HIV rapid testing in substance abuse treatment: implementation following a clinical trial

The Substance Abuse Mental Health Services Administration has promoted HIV testing and counseling as an evidence-based practice. Nevertheless, adoption of HIV testing in substance abuse treatment programs has been slow. This article describes the experience of a substance abuse treatment agency where, following participation in a clinical trial, the agency implemented an HIV testing and counseling program. During the trial, a post-trial pilot, and early implementation the agency identified challenges and developed strategies to overcome barriers to adoption of the intervention. Their experience may be instructive for other treatment providers seeking to implement an HIV testing program. Lessons learned encompassed the observed acceptability of testing and counseling to clients, the importance of a "champion" and staff buy-in, the necessity of multiple levels of community and agency support and collaboration, the ability to streamline staff training, the need for a clear chain of command, the need to develop program specific strategies, and the requirement for sufficient funding. An examination of costs indicated that some staff time may not be adequately reimbursed by funding sources for activities such as adapting the intervention, start-up training, ongoing supervision and quality assurance, and overhead costs.     

Estimation of the Distribution Function of a Standardized Statistic

For estimating the distribution of a standardized statistic, the bootstrap estimate is known to be local asymptotic minimax. Various computational techniques have been developed to improve on the simulation efficiency of uniform resampling, the standard Monte Carlo approach to approximating the bootstrap estimate. Two new approaches are proposed which give accurate yet simple approximations to the bootstrap estimate. The second of the approaches even improves the convergence rate of the simulation error. A simulation study examines the performance of these two approaches in comparison with other modified bootstrap estimates.     

Reliability and reactivity of three new functional assessment measures

This study of the reliability of three new tests of work performance considered the effect of test reactivity on measured performance. The tests are components of an employment screening battery designed for placement of applicants in automotive assembly jobs. Statistical measures of reliability were compared with a simple measure of test reactivity in a sample of 51 healthy adults. The effect of test reactivity on employment selection decisions using various cut scores was studied. Test reactivity is found to be a significant threat to reliability that must be considered when skill-based performance tests are used on a serial basis. When intended for use on a serial basis, such tests should be studied for both reliability and reactivity. In addition to reporting traditional statistical indices of reliability, an index of the reactivity should be reported.     

Reliability of independent observer judgments of level of lift effort in a kinesiophysical Functional Capacity Evaluation

Functional Capacity Evaluation includes manual materials handling as a primary component. Return to work decisions are often made or influenced by both the heaviest amount of weight that can be safely lifted and the weight that can be handled repetitiously. Kinesiophysical observational criteria were developed to allow trained judges to categorize lifting in order to identify the category of lift effort. Bothinter rater and intrarater reliability were high. When light or heavy categories were isolated for accuracy there were no errors in judge's ratings.     

Negotiated time-out: a de-escalation tool for couples

Many state domestic violence intervention standards mandate that treatment for offenders should be separate from any treatment offered to victims. In this article we advocate that in cases of low-level violence, when couples choose to remain together, certain aspects of treatment should be offered conjointly. Specifically, our feedback from victims and offenders suggests that one tool generally taught to offenders-time-out--is often ineffective and can be used abusively when partners are not taught the tool concurrently. We describe the negotiated time-out procedure that we developed and use feedback from our clients to illustrate its usefulness.     

Programme budgeting in the health sector

The growth of the public sector has been accompanied by an increased interest in this sector among economists and non-economists alike. Much of this interest has been directed towards the overall size of the public sector, and the efficient allocation of resources within the public sector has remained comparatively neglected. This paper outlines some of the problems of resource allocation facing decision-makers in the public sector, and reviews the actual and potential uses of one decision-making tool—programme budgeting—in improving resource allocation. The health care sector is chosen to illustrate the technique of programme budgeting, the practical and conceptual problems of implementation, and the limitations as well as the possibilities offered by this approach.     

What is the role of e-technology in mental health services and psychiatric research?

In this article, the role of e-technology is explored, with an emphasis on the advantages and disadvantages of its use for health care and mental health research. E-technology is broadly understood to include the Internet and related information technologies, and in recent years, its use has grown rapidly. The Internet is a major source of health information, and there is potential to deliver enhanced services through this medium. In addition, e-technology's role in future mental health service delivery and research will continue to expand as increased numbers of consumers, caregivers, health professionals, and the general population go online, particularly as the technology is refined and made even more user friendly.     

The Desire to Gamble: The Influence of Outcomes on the Priming Effects of a Gambling Episode

The influence of gambling outcomes on the efficacy of a short gambling episode to prime motivation to continue gambling was determined in two experiments in which desire to gamble was evaluated while participants played a slot machine located in a virtual reality casino. In experiment 1, 38 high-risk [>3 Problem Gambling Severity Index (PGSI)] [Ferris and Wynne (The Canadian problem gambling index: final report, 2001)] and 36 non-problem gamblers (0 PGSI) either won or lost a modest amount. Among high-risk gamblers, winning resulted in a greater increase in the desire to continue gambling than did losing. In experiment 2, 39 high-risk, 33 low-risk (0 < PGSI < 3), and 31 non-problem gamblers experienced either a single large win or a series of small wins (equivalent monetary gain). Participants were permitted to continue playing as long as they wanted (all subsequent spins being losses) thus permitting evaluation of persistence (resistance to extinction). Throughout, desire to gamble was assessed using a single item measure. High-risk gamblers who experienced a large win reported significantly greater desire to gamble upon voluntary cessation than those who experienced a series of small wins. It seems that the priming effects of a short gambling episode are contingent on the pattern of outcomes experienced by the gambler. The data were related to motivational factors associated with gambling, gambling persistence, and chasing losses.     

The shape of the hazard function: Does the generalized gamma have the last word?

This paper compares the five-parameter beta generalized gamma (BGG) distribution to the three-parameter generalized gamma (GG). Both distributions include the four standard hazard shapes that we believe is an important property for any parametric family. For several BGG distributions, we select matching GGs and compute the Kullback-Liebler distance, observing remarkable agreement. We explore the beta parameters' influence on the matched GG parameters, detecting a strong connection between the distributions. Lastly, we compare the distributions using two real-data examples. We conclude from these comparisons that the BGG is not likely to be more useful for analytical purposes than the simpler GG.