Predictors of treatment outcome in a child and adolescent psychiatry clinic: A naturalistic exploration

We present data on predictors of treatment outcome for 3200 consecutive referrals to a child and adolescent psychiatry clinic. Using Reliable Change Index (RCI) methodology, we divided children into those who, between intake and discharge, improved, stayed the same, or got worse according to clinician-rated impairment. Most predictors of improvement were related to parent variables (marital status, maternal anxiety, and ethnicity), while those associated with deterioration were tied to child status (extent of psychiatric comorbidity, history of placement in a self-contained classroom, and a prior trial of psychotropic medications). The implications of these findings for data-driven program development, clinic management, treatment planning, and systems of care are discussed.     

Delirium: a very common problem you may not recognize

Older adults with multiple pre-existing conditions are admitted to hospitals with acute illnesses and injuries every day. Delirium is not recognized by clinicians across health care settings. With awareness of risk factors and knowledge of delirium, nurses can play a pivotal role in the early identification, treatment, and, most important, prevention of delirium in older adults. Nurses often display a lack of knowledge related to delirium and the complex symptoms that appear differently in the presence of other complicating co-morbid conditions in aging adults. Nurses play a crucial role in keeping patients safe and ensuring optimal outcomes, regardless of the setting. With the growing population of older adults and the expected increases in chronic illness and dementia, delirium is a problem nurses are likely to experience in all practice settings. Knowing what to look for facilitates recognizing the risk and acting early to minimize (or even prevent) delirium.     

Immigration policies that include or exclude: a South African public opinion study of immigration policy preferences

South Africa is a regional hub for migration on the African continent and is home to a growing documented international migrant community. Foreigners in the country, however, often face violations of their established rights and are the victims of abuse. This paper examines public support for policies that would exclude international migrants from the country. Data from the 2013 South African Social Attitudes Survey, a nationally representative opinion poll (N = 2739) of all adults in the country, are used. This poll found that many South Africans favoured restrictive immigration policies and opposed granting foreigners the same rights as citizens. Multivariate analysis is employed to discern determinants of this opposition. Respondents’ perceptions of the population sizes of foreigners in their communities did not affect support for inclusion. It can be inferred, therefore, that the growth of the immigrant population has not provoked exclusionary attitudes in the country. Rather, results revealed, it is national pride (cultural versus political) and fears about the consequences of immigration that drive such attitudes. Programmes and policies designed to improve public perceptions of how foreigner impact society and the promotion of a nationalism characterised by inclusive multicultural civic patriotism may improve public support for the inclusion of international immigrants.     

ANTITRUST ECONOMICS AND CONSUMER PROTECTION ECONOMICS IN POLICY AND LITIGATION: WHY THE DISPARITY?

The lag in the use of microeconomics in consumer protection policy and litigation—as compared with the use of microeconomics in antitrust/competition policy and litigation—has at least three causes: a considerably shorter period of intellectual development; the specific historical origins and culture of the U.S. Federal Trade Commission (FTC), where this disparity is especially noticeable; and the splintering of consumer protection responsibilities across a very large number of federal and state agencies. This paper will expand on these themes and discuss their implications—including the opportunities for expanded research in the area of consumer protection economics. (JEL B12, B13, B21, D18, L41)     

Family Policy and Complex Contemporary Families: A Decade in Review and Implications for the Next Decade of Research and Policy Practice

Prior Journal of Marriage and Family decade-in-review articles have grappled with the definition and role of family policy for research and policy practice while emphasizing its value to both. In this article, we begin with a broad conceptualization of family policy that encompasses actions intended to achieve explicitly stated goals for families (explicit policies) and those that affect families without an explicitly stated goal for doing so (implicit policies), which we believe provides a solid framework for guiding and understanding both research and practice in the field. Second, we review major U.S. policy initiatives in the past decade and their documented and potential effects on families. Third, we describe several key aspects by which contemporary families have become more diverse and complex. Fourth, we discuss the implications of ongoing family complexity for public policies. We conclude with a discussion about future research and policy development in the context of contemporary family complexity.     

EFFECTS OF EXPOSURE ON PREVALENCE AND CUMULATIVE RELATIVE RISK: DIRECT AND INDIRECT EFFECTS IN A RECURSIVE HAZARD MODEL

This paper outlines decomposition methods for assessing how exposure affects prevalence and cumulative relative risk. Let     x     denote a vector of exogenous covariates and suppose that a single dimension of time   t   governs two event processes     T ₁  and   T ₂.    If the occurrence of the event     T ₁    determines entry into the risk of the event     T ₂,    then subgroup variation in     T ₁    will affect the prevalence     T ₂,    even if subgroups in the population are otherwise identical. Although researchers often acknowledge this phenomenon, the literature has not provided procedures to assess the magnitude of an exposure effect of     T ₁    on the prevalence of     T ₂.    We derive decompositions that assess how variation in exposure generated by direct and indirect effects of the covariates     x     affect measures of absolute and relative prevalence of     T ₂.    We employ a parametric but highly flexible specification for baseline hazard for the     T ₁  and   T ₂    processes and use the resulting parametric proportional hazard model to illustrate the direct and indirect effects of family structure when     T ₁    is age at first sexual intercourse and     T ₂    is age at a premarital first birth for data on a cohort of non-hispanic white U.S. women.     

Analyzing the Homeland Security of the U.S.-Mexico Border

We develop a mathematical optimization model at the intersection of homeland security and immigration, that chooses various immigration enforcement decision variables to minimize the probability that a terrorist can successfully enter the United States across the U.S.-Mexico border. Included are a discrete choice model for the probability that a potential alien crosser will attempt to cross the U.S.-Mexico border in terms of the likelihood of success and the U.S. wage for illegal workers, a spatial model that calculates the apprehension probability as a function of the number of crossers, the number of border patrol agents, and the amount of surveillance technology on the border, a queueing model that determines the probability that an apprehended alien will be detained and removed as a function of the number of detention beds, and an equilibrium model for the illegal wage that balances the supply and demand for work and incorporates the impact of worksite enforcement. Our main result is that detention beds are the current system bottleneck (even after the large reduction in detention residence times recently achieved by expedited removal), and increases in border patrol staffing or surveillance technology would not provide any improvements without a large increase in detention capacity. Our model also predicts that surveillance technology is more cost effective than border patrol agents, which in turn are more cost effective than worksite inspectors, but these results are not robust due to the difficulty of predicting human behavior from existing data. Overall, the probability that a terrorist can successfully enter the United States is very high, and it would be extremely costly and difficult to significantly reduce it. We also investigate the alternative objective function of minimizing the flow of illegal aliens across the U.S.-Mexico border, and obtain qualitatively similar results.