THE COURSE OF AXIS I AND AXIS II DISORDERS IN CLINICAL HIGH RISK (CHR) ADOLESCENTS

The detrimental impact of psychosis on individuals and society has sparked interest in early detection and intervention strategies to improve outcomes for those who are high-risk for developing psychosis. This study used data collected by the Recognition and Prevention (RAP) program to explore the progression of Axis I and Axis II disorders, clinical and functional characteristics, and predictors of conversion in a Clinical High Risk (CHR) sample. Using the RAP Program’s classification system, participants were assigned to the following subgroups based on symptom presentation: Clinical High Risk Positive (CHR+) which is defined by the presence of attenuated positive symptoms and Clinical High Risk Negative (CHR-) which requires the presence of attenuated negative symptoms. Participants consisted of 156 subjects (110 males and 46 females) who participated in the RAP Program during Phase I (2000-2006) and were separated into the high-risk groups: CHR+ and CHR-. These results indicated that Axis I disorders (mood, anxiety, substance use, and attention-deficit and disruptive behavior disorders) presented similarly at baseline in the CHR subgroups, however there were significant differences in the prevalence rates of paranoid personality disorder, borderline personality disorder, and schizoid personality disorder. In exploring the relationships between psychiatric disorders, attenuated symptoms, and functioning, it was found that lower levels of role functioning were associated with mood disorders for CHR- participants. Additionally, social functioning and attenuated negative symptoms were found to have an impact on Cluster A personality presentation in both CHR subgroups. This study also explored the progression of psychiatric disorders, and results demonstrated that mood, anxiety, attention-deficit and disruptive behavior disorders, and personality disorders were persistent and recurrent from baseline to follow-up in both subgroups. Additionally, in examining predictors of conversion, positive symptoms were found to be the strongest predictor of conversion to psychosis and mood disorders were found to be a significant predictor of non-conversion. The results from this study convey that CHR adolescents present with a constellation of diagnoses and symptoms. The findings suggest that it may be beneficial to continue to screen individuals diagnostically to develop specific intervention strategies based on how participants are assigned to high-risk groups

Uplifting The Black Race - only males need apply : Black male militancy in Malcom X, Panther, Boyz n' the hood, and Get on the bus

This thesis examines Malcolm X, Panther, Boyz N' The Hood and Get On The Bus, and reveals that a deliberate attempt is made on the part of these narratives to construct a specific black identity in relation to black activism. These films position black males in a space which allows them to directly affect issues regarding black identity, political activism, the black community, and the nation. Furthermore, Malcolm X, Panther, Boyz and Get On The Bus specifically address young black males, and favor a discourse that is from a particular male standpoint. As a result, the films articulate black manhood through militancy and its subsequent sexual appeal. Since the focus of these films is intentionally on the male characters, the black woman's role in the liberation struggle is portrayed as being of little consequence. This is not to say that the narratives do not make an effort to confront and challenge narrow visions of black masculinity. In essence, black women are included, even if it is through their mere "visibility." However, each film promotes a discourse which reiterates that the black liberation struggle and uplift of the race as a whole is dependant on black men. (Abstract shortened by UMI.

A call for responsible innovation in mobile mental health:findings from a content analysis and ethical review of the depression app marketplace

Mobile mental health presents many ethical challenges in the wild. These ethical issues and associated values were explored through a content analysis and ethical review of the depression app marketplace. App search and data collection was performed in Google Play Store (UK) and Apple iTunes (UK) between October to November 2018. Iterative data extraction and coding of ethical variables and values were conducted prior to synthetization of issues and themes. Search found 353 unique apps for depression. Analysis uncovered a range of ethical issues including: limited evidence of intervention validity, fidelity, and outcomes; insufficient safeguarding and duty of care; non-multisector development teams; lack of independent certification and regulation; lack of information and transparency for informed user choices; and concerns with privacy, confidentiality, and user permissions. These findings highlighted the presence and absence of ethical values in apps for depression, with most apps failing to reflect many key values. Our findings suggest a need for greater ethical value sensitive design in mobile mental health. This is challenging given the field’s multidisciplinarity and value conflicts. We encourage designers to adopt a responsible innovation approach to creating technologies that meet these ethical demands

A call for responsible innovation in mobile mental health : content analysis of the depression app marketplace

Mobile mental health presents many ethical challenges in the wild. These ethical issues and associated values were explored through a content analysis and ethical review of the depression app marketplace. App search and data collection was performed in Google Play Store (UK) and Apple iTunes (UK) between October to November 2018. Iterative data extraction and coding of ethical variables and values were conducted prior to synthetization of issues and themes. Search found 353 unique apps for depression. Analysis uncovered a range of ethical issues including: limited evidence of intervention validity, fidelity, and outcomes; insufficient safeguarding and duty of care; non-multisector development teams; lack of independent certification and regulation; lack of information and transparency for informed user choices; and concerns with privacy, confidentiality, and user permissions. These findings highlighted the presence and absence of ethical values in apps for depression, with most apps failing to reflect many key values. Our findings suggest a need for greater ethical value sensitive design in mobile mental health. This is challenging given the field’s multidisciplinarity and value conflicts. We encourage designers to adopt a responsible innovation approach to creating technologies that meet these ethical demands

A content analysis and ethical review of mobile applications for depression:Exploring the app marketplace

BACKGROUND Research investigating commercial mobile applications for depression have shown a range of concerns from limited research evidence, poor treatment fidelity, and issues with privacy and data security. This study advances this work through a content analysis and ethical review of app store listings of apps for depression. Whilst past content analyses and app reviews have highlighted some ethical and safety concerns, there has been no focussed ethical review to consider how these issues may present to potential users who seek to find help and support through the app stores. METHODS We conducted search of the Google Play Store and Apple iOS App Store in October and November 2018. Apps were included in the review if their description mentioned use for depression. Apps were reviewed for treatment information and ethical issues. RESULTS We identified 353 eligible depression apps. Treatment approach varied across apps, with 24 different treatment approaches being described by developers. Treatment strategies also varied, with 34 different strategies being listed. The review showed the use of several non-evidence-based approaches and strategies. Also evident was the continued lack of research evidence for most apps (314/353) and a general lack of transparency in the information provided to potential users. These ethical issues were further explored within the framework of psychological ethical principles, with the review highlighting issues in areas of beneficence/nonmaleficence, fidelity and responsibility, integrity, justice, and respect of person’s rights and dignity. DISCUSSION Despite advances in mobile mental health, commercial mental health apps continue to trail in evidence and practice. There is need for greater research into the efficacy and outcomes of treatment strategies and combinations of approaches. There is also great need for increased transparency of information to help users to make informed and safe choices. Many of the ethical issues discussed can be addressed by presenting potential users with clear and accurate information

Evaluation of treatment descriptions and alignment with clinical guidance of apps for depression on app stores : systematic search and content analysis

Background: The use of apps for the treatment of depression shows great promise. However, there is uncertainty regarding the alignment of publicly available apps for depression with clinical guidance, their treatment fidelity and evidence base, and their overall safety.Objective: Built on previous analyses and reviews, this study aims to explore the treatment and safety issues of publicly available apps for depression.Methods: We conducted a content analysis of apps for depression in the 2 main UK app stores (Google Play and Apple App Store). App store listings were analyzed for intervention content, treatment fidelity, and fit with the National Institute for Health and Care Excellence (NICE) guidelines for the treatment of depression in adults.Results: A total of 353 apps for depression were included in the review. App descriptions reported the use of 20 treatment approaches and 37 treatment strategies. Many apps used transdiagnostic (155/353, 43.9%) and multitheoretical interventions to treat multiple disorders including depression. Although many interventions appeared to be evidence-informed, there were issues with treatment fidelity, research evidence, and fit with clinical guidelines. None of the apps fully aligned with the NICE guidelines for depression.Conclusions: App developers have adopted many evidence-informed treatments in their interventions; however, more work is needed to improve clinical validity, treatment fidelity, and the safety of apps. We urge developers to consult relevant guidelines and standards, and to engage in reflective questioning on treatment and safety to address these issues and to improve treatment content and intervention design

Impact of COVID-19 on cardiovascular testing in the United States versus the rest of the world

Objectives: This study sought to quantify and compare the decline in volumes of cardiovascular procedures between the United States and non-US institutions during the early phase of the coronavirus disease-2019 (COVID-19) pandemic. Background: The COVID-19 pandemic has disrupted the care of many non-COVID-19 illnesses. Reductions in diagnostic cardiovascular testing around the world have led to concerns over the implications of reduced testing for cardiovascular disease (CVD) morbidity and mortality. Methods: Data were submitted to the INCAPS-COVID (International Atomic Energy Agency Non-Invasive Cardiology Protocols Study of COVID-19), a multinational registry comprising 909 institutions in 108 countries (including 155 facilities in 40 U.S. states), assessing the impact of the COVID-19 pandemic on volumes of diagnostic cardiovascular procedures. Data were obtained for April 2020 and compared with volumes of baseline procedures from March 2019. We compared laboratory characteristics, practices, and procedure volumes between U.S. and non-U.S. facilities and between U.S. geographic regions and identified factors associated with volume reduction in the United States. Results: Reductions in the volumes of procedures in the United States were similar to those in non-U.S. facilities (68% vs. 63%, respectively; p = 0.237), although U.S. facilities reported greater reductions in invasive coronary angiography (69% vs. 53%, respectively; p < 0.001). Significantly more U.S. facilities reported increased use of telehealth and patient screening measures than non-U.S. facilities, such as temperature checks, symptom screenings, and COVID-19 testing. Reductions in volumes of procedures differed between U.S. regions, with larger declines observed in the Northeast (76%) and Midwest (74%) than in the South (62%) and West (44%). Prevalence of COVID-19, staff redeployments, outpatient centers, and urban centers were associated with greater reductions in volume in U.S. facilities in a multivariable analysis. Conclusions: We observed marked reductions in U.S. cardiovascular testing in the early phase of the pandemic and significant variability between U.S. regions. The association between reductions of volumes and COVID-19 prevalence in the United States highlighted the need for proactive efforts to maintain access to cardiovascular testing in areas most affected by outbreaks of COVID-19 infection