OCCASIONAL REVIEW
Key messages from
reviews of serious child
protection cases
2017e2021
Isabel Cowling
Joanna Garstang
Abstract
The importance of safeguarding vulnerable children from harm re-
mains a key priority. Organisational changes to the structure of child
protection services in England were introduced in 2018, altering the re-
view process for serious safeguarding cases. This article provides an
overview of the new multi-agency arrangements and summarizes key
learning points from the final analysis of Serious Case Reviews be-
tween 2017 and 2019 and the annual review of Local Child Safeguard-
ing Practice Reviews from 2021. Recurring themes highlighted in the
reviews include the problem of neglect, contextual safeguarding,
and race and racism. We will also consider three aspects of profes-
sional practice which influence safeguarding work: the complexities
of ‘effective challenge’; interprofessional communication; and manag-
ing professional disagreement.
Keywords Abuse; neglect; professional challenge; safeguarding
Introduction
Child Safeguarding Practice Reviews (CSPRs) are systematic re-
views of serious child safeguarding cases, which occur at both a
local and national level. Serious cases are defined as those in
which a child or young person has died or suffered significant
harm due to abuse or neglect. The purpose of CSPRs is to
improve safeguarding practice by identifying learning points to
avoid similar incidents occurring in the future. The reviews are
not investigations of what happened or looking to find culpa-
bility, but may occur in parallel with other processes, such as
police investigations or a Joint Agency Response following child
death. The CSPR process started in 2018, replacing Serious Case
Reviews (SCRs), which commenced in 1988. There has been an
analysis of all SCRs every two or three years since 1998, and an
Isabel Cowling MBChB MRCPCH ST4 Paediatric Trainee, Park House
Children’s Centre, Birmingham, UK. Conflicts of interest: none
declared.
Joanna Garstang MBChB MSc PhD Consultant Community
Paediatrician, Allen’s Croft Children’s Centre, Birmingham, UK.
Conflicts of interest: Dr Garstang has been funded by the Department
for Education to undertake 2011e14, 2014e17 and 2017e19
analysis and overview of Serious Case Reviews, and funded by the
Child Safeguarding Practice Review Panel to undertake the 2020 and
2021 analysis of Local Child Safeguarding Practice Reviews. The
views represented in this article of those of the authors alone.
PAEDIATRICS AND CHILD HEALTH 33:12
annual analysis of CSPRs since 2020, looking for key learning
and themes across cases.
This article summarizes the changes to child safeguarding
practices in England that were introduced in 2018. We will also
discuss key learning points identified in the final analysis of SCRs
between 2017 and 2019 and the annual review of Local Child
Safeguarding Practice Reviews from 2021.
Child safeguarding practice review process
Reforms to the child protection system in England were intro-
duced in 2018 in response to the Wood review of Local Safe-
guarding Children Boards (LSCBs). The Wood review was
heavily critical of LCSBs, describing the existing processes as
costly, ineffective and failing to achieve the necessary levels of
inter-agency working (Wood, 2016). In line with recommenda-
tions from the Wood review, LSCBs were replaced by Local
Safeguarding Children Partnerships (LSCPs) and a new system of
local and national reviews was established. An overview of the
process is outlined in Figure 1. The restructure aims to improve
joint working, oversight and delivery of child safeguarding; and
improve the rate and quality of reviews and to disseminate
learning more effectively.
Local reviews
Local Child Safeguarding Practice Reviews are undertaken by
Local Safeguarding Children Partnerships in England. These
partnerships consist of three statutory partners; the local au-
thority, the Integrated Care Board, and the police, who have
equal responsibility for safeguarding children in their area.
Partnerships will also consist of other relevant agencies and or-
ganisations, including schools and other providers of education
and training, charities and youth offending teams.
When a serious safeguarding case is identified, the local au-
thority will notify the local safeguarding partnership, who will
undertake a rapid review of the case. Rapid reviews aim to gather
the facts of the case, consider the potential for learning and decide
whether further evaluation is required, and should be completed
within 15 working days of the incident. Not all serious cases will
result in a further review, but those where the potential for further
learning has been identified. If appropriate, local partnerships will
then commission and oversee a more detailed review of this case,
known as a Local Child Safeguarding Practice Review (LCSPR).
This should be completed and published within six months from
the date of the decision to initiate a review. Delays to publication
may occur in cases affected by criminal proceedings or prosecu-
tions, but partnerships should act on any learning identified in the
meanwhile. LCSPRs are published on the safeguarding partnership
website and also available from the National Society for the Pre-
vention of Cruelty to Children (NSPCC) repository, whereas rapid
reviews are not published. The Department for Education are also
notified of all serious safeguarding cases.
National reviews
National reviews are commissioned by the Child Safeguarding
Practice Review Panel (the Panel). The Panel receive copies all
rapid reviews and LCSPRs and decide whether it is appropriate to
commission a national review of a single case or a group of cases
406 Ó 2023 Elsevier Ltd. All rights reserved.
 OCCASIONAL REVIEW

The process for Child Safeguarding Practice Reviews

Local authority notifies the local safeguarding partnership of a serious

safeguarding case

Rapid review conducted within 15 working days to identify learning points and
to determine if a Local Child Safeguarding Practice Review (LCSPR) is required

If appropriate, a LCSPR is comissioned by the local safeguarding partnership to

identify further learning and improvements to practice

LCSPR report published on the safeguarding partnership website and the

NSPCC repository within six months

All rapid reviews and LCSPRs reviewed by the Child Safeguarding Practice
Review Panel to determine if a national review is required

Summarized from Child Safeguarding Practice Review Panel guidance for safeguarding
partners (HM Government, 2022)

Figure 1

around a similar theme, such as criminal exploitation or neglect. was published in 2022. This included 84 cases submitted to the
The Panel are also responsible for maintaining oversight of the Panel in 2021. Here we will focus on key themes highlighted in
system of national and local reviews to ensure these processes both reviews; the problem of neglect, contextual safeguarding
are operating effectively. and race and racism.

Learning from child safeguarding practice reviews The impact of neglect

Reviews are about promoting and sharing information to improve
the way in which organisations and agencies work together to
safeguard and promote the welfare of children. A learning sum-
mary and action plan is published following each rapid review to
identity improvements which should be implemented locally.
Reports from local and national reports are also published with
recommendations and action plans and learning is disseminated to
relevant professionals through dedicated learning events. Local
safeguarding partnerships submit an annual report to the national
Panel, who in turn publish an annual report to provide an over-
view of learning from the previous 12 months.
The Royal College of Paediatrics and Child Health (RCPCH)
define neglect as ‘the persistent failure to meet a child’s basic
physical and/or psychological needs, which likely results in the
serious impairment of the child’s health or development’. Whilst
neglect is rarely a direct cause of death, it is often highlighted in
serious safeguarding cases and featured in nearly three quarters
of the SCRs examined in the 2017e19 analysis. Another feature
in the periodic reviews is the concept of ‘normalisation of
neglect’, where professionals become accustomed to working in
areas with high levels of deprivation, which may in turn lead to
desensitisation to the warning signs of neglect.

Learning from the final analysis of serious case reviews
(2017e2019) and the annual review of Local Child
Safeguarding Practice Reviews (2021)
The Department for Education has commissioned periodic ana-
lyses of SCRs since 2001. These provide key reflections and
learning points for professionals working in paediatrics. The
ninth and final review was published in December 2022, which
provided an overview and analysis of 235 cases occurring be-
tween April 2017 and September 2019. Following changes to the
safeguarding architecture, the second annual review of LCSPRs
Neglect in the context of poverty
The relationship between poverty and neglect is complex, and it
can be challenging to distinguish between the two. There is
evidence illustrating that poverty and inequality increase the
risk of harm to children, yet identifying neglect as distinct
from poverty remains a huge challenge for professionals,
particularly in areas with high levels of deprivation. In such
circumstances, professionals may be unable to distinguish
neglect from poor living conditions, or feel at risk of further
stigmatising families living in socioeconomic hardship. In many
serious safeguarding reviews, the authors noted that neglect

PAEDIATRICS AND CHILD HEALTH 33:12 407 Ó 2023 Elsevier Ltd. All rights reserved.
 OCCASIONAL REVIEW

was often misidentified or downplayed and that systems for

reporting and recording neglect were not consistently used. In
addition, there was no clear understanding of the impact of the
home conditions on child’s daily life. Indicators of neglect
published by the NSPCC are summarized in Box 1. An example
of failing to identify neglect in the context of poverty is
described in Box 2.
An example of failing to identify neglect in the context of
poverty
‘The potential signs of abuse/neglect observed by the professionals
who visited the family at home were largely left unchallenged, the
view was that the parents were doing as well as expected in the
circumstances that they were living in and if some permanent ac-
commodation could be found this would help, especially in giving the
younger children more space to play in.’

National Society for the Prevention of Cruelty to Children Taken from Learning for the future: final analysis of serious case reviews,
2017 to 2019.5
(NSPCC) indicators of neglect

Indicators of neglect defined by the NSPCC include: Box 2

C living in an unsuitable home environment, for example in a house
that isn’t heated throughout winter Identifying and addressing neglect
C being left alone for a long time Equipping front-line staff to identify and address neglect in the
C be smelly or dirty context of deprivation is a key. Professionals must remain sen-
C wear clothing that hasn’t been washed and/or is inadequate (for sitive to the impact of economic hardship on parents’ ability to
example, not having a winter coat) care for their children, whilst recognising the significant impact
C seeming particularly hungry, seem not to have eaten breakfast or of neglect on a child’s long-term health and well-being. Use of an
have no packed lunch/lunch money assessment tool, such as the Graded Care Profile 2 (GCP2; Smith
et al., 2019), can assist practitioners in undertaking a compre-
Children who are suffering from neglect may also suffer from poor hensive and evidence-based assessment of families when neglect
health, including: is known or suspected. The GCP2 tool is primarily for the use of
C untreated injuries health visitors and social workers, but could occasionally be used
C medical and dental issues by paediatricians. Regular review of the family enables a greater
C repeated accidental injuries due to lack of supervision understanding of the daily impact of neglect on the child, helping
C untreated and/or recurring illnesses or infections to assess when thresholds for intervention have been reached.
C long term or recurring skin sores, rashes, flea bites, scabies or Practitioners should be mindful of the risks of superficial man-
ringworm agement approaches, for example focusing on practical tasks,
C anaemia such as the provision of food bank vouchers and new furniture,
Younger babies and young children may also present with:
and instead consider the underlying reasons for why families are
in difficulty. In addition, there must be consistent information
C frequent and untreated nappy rash
sharing between professionals, particularly when a child moves
C failure to thrive (not reaching developmental milestones or not
within and between local authorities.
growing at an appropriate rate for their age)

Older children, who are experiencing neglect may display unusual Key message
behaviour, or their behaviour may change. You may notice or become ‘Not all poor children are neglected and not all neglected children
aware that a child: are poor, but it is widely accepted that poverty is a ‘contributory
C has poor language, communication or social skills causal factor’ for abuse and neglect.’ (Bywaters et al., 2016, p. 33).
C withdraws suddenly or seems depressed
C appears anxious Contextual safeguarding
C becomes clingy Contextual safeguarding is an approach to understanding and
C is aggressive responding to young people’s experiences of significant harm from
C displays obsessive behaviour outside of the family, by considering the different contexts in
C shows signs of self-harm which children live and interact, such as peer group, school,
C is particularly tired neighbourhood and online through social media.1 Forms of extra-
C finds it hard to concentrate or participate in activities familial harm include child criminal exploitation (CCE), county
C has changes in eating habits lines, child sexual exploitation (CSE) and involvement in gangs. In
C misses school these circumstances, conventional child protection approaches
C starts using drugs or alcohol that focus on intra-familial harm may not be helpful or appro-
C is not brought to medical appointments such as vaccinations or priate, and timely intervention in the community is necessary.
check-ups
Identifying vulnerability
Taken from Learning for the future: final analysis of serious case reviews,
2017 to 2019.5
It is important that professionals recognise and understand the
underlying factors in a young person’s background that may in-
crease their vulnerability to extra-familial harm, including do-
Box 1 mestic abuse, parental criminality, drug use, neglect and exposure

PAEDIATRICS AND CHILD HEALTH 33:12 408 Ó 2023 Elsevier Ltd. All rights reserved.
 OCCASIONAL REVIEW
to violence. These adverse childhood experiences may push ad-
olescents towards harmful peer contexts outside of the family
home. A joint child safeguarding practice review commissioned
by the Bristol, South Gloucestershire and North Somerset Safe-
guarding Children Partnerships analysed a series of rapid reviews
of eight young people impacted by peer-on-peer abuse and knife
crime, seven of whom were the victims of stabbings. The review
highlighted that most of the young people came to the attention of
services relatively late, despite several known risk factors asso-
ciated with extra-familial harm, such as going missing, carrying
weapons, drug use, disruptive behaviour and school exclusion.
This demonstrates the importance of recognising the signs and
behaviours indicative of adverse childhood experiences at an
early stage, in order to deliver early help and increase protective
factors. Vulnerability and risk factors for extra-familial harm are
summarized in Box 3. Risk assessment tools, such as the Cafcass
Child Exploitation Screening Tool, are also useful for assessing a
child’s level of risk of CSE and Child Sexual Abuse (CSA).
Vulnerability and risk factors for extra-familial harm
Background vulnerability:
C domestic violence
C physical abuse
C family involvement in drugs, criminality or serious violence
C imprisonment of family members
C ADHD, special educational needs and speech and language
difficulties
C cognitive difficulties
C multiple placements in foster care
Current or chronic risks:
C being out of school
C substance use
C home conditions and overcrowding
C conflict at home
C low mood, anxiety and self-harm
C care status
Conditional dynamic risks:
C exclusion from school
C possession of drugs, weapons, money, burner phones
C involvement with offending peer groups
C repeated incidents of going missing
C previous victimisation
C association with known county lines offenders
C multiple contacts with police
Adapted from Cross-Border Peer-on-Peer Abuse and Child Criminal Exploi-
tation: A Thematic Child Safeguarding Practice Review.6
Box 3
Race and racism
The Children Act 1989 states that a child’s race, religion, culture
and language must be taken into consideration during assessments
and interventions, and this also applies to safeguarding practice.
Working effectively with minoritised children and families requires
an understanding of their racial and cultural needs and the impact
of racism, which may present as invisibilisation or adultification.
PAEDIATRICS AND CHILD HEALTH 33:12
Invisibilisation
Nearly a third of the safeguarding cases submitted to the Panel in
2021 featured children or young people who were of Black and
other ethnic minority backgrounds. However, in the majority of
reviews the family’s ethnicity was not stated. This is an example
of ‘invisibilisation’, whereby identity characteristics of racialised
and minoritised groups are not acknowledged by those in au-
thority.2 In some cases, concealing the family’s race or ethnicity
was cited as an attempt to protect the child’s identity and ensure
anonymity. However, by overlooking the racial, ethnic and cul-
tural characteristics of the children, practitioners fail to
acknowledge these may be relevant factors which shaped the
experiences and views of the family and how professionals and
services responded to them. Racial, ethnic, and cultural identities
should be given proper weight when exploring the lives of chil-
dren and families in practice.
Adultification
Adolescents may come to the attention of the police for offending
behaviours, yet police officers may not always take into account
the safeguarding needs of the child and instead focus on the
criminal justice response to offending. This issue, of treating
children as though they were older than they are, is termed
‘adultification’.3 In a number of serious safeguarding reviews,
young people were viewed as ‘streetwise’ ‘resilient’ or ‘mature’
and their true vulnerability was concealed, leading to notions of
responsibility and culpability. The issue of adultification
disproportionately affects children and young people from Black
and ethnic minority backgrounds and this group of children are
therefore at increased risk of their safeguarding needs being
unmet. The Local Child Safeguarding Practice Review of ‘Child
Q’ published by City and Hackney Safeguarding Children Part-
nership in March 2022 is one of the first reviews in England to
explicitly refer to adultification as a factor influencing the safe-
guarding of a Black child (Box 4).
The case of Child Q
In 2020, Child Q, a Black female child of secondary school age, was
strip searched by female police officers from the Metropolitan Police
Service. The search, which involved the exposure of Child Q’s inti-
mate body parts, took place on school premises, without an
Appropriate Adult present and with the knowledge that Child Q was
menstruating. Teachers told the review that on the day of the search
they believed Child Q was smelling strongly of cannabis and sus-
pected that she might be carrying drugs. On questioning Child Q, she
denied using or having any drugs in her possession. A search of her
bag, blazer, scarf, and shoes revealed nothing of significance. No
drugs were found during the strip search. Authors of the Local Child
Safeguarding Practice Review note that Child Q “received a largely
criminal justice and disciplinary response from the adults around her,
rather than a child protection response’ suggestive of how ‘adultifi-
cation bias might have been evident in practice”.
Taken from Local Child Safeguarding Practice Review.7
Box 4
409 Ó 2023 Elsevier Ltd. All rights reserved.
 OCCASIONAL REVIEW
Key message
Adultification is ‘a form of bias where children from Black,
Asian and minoritised ethnic communities are perceived as
being more ‘streetwise’, more ‘grown up’, less innocent and
less vulnerable than other children. This particularly affects
Black children, who might be viewed primarily as a threat rather
than as a child who needs support.’ (Gamble and McCallum,
2020, p. 34).
Challenges in safeguarding practice
Practitioners working with children and families operate in
increasing complex circumstances and face numerous challenges
affecting their ability to adequately safeguard children within
their care. Three key challenges for professionals were high-
lighted in the 2017e19 analysis of SCRs: the complexities of
‘effective challenge’; interprofessional communication; and
managing professional disagreement.
Effective challenge
The balance between supporting families and protecting children
is at the heart of effective child protection practice, yet in reality
this can be difficult to achieve. A lack of effective challenge in-
cludes occasions where professionals fail to question parents’
account of events or there is reluctance to investigate child
welfare concerns. Building a respectful, supportive relationship
with parents and understanding their experiences should be
balanced alongside a sufficiently investigative attitude. A degree
of respectful uncertainty or healthy scepticism should be applied
using an objective, sensitive, and child-focused approach,
ensuring that parental perspectives and accounts of events are
considered alongside other sources of information. The impor-
tance of professional challenge was highlighted by Lord Laming
in the Victoria Climbie Inquiry (Box 5). An example of ineffective
parental challenge leading to significant harm is described in
Box 6.
The importance of professional challenge
‘While I accept that social workers are not detectives, I do not
consider that they should simply serve as the passive recipients of
information, unquestioningly accepting all that they are told by the
carers of children about whom there are concerns. The concept of
‘respectful uncertainty’ should lie at the heart of the relationship
between safeguarding professionals and the family. It does not
require social workers to constantly interrogate their clients, but it
does involve the critical evaluation of information that they are
given.’
Taken from The Victoria Climbie Inquiry: report of an inquiry (Laming, 2003).
Box 5
PAEDIATRICS AND CHILD HEALTH 33:12
The case of Mary
Mary, a 13-year-old girl, died on the 19th February 2018 following a
severe asthma attack. In the years leading up to her death, repeated
concerns had been raised about the poor management of her asthma
and the conditions of the family home which may have exacerbated
her condition. Throughout her life, Mary had not been taken to
numerous medical appointments relating to her asthma. Pro-
fessionals working with her mother adopted a supportive orienta-
tion, encouraging attendance rather than questioning absence. The
author of the Serious Case Review notes that “professionals in the
main, made too many allowances for her mother and were insuffi-
ciently challenging.”
Taken from Serious Case Review.8
Box 6
Hostile relationships
A significant barrier to effective challenge is working with hostile
or threatening families. Professionals may be reluctant to chal-
lenge parents who evoke fear or anxiety, as they are ‘overcome
by the emotional intensity of the work and complex interactions
with angry, resistant parents and family friends’.4 Working with
families where there are high levels of conflict and violence can
also result in professional paralysis, a breakdown in working
relationships, and failure to adequately safeguard children.
Practitioners should be aware that working with hostile families
may reduce their level of professional curiosity and should seek
appropriate support and supervision. Additionally, organisations
must establish robust policies to protect the physical and psy-
chological safety of staff, to ensure professionals have the con-
fidence to exercise effective challenge in their working
environments.
Professional optimism
A further barrier to effective challenge is the risk of professional
optimism, where practitioners think the best of parents and are
over-optimistic about the potential for change. Professionals may
focus on small improvements made by parents, which detracts
attention from other significant risks and the ongoing experience
of the child. This optimism may also manifest as ‘start again
syndrome’, where the past is disregarded and the slate is ‘wiped
clean’ each time new professionals begin working with the
family. This can result in interventions being repeated again and
again without acknowledging the ongoing risk to the child.
Professionals must not downplay past concerns based on recent
improvements in parenting and should apply critical reflection as
to whether outcomes are improving for the child.
Interprofessional communication
Good communication between agencies is an integral part of
supporting families and safeguarding children. Errors, omissions
or misunderstandings in relation to information-sharing are often
410 Ó 2023 Elsevier Ltd. All rights reserved.
 OCCASIONAL REVIEW
cited as key contributing factors in serious safeguarding cases. In
practice, there are several systemic issues and complexities that
can impact information-sharing between professionals. A central
theme explored in the 2017e19 analysis of SCRs is the impor-
tance of distinguishing between information exchange and
effective communication. In many cases, a wealth of information
was shared between agencies, yet this information was either not
understood or its significance, in terms of risk to the child, was
not appreciated by other agencies.
Practitioners should be mindful of how information they
provide may be interpreted by other professionals and employ
measures to reduce the risk of miscommunication. This includes
explaining medical information for non-healthcare professionals,
avoiding the use of jargon and providing a clear description of
what the information means for the child. Effective communi-
cation between agencies is particularly important when families
move areas, in order to facilitate continuity of care and prevent
families slipping through the net.
Professional disagreement
Effective multi-agency working is a fundamental principle of
safeguarding practice, and this includes respectful challenge
between professionals to ensure decision-making is robust. The
2017e19 triennial analysis of SCRs highlighted that disagree-
ments frequently arise in relation to levels of risk and thresholds
for intervention, particularly for professionals referring children
to social care. Professional hierarchies often act as a barrier to
constructive interprofessional challenge, as practitioners may
feel reluctant to disagree with senior colleagues. Several re-
views emphasised the need for professionals to utilise formal
escalation policies between and within agencies, to allow
constructive dialogue when differences of opinion arise. Prac-
titioners should be empowered to use their professional au-
thority to challenge the decisions and perspectives of other
colleagues to ensure safeguarding protocols are rigorous and
effective.
Conclusion
Organisational changes to child protection practices in England
has resulted in a new system of local and national reviews, which
aim to streamline the learning process for serious safeguarding
cases. Identifying and responding to neglect remains a key chal-
lenge for professionals, especially in the context of co-existing
PAEDIATRICS AND CHILD HEALTH 33:12
poverty. Recognising vulnerability and risk factors for extra-
familial harm forms an important part of contextual safeguard-
ing practice and is particularly important for professionals
working with adolescents. Understanding how racial injustice
may present in safeguarding practice is essential for professionals
working with children and families from ethnic minority back-
grounds. Effective safeguarding practice involves professional
curiosity, good communication and managing professional dis-
agreements to ensure the child’s welfare is prioritised. A
REFERENCES
1 Firmin C. Contextual risk, individualised responses: an assessment
of safeguarding responses to nine cases of peer-on-peer abuse.
Child Abuse Rev 2018; 27: 42e57.
2 Hope EC, Brinkman M, Hoggard LS, et al. Black adolescents’
anticipatory stress responses to multilevel racism: the role of racial
identity. Am J Orthopsychiatry 2021; 91: 487e98.
3 Davis J, Marsh N. Boys to men: the cost of ‘adultification’ in
safeguarding responses to Black boys. Crit Radic Soc Work 2020;
8: 255e9.
4 Ferguson H. How children become invisible in child protection
work: findings from research into day-to-day social work practice.
Br J Soc Work 2017; 47: 1007e23.
5 Dickens J, Taylor J, Cook L, et al. Learning for the future: final
analysis of serious case reviews, 2017e2019. UK Government:
Department for Education, 2020.
6 Harris J. Cross-border peer-on-peer abuse and child criminal
exploitation: a thematic child safeguarding practice review. For
Keeping Bristol Safe Partnership, South Gloucestershire Children’s
Partnership and North Somerset Safeguarding Children Partner-
ship, 2021.
7 Gamble J, McCallum R. Local child safeguarding practice review:
child Q. City of London and Hackney Safeguarding Children Part-
nership, 2022.
8 Held J. Serious case review of young person mary. Suffolk Safe-
guarding Partnership, 2020.
FURTHER READING
Dickens J, Taylor J, Cook L, et al. Annual review of local child safe-
guarding practice reviews. UK Government: Department for Edu-
cation, 2022.
https://www.researchinpractice.org.uk/all/news-views/2022/
december/key-safeguarding-issues-challenges-and-implications-
learning-from-serious-case-reviews/.
411 Ó 2023 Elsevier Ltd. All rights reserved.