Barriers and Facilitators of Responding to Problem Gambling: Perspectives from Australian Mental Health Services

Despite high rates of comorbidity between problem gambling and mental health disorders, few studies have examined barriers or facilitators to the implementation of screening for problem gambling in mental health services. This exploratory qualitative study identified key themes associated with screening in mental health services. Semi-structured interviews were undertaken with 30 clinicians and managers from 11 mental health services in Victoria, Australia. Major themes and subthemes were identified using qualitative content analysis. Six themes emerged including competing priorities, importance of routine screening, access to appropriate screening tools, resources, patient responsiveness and workforce development. Barriers to screening included a focus on immediate risk as well as gambling being often considered as a longer-term concern. Clinicians perceived problem gambling as a relatively rare condition, but did acknowledge the need for brief screening. Facilitators to screening were changes to system processes, such as identification of an appropriate brief screening instrument, mandating its use as part of routine screening, as well as funded workforce development activities in the identification and management of problem gambling.     

Understanding engagement in the Program of Assertive Community Treatment (PACT) from the perspectives of individuals receiving treatment

ABSTRACT

Engagement of individuals with serious mental illnesses in community mental health services is a significant challenge. The Program of Assertive Community Treatment (PACT) is an individual-centered and self-contained mental health program that provides psychiatric treatment, rehabilitation, and support services to persons with serious mental illness who have a history of or likelihood of disengagement with services. Understanding what helps and hinders consumers’ involvement in PACT services may provide information on how to tailor engagement strategies to individuals based on their treatment needs and preferences. The current study builds on existing studies by exploring factors that help and hinder engagement in PACT services from the perspectives of individuals receiving treatment. We conducted open-ended, semi-structured interviews with 17 individuals receiving PACT services. Nine themes were identified through thematic analysis: Desirable qualities of PACT, Focusing on positive outcomes, PACT as a safety net, Recovery orientation, Practical barriers, Conflictual relationships, and Medication side-effects. We conclude that the development of a trusting, therapeutic relationship that is collaborative and person-centered and that is facilitated by both practical and emotional support is critical to engaging individuals in treatment and maximizing positive outcomes.     

Layered adaptive importance sampling

Monte Carlo methods represent the de facto standard for approximating complicated integrals involving multidimensional target distributions. In order to generate random realizations from the target distribution, Monte Carlo techniques use simpler proposal probability densities to draw candidate samples. The performance of any such method is strictly related to the specification of the proposal distribution, such that unfortunate choices easily wreak havoc on the resulting estimators. In this work, we introduce a layered (i.e., hierarchical) procedure to generate samples employed within a Monte Carlo scheme. This approach ensures that an appropriate equivalent proposal density is always obtained automatically (thus eliminating the risk of a catastrophic performance), although at the expense of a moderate increase in the complexity. Furthermore, we provide a general unified importance sampling (IS) framework, where multiple proposal densities are employed and several IS schemes are introduced by applying the so-called deterministic mixture approach. Finally, given these schemes, we also propose a novel class of adaptive importance samplers using a population of proposals, where the adaptation is driven by independent parallel or interacting Markov chain Monte Carlo (MCMC) chains. The resulting algorithms efficiently combine the benefits of both IS and MCMC methods.     

Enabling robust assessment of QTc prolongation in early phase clinical trials

Since the implementation of the International Conference on Harmonization (ICH) E14 guideline in 2005, regulators have required a “thorough QTc” (TQT) study for evaluating the effects of investigational drugs on delayed cardiac repolarization as manifested by a prolonged QTc interval. However, TQT studies have increasingly been viewed unfavorably because of their low cost effectiveness. Several researchers have noted that a robust drug concentration‐QTc (conc‐QTc) modeling assessment in early phase development should, in most cases, obviate the need for a subsequent TQT study. In December 2015, ICH released an “E14 Q&As (R3)” document supporting the use of conc‐QTc modeling for regulatory decisions. In this article, we propose a simple improvement of two popular conc‐QTc assessment methods for typical first‐in‐human crossover‐like single ascending dose clinical pharmacology trials. The improvement is achieved, in part, by leveraging routinely encountered (and expected) intrasubject correlation patterns encountered in such trials. A real example involving a single ascending dose and corresponding TQT trial, along with results from a simulation study, illustrate the strong performance of the proposed method. The improved conc‐QTc assessment will further enable highly reliable go/no‐go decisions in early phase clinical development and deliver results that support subsequent TQT study waivers by regulators.     

<Emphasis Type="BoldItalic">MAD-STEC</Emphasis>: a method for multiple automatic detection of space-time emerging clusters

Crime or disease surveillance commonly rely in space-time clustering methods to identify emerging patterns. The goal is to detect spatial-temporal clusters as soon as possible after its occurrence and to control the rate of false alarms. With this in mind, a spatio-temporal multiple cluster detection method was developed as an extension of a previous proposal based on a spatial version of the Shiryaev–Roberts statistic. Besides the capability of multiple cluster detection, the method have less input parameter than the previous proposal making its use more intuitive to practitioners. To evaluate the new methodology a simulation study is performed in several scenarios and enlighten many advantages of the proposed method. Finally, we present a case study to a crime data-set in Belo Horizonte, Brazil.     

Testing for bioequivalence of highly variable drugs from TR‐RT crossover designs with heterogeneous residual variances

Traditional bioavailability studies assess average bioequivalence (ABE) between the test (T) and reference (R) products under the crossover design with TR and RT sequences. With highly variable (HV) drugs whose intrasubject coefficient of variation in pharmacokinetic measures is 30% or greater, assertion of ABE becomes difficult due to the large sample sizes needed to achieve adequate power. In 2011, the FDA adopted a more relaxed, yet complex, ABE criterion and supplied a procedure to assess this criterion exclusively under TRR‐RTR‐RRT and TRTR‐RTRT designs. However, designs with more than 2 periods are not always feasible. This present work investigates how to evaluate HV drugs under TR‐RT designs. A mixed model with heterogeneous residual variances is used to fit data from TR‐RT designs. Under the assumption of zero subject‐by‐formulation interaction, this basic model is comparable to the FDA‐recommended model for TRR‐RTR‐RRT and TRTR‐RTRT designs, suggesting the conceptual plausibility of our approach. To overcome the distributional dependency among summary statistics of model parameters, we develop statistical tests via the generalized pivotal quantity (GPQ). A real‐world data example is given to illustrate the utility of the resulting procedures. Our simulation study identifies a GPQ‐based testing procedure that evaluates HV drugs under practical TR‐RT designs with desirable type I error rate and reasonable power. In comparison to the FDA's approach, this GPQ‐based procedure gives similar performance when the product's intersubject standard deviation is low (≤0.4) and is most useful when practical considerations restrict the crossover design to 2 periods.     

Alone and adrift: The association between mass school shootings,school size,and student support

Background

School shootings have approached epidemic levels in recent years. While mental illness is undoubtedly involved in nearly all cases of mass school violence, we sought to determine how environmental context may exacerbate preexisting personal factors. The present study investigated the associations between mass school shootings, school enrollment size, student–teacher ratios, and student transitions.

Analysis of Blogs,Forums, and Social Networks

It is impossible to imagine the contemporary Internet without social media. Government agents, commercial, state, and social organizations, the opposition, and other citizens use social media as a giant turbine. Unfortunately, this turbine can also be used to spread disinformation as well as hostile propaganda on a mass scale. In this article we show how vulnerable social media are to infiltration by botnets with the goal of launching information attacks.     

The Peasant World in the Discourse of Generational Sorrow

This article spells out the methodological considerations and various procedural and methodological subtleties developed over the author's quarter century of sociological field studies of Russia's peasant worlds. Particular attention is paid to “voices from below”—peasant discursive formats that capture, in natural and undiluted form, the evolution of peasant practices constituting the core of everyday life. In particular, the phenomenon of generational sorrow and a special chronological nostalgia that functions as a “social gyroscope” is identified and discursively captured. This phenomenon is noteworthy and useful for its ability to retain a record of the productively longed for past in a rural community's collective memory and thereby influence new peasant worlds taking shape today.     

Family engagement within the context of assessment in child protection practice: The case of Estonia

Engagement in the context of child protection is of significant international interest, as the participation of family is a central notion in child and family social work. Drawing on in‐depth, semistructured interviews with a sample of 26 child protection workers in 1 region in Estonia, this article reports the findings of the participants' perspectives on family engagement in the context of child protection assessment. Child protection workers perceive the engagement related to 3 aspects: first, it is associated to the acts of the worker; second, it is associated to parental part of actions—depending on parents themselves; and third, engagement was seen as “doing together” with the family, referring to partnership. The aim of the engagement was mainly considered in the terms of empowerment—empowering family to cope on their own and to take charge of their lives. The negative image of child protection was recognised as one of the main barriers to the family engagement. Understanding the family and their situation was seen as the basis for a trusting relationship, being the most crucial factor to promoting family engagement.