Improving interim decisions in randomized trials by exploiting information on short‐term endpoints and prognostic baseline covariates

Conditional power calculations are frequently used to guide the decision whether or not to stop a trial for futility or to modify planned sample size. These ignore the information in short‐term endpoints and baseline covariates, and thereby do not make fully efficient use of the information in the data. We therefore propose an interim decision procedure based on the conditional power approach which exploits the information contained in baseline covariates and short‐term endpoints. We will realize this by considering the estimation of the treatment effect at the interim analysis as a missing data problem. This problem is addressed by employing specific prediction models for the long‐term endpoint which enable the incorporation of baseline covariates and multiple short‐term endpoints. We show that the proposed procedure leads to an efficiency gain and a reduced sample size, without compromising the Type I error rate of the procedure, even when the adopted prediction models are misspecified. In particular, implementing our proposal in the conditional power approach enables earlier decisions relative to standard approaches, whilst controlling the probability of an incorrect decision. This time gain results in a lower expected number of recruited patients in case of stopping for futility, such that fewer patients receive the futile regimen. We explain how these methods can be used in adaptive designs with unblinded sample size re‐assessment based on the inverse normal P‐value combination method to control Type I error. We support the proposal by Monte Carlo simulations based on data from a real clinical trial.     

‘If I were given the chance’: understanding the use of leisure time by adults with learning disabilities

Despite UK government policy emphasising the rights and choices of people with learning disabilities, opportunities to choose fulfilling leisure activities remain severely constrained. Following a brief literature review we present a co-inquiry study developing a deeper understanding of the persistent space between actual and desired use of leisure time. We explore the potential of the capability approach to aid understanding of learning disabled people’s constrained choices of leisure activities, and constrained roles as researchers, as matters of human rights and social justice.     

Clinician Perspectives on the Circle of Security‐Parenting (COS‐P) Program: A Qualitative Study

This study examined the perspectives of clinicians who facilitate Circle of Security‐Parenting (COS‐P) groups in community health settings. The therapists were from two services: a specialist perinatal and infant mental health consultation service and a child at risk health service. In particular, we were interested in their perceptions of the strengths, weaknesses, challenges, and possible improvements to the model as applied to their clinical settings. Two focus group interviews, involving eight clinicians and clinical supervisors from a diverse range of professional backgrounds, were conducted by an independent interviewer. A discussion guide consisted of a series of open‐ended questions related to the participants’ experiences of delivering COS‐P. Therapists found COS‐P to be effective, feasible to deliver, user‐friendly, flexible, and generalisable to diverse client subgroups. The compassionate and non‐judgmental therapeutic stance was considered a strength of the model. Clinicians highlighted their adoption of the model across their professional and personal lives and the critical importance of supervision. In conclusion, COS‐P is a popular and promising intervention which targets the parent–child relationship that can be successfully delivered to mothers affected by moderate to severe mental health problems.     

Gendered and classed experiences of work–family conflict among lone mothers in Sweden

ABSTRACT

Research on the relationship between lone motherhood and social class is indeed limited. Drawing on 39 in-depth interviews, the overall aim of this article is to increase knowledge of the ways that working conditions and access to economic resources impact on Swedish lone mothers’ opportunities to integrate paid work and family. One assumption is that lone mothers are guided by culturally shaped ideas about the proper way to be a mother, and that variance between mothers’ notions of good mothering and the means for their realization, i.e. sociological ambivalence, may give rise to conflicts and dilemmas. Results show that low incomes, non-standard hours and temporary employment reduced working-class mothers’ prospects of practising the kind of mothering they considered proper, creating dilemmas and high levels of conflict. Mothers could not always effectively use the rights granted to parents by the Swedish welfare state. The variances between notions about good mothering and the means for realizing them were not as big for middle-class mothers, thanks to greater access to economic capital and flexible working hours. Different opportunity structures hence significantly influenced lone mothers’ opportunity to combine paid work and caring commitments in ways they found appropriate.     

Immigrant students and their teachers – exploring various constellations of acculturation orientations and their impact on school adjustment

ABSTRACT

The present study examined what impact various constellations of acculturation orientations of immigrant students and their teachers have on the students’ school adjustment. For this purpose, the study analysed the acculturation orientations of 1106 5th graders and their class teachers in Switzerland. Using multiple regression analysis, we found that immigrant students were more satisfied at school if their teachers had similar attitudes about cultural assimilation and cultural diversity and could, thus, be said to have congruent acculturation orientations. With respect to students’ academic self-concept, immigrant students with a minority orientation whose teachers value cultural diversity including the heritage culture of their students showed a lower academic self-concept despite matching acculturation orientations. We interpret this result as a dilemma of teachers between the endeavour to develop culturally sensitive attitudes and behaviours and the risk to create stereotype threat and its negative effects through addressing cultural differences. Furthermore, a mismatch between the students’ (bi-)national identification at school and the teacher’s perception of the student as an immigrant or a native-born student could be shown to have adverse effects on the academic self-concept in the group of students with older teachers (50+ years).     

Mental health service navigation: a scoping review of programmatic features and research evidence

ABSTRACT

Service navigation is a care coordination approach that is designed to resolve barriers and facilitate access to needed services. Originating within primary and specialty health care sectors, navigation models have recently emerged to support engagement with mental health services. Presently little is known about the nature, extent, and research evidence for mental health service navigation programs. To address this gap in knowledge, this study undertook a scoping review to identify, describe, and appraise current models of mental health service navigation. Data sources included PsychINFO, Medline, CINAHL, and Google Scholar. Inclusion eligibility required studies to describe a study design, recruitment strategy, navigation approach, sample characteristics, and study outcomes. Searches were constrained to English language and published after January 1, 2000. Twenty-five studies met the inclusion criteria. Navigation programs targeted diverse populations and were delivered in-person, by telephone, and online. Navigators included peers, paraprofessionals, clinicians, teams, and web applications. Eleven studies reported results from randomized trials, remaining programs employed program evaluation, qualitative, or CBPR methodologies. Common features of navigation programs included engagement, assessment, service identification, referral, and monitoring/follow-up. Current evidence for mental health service navigation is promising, although additional rigorous randomized controlled trials are needed.     

Automated selection of post‐strata using a model‐assisted regression tree estimator

Despite having desirable properties, model‐assisted estimators are rarely used in anything but their simplest form to produce official statistics. This is due to the fact that the more complicated models are often ill suited to the available auxiliary data. Under a model‐assisted framework, we propose a regression tree estimator for a finite‐population total. Regression tree models are adept at handling the type of auxiliary data usually available in the sampling frame and provide a model that is easy to explain and justify. The estimator can be viewed as a post‐stratification estimator where the post‐strata are automatically selected by the recursive partitioning algorithm of the regression tree. We establish consistency of the regression tree estimator and a variance estimator, along with asymptotic normality of the regression tree estimator. We compare the performance of our estimator to other survey estimators using the United States Bureau of Labor Statistics Occupational Employment Statistics Survey data.