monthly migraine attack frequency and severity, but in 26% of patients, there was lack of efficacy with the drug [53].
It inhibits calcium entry and prevents intoxication of cells exposed to cerebral hypoxia due to cortical spreading depression [54]. Various drugs used are summarized in Table 7. Other possible mechanisms include inhibition of 5-HT release, inhibition of neurovascular inflammation, and cortical spreading depression.
Drugs | Comment |
---|---|
1. Flunarizine |
|
2. Verapamil |
|
Calcium channel blockers and dosage.
It is a combination of valproic acid and sodium valproate. It is used at a dose of 500–1500 mg/day. Mechanisms include prolongation of sodium channel inactivation, suppression of calcium-mediated T current, and inhibition of gamma-aminobutyric acid (GABA) transaminase. Adverse effect includes nausea, vomiting, gastrointestinal distress, alopecia, and craniofacial abnormalities in fetus [56].
Topiramate is a recently approved drug for migraine prophylaxis. Starting dose of 15–25 mg at bedtime and increase 15–25 mg/week [57]. Mechanisms include blocking of the voltage-gated sodium channel and inhibition of activation of AMPA-kainate receptor of glutamate, and it also enhances postsynaptic GABAA receptor current. Adverse effects include somnolence, fatigue, weight loss, nervousness, and precipitation of renal calculi.
It inhibits GABA transporter (GAT-1) and thereby reduces GABA uptake into the neurons and glia. It is still not approved by the FDA. In an open-label trial of 41 patients who failed with treatment of valproates with 4 mg QID, 33/41 patients showed 50% reduction in migraine attacks, and 5 patients showed complete remission in migraine [58].
It modifies synaptic release of glutamate/GABA by binding to specific synaptic protein (SV2A). Anecdotal evidence says prevention of migraine. A 10-week open-label study, evaluating efficacy and safety of LCT for pediatric migraine in a population of 30 children or adolescents aged 6–19 years, showed a reduction in headache frequency and severity [59].
It blocks voltage-dependent sodium and T-type calcium channels and decreases glutamate-mediated excitatory neurotransmission. Also, it inhibits excessive NO production and helps in scavenging NO and hydroxyl radicals. In an open-label trial, 33 patients with migraine headache, refractory to other preventive therapies, were given a dose of 100–600 mg every third day. Results showed that 65% of patients had a reduction in frequency of migraine attacks [60].
Possible mechanisms include reuptake inhibition of serotonin and noradrenaline, α-adrenergic and NMDA-receptor antagonism, sodium and calcium channel blocking action, and potassium channel activation. Increase in GABAB receptor action and opioid receptor binding/opioid-mediated effect is another minor action. It reduces inflammation by decreasing prostaglandin (PGE2) and tumor necrosis factor (TNF-α). Various drugs are summarized in Table 8. Venlafaxine is used at a dose of 75–225 mg: a double-blind placebo controlled trial showed that the drug was better than placebo, starting with 37.5 mg extended release tablet/week followed by 75 mg for another week and then 150 mg extended release in the morning [61].
Drugs | Daily doses |
---|---|
Amitriptyline | 10–400 mg |
Doxepin | 10–300 mg |
Nortriptyline | 10–150 mg |
Protriptyline | 5–60 mg |
Antidepressant dosage.
The renin-angiotensin system plays a role in neurogenic inflammation and causes increased susceptibility to oxidative stress. It also causes endothelial dysfunction and neuromodulator in nociception. Lisinopril alters sympathetic activity and inhibits free radical activation. It also increases prostacyclin synthesis and blocks the degradation of bradykinin, substance P, and encephalin. In a double-blind placebo-controlled crossover study, patients aged 19–59 years with migraine were treated with 20 mg Lisinopril for 11 weeks—21% of patients showed 50% reduction in migraine attacks [62]. In a comparative study of candesartan vs propranolol for migraine prophylaxis in 72 patients, 43% of patients showed greater than 50% reduction in migraine, and it was equally efficacious to propranolol [63].
It is the FDA-approved drug for prophylaxis of chronic migraine at doses ranged from 155 to 195 IU, and it is injected in seven craniofacial and neck muscles, usually the temporalis. It inhibits neurogenic inflammation by inhibiting the release of nociceptive mediators like glutamate, substance P, and CGRP from the peripheral terminals of the efferent nerves. The analgesic action of onabotulinum toxin is central but yet to be proved. It will effect 3 h after injection and last for at least 7 days. Novel delivery routes such as topical/subcutaneous applications are under research [64].
It is used to limit the excessive inflammatory response through H3 receptor activation. Drugs include Nα-methylhistamine and investigational drug SCH 50971. Phase III double-blind placebo-controlled trial for 12 weeks in 60 patients with a dose of 1–3 mg twice a week caused a reduction in headache frequency, intensity, and duration in 80% of patients. It helps in reducing the dose of analgesics used [65].
Preclinical studies showed inhibition of cortical spreading depression by the drug. It inhibits neurogenic inflammation and also the gap junctional intercellular communication (GJIC) between the neurons and satellite glial cells. Various randomized double-blind parallel group placebo-controlled multicenter studies for acute migraine were tried. There are conflicting reports of headache relief at 2/4 h and reasons are not found. In one study with 40 mg on 39 patients, it was found to be effective for migraine with aura when compared to that without it, reinforcing its inhibitory effect on CSD [66].
Multiple studies show migraine is associated with low levels of magnesium. It causes an influx of calcium into the neurons, causing glutamate release into the neurons, which results in neuronal activation. The onset and propagation of cortical spreading depression is delayed and decreases. It also causes change in neurotransmitter secretion and intensifies the secretion of substance P. It is used in patients with aura and premenstrual migraine and is used at a dose of 1, 0 g IV and 300–600 mg orally in chelated magnesium (taurate, glycinate, oxide) [67]. Magnesium plus
It promotes electron transfer from complex I and II to cytochrome C and helps in ATP production. It protects the mitochondria from free radical damage. A study of 1478 migraine patients of age range 3–22 years showed low levels of CoQ in 33% of patients. A randomized controlled trial of 42 patients receiving 100 mg TID for 3 months found it superior to placebo, and 48% of subjects have greater than 50% reduction in migraine attacks [68].
It is a cofactor in the Krebs cycle. Abnormal phosphorylation of ADP to ATP is prevented with riboflavin. A randomized controlled trial with 400 mg riboflavin taken daily for 3 months was superior to placebo for reduction of migraine frequency [69]. A randomized controlled trial with 400 mg of riboflavin plus feverfew and low-dose magnesium was comparable to a 25 mg active riboflavin. Greater than 40% of patients showed 50% reduction in migraine attacks [70].
It helps in the conversion of homocysteine to methionine. Studies show vitamin B12 deficiency causes increase levels of urine methylmalonic acid levels in patients and worsens migraine. A possible mechanism of vitamin B12 action in migraine includes its excitatory role in the CNS by acting on NMDA receptors. It also plays a significant role in initiation, duration, and progression of migraine and activation of trigeminovascular system [71].
It is sold as capsules of dried leaves of the weed plant Tanacetum parthenium. Animal models show feverfew acts by inhibition of nitroglycerine-induced fos expression and inhibition of nuclear factor-kappa β. An open-label trial with T. parthenium (300 mg) plus Salix alba (white willow) for 12 weeks showed a decrease in pain intensity and duration of migraine. A randomized double-blind placebo-controlled trial (riboflavin 400 mg + magnesium 300 mg + feverfew 100 mg) for 3 months showed positive results. Recently two randomized clinical trials (RCT) of a purified stable extract of feverfew, MIG99, were ineffective in migraine, and clinical effects were very low with various complications [72].
Petasites hybridus is a potential poisonous plant but the detoxified root extract is safe. Mechanisms include inhibition of the synthesis of leukotrienes. It also decreases the intracellular concentration of calcium. It is used in the prophylaxis of migraine in children. A small study of 100 mg/day and a larger one of 150 mg/day vs placebo have shown efficacy [73].
With many newer agents now under clinical trials as well as in use, physicians should be aware of these drugs and their side effects, so they can use these agents for treating recurrent and chronic cases of migraine. Also, further well-designed clinical trials are needed to prove the efficacy of these agents in treatment of migraine. So, further research is needed to find out the safest and most effective treatment for chronic migraine, further designing proper animal models for studying migraine, to identify newer drug targets and how to prevent the migraine at the patient level from acute attack going in for chronic attack.
Nil.
NSAIDS | nonsteroidal anti-inflammatory drugs |
GJIC | gap junctional intercellular communication |
CGRP | calcitonin gene-related peptide |
NO | nitric oxide |
NMDA | N-methyl-d-aspartate receptor |
DHE | dihydroergotamine |
ATP | adenosine triphosphate |
ADP | adenosine diphosphate |
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