Barriers to recovery and recommendations for change: the Pennsylvania Consensus Conference on psychiatry\u27s role.

OBJECTIVE: Recovery has emerged over the past decade as a dominant theme in public mental health care. METHODS: The 2006 Pennsylvania Consensus Conference brought together 24 community psychiatrists to explore the barriers they experienced in promoting recovery and their recommendations for change. RESULTS: Twelve barriers were identified and classified into one of three categories: psychiatry knowledge, roles, and training; the need to transform public mental health systems and services; and environmental barriers to opportunity. Participants made 22 recommendations to address these barriers through changes in policies, programs, and psychiatric knowledge and practice. CONCLUSIONS: The recommendations identify areas for change that can be accomplished through individual psychiatrist action and organized group efforts

Using Statistical and Judgmental Reviews to Identify and Interpret Translation Differential Item Functioning

The purpose of this study was to evaluate the equivalence of two translated tests using statistical and judgmental methods. Performance differences for a large random sample of English- and French-speaking examinees were compared on a grade 6 mathematics and social studies provincial achievement test. Items displaying differential item functioning (DIF) were flagged using three popular statistical methods—ManteTHaenszel, Simultaneous Item Bias Test, and logistic regression—and the substantive meaning of these items was studied by comparing the back-translated form with the original English version. The items flagged by the three statistical procedures were relatively consistent, but not identical across the two tests. The correlation between the DIF effect size measures were also strong, but far from perfect, suggesting that two procedures should be used to screen items for translation DIF. To identify the DIF items with translation differences, the French items were back-translated into English and compared with the original English items by three reviewers. Two of seven and six of 26 DIF items in mathematics and social studies respectively were judged to be nonequivalent across language forms due to differences introduced in the translation process. There were no apparent translation differences for the remaining items, revealing the necessity for further research on the sources of translation differential item functioning. Results from this study provide researchers and practitioners with a better understanding of how three popular DIF statistical methods compare and contrast. The results also demonstrate how statistical methods inform substantive reviews intended to identify items with translation differences.Le but de cette étude était d'évaluer l'équivalence de deux examens traduits avec des méthodes basées sur les statistiques et d'autres reposant sur le jugement. On a comparé les différences dans la performance d'un grand échantillon aléatoire de sujets anglophones et francophones qui avaient complété des examen provinciaux de sixième année en mathématiques et en études sociales. Les items démontrant une divergence par rapport aux autres (differential item functioning - DIF) ont été marqués d'un indicateur dans le contexte de trois méthodes statistiques bien connues - Mantel-Haenszel, Simultaneous Item Bias Test et la régression logistique. La signification de fond de ces items a été étudiée en comparant la version traduite de l'examen avec l'original en anglais. Les items marqués par les trois procédures statistiques étaient relativement constants mais pas identiques d'une version à l'autre. Alors que la corrélation entre les mesures de l'effet DIF étaient aussi forte, elle était loin d'être parfaite, ce qui suggère que l'on devrait avoir recours à deux procédures dans le dépistage du DIF en traduction. Pour identifier les items DIF présentant des différences en traduction, trois réviseurs ont comparé les items français retraduits en anglais avec les originaux en anglais. Ceux-ci ont jugé que deux sur sept items en mathématiques et six sur vingt-six items en études sociales n'étaient pas équivalents d'une langue à l'autre à cause des différences introduites par le processus de traduction. Les autres items ne présentaient pas de différences apparentes de traduction, ce qui révèle le besoin de poursuivre la recherche sur les sources du DIF en traduction. Les résultats de cette étude aideront les chercheurs et les praticiens à mieux comprendre les similarités et les différences entres trois méthodes statistiques DIF souvent employées. De plus, ils démontrent comment les méthodes statistiques contribuent aux études de signification dont le but est l'identification des items présentant des différences de traduction

Measuring the Impact of Cause-Related Marketing: A Meta-Analysis of Nonprofit and For-profit Alliance Campaigns

Cause-related marketing (CRM) campaigns are a type of joint venture between a business concern and a nonprofit organization. To determine effect sizes for these campaigns, a series of bivariate meta-analyses were conducted using a random effects assumption. Results included the effect of CRM advertising on brand attitudes, r = .248, 95% CI(0.189,0.373), and purchase intentions, r = .277, 95% CI(0.141, 0.404), and the effect of cause-brand fit on brand attitudes, r = .239, 95% CI(0.167,0.309), and purchase intentions, r = .319, 95% CI(0.206, .423). Unfortunately for nonprofit organizations, none of the seven meta-analyses conducted found any effect for the study characteristic, type of cause (generic or branded company). Thus, the contribution of a specific nonprofit organization’s brand did not have a significant impact on consumer attitudes or behavioral intentions to purchase CRM products

River-Wide Habitat Availability for Fish Habitat Guilds: Implications for In-Stream Flow Protection

The variation in river discharge alters habitat heterogeneity with implications for the distribution of fish species with different habitat requirements. Assessments of habitat availability following changes in river discharge are difficult to apply at broad spatial scales and with relevance to multiple species. We used a MesoHABSIM modeling approach to quantify river-wide changes in habitat availability for five fish habitat guilds under three river discharge levels along the Niobrara River, NE, USA.We used a time-series of river discharge (1958–2010) to create uniform continuous under-threshold habitat duration curves that identified habitat conditions that may result in periods of stress for fish communities along the Niobrara River. Habitat availability for each fish habitat guild was dependent on river discharge and location along the river. Habitat availability for fish habitat guilds ranged from 5% to 49% of the total channel area suggesting habitat availability may, at times, be limited. We provide river discharge guidelines for bioperiods that limit the frequency and duration of stressful habitat conditions. Understanding interactions between river discharge and habitat availability through time and at river-wide scales may aid in managing for ecological integrity by including protection of river discharge variability to support multiple fish habitat guilds

New fields on super Riemann surfaces

A new $(1,1)$-dimensional super vector bundle which exists on any super Riemann surface is described. Cross-sections of this bundle provide a new class of fields on a super Riemann surface which closely resemble holomorphic functions on a super Riemann surface, but which (in contrast to the case with holomorphic functions) form spaces which have a well defined dimension which does not change as odd moduli become non-zero.Comment: 12pp, kcl-th-94-

The theoretical and practical determination of clinical cut-offs for the British Sign Language versions of PHQ-9 and GAD-7.

BACKGROUND: The PHQ-9 and the GAD-7 assess depression and anxiety respectively. There are standardised, reliability-tested versions in BSL (British Sign Language) that are used with Deaf users of the IAPT service. The aim of this study is to determine their appropriate clinical cut-offs when used with Deaf people who sign and to examine the operating characteristics for PHQ-9 BSL and GAD-7 BSL with a clinical Deaf population. METHODS: Two datasets were compared: (i) dataset (n = 502) from a specialist IAPT service for Deaf people; and (ii) dataset (n = 85) from our existing study of Deaf people who self-reported having no mental health difficulties. Parameter estimates, with the precision of AUC value, sensitivity, specificity, positive predicted value (ppv) and negative predicted value (npv), were carried out to provide the details of the clinical cut-offs. Three statistical choices were included: Maximising (Youden: maximising sensitivity + specificity), Equalising (Sensitivity = Specificity) and Prioritising treatment (False Negative twice as bad as False Positive). Standard measures (as defined by IAPT) were applied to examine caseness, recovery, reliable change and reliable recovery for the first dataset. RESULTS: The clinical cut-offs for PHQ-9 BSL and GAD-7 BSL are 8 and 6 respectively. This compares with the original English version cut-offs in the hearing population of 10 and 8 respectively. The three different statistical choices for calculating clinical cut-offs all showed a lower clinical cut-off for the Deaf population with respect to the PHQ-9 BSL and GAD-7 BSL with the exception of the Maximising criteria when used with the PHQ-9 BSL. Applying the new clinical cut-offs, the percentage of Deaf BSL IAPT service users showing reliable recovery is 54.0 % compared to 63.7 % using the cut-off scores used for English speaking hearing people. These compare favourably with national IAPT data for the general population. CONCLUSIONS: The correct clinical cut-offs for the PHQ-9 BSL and GAD-7 BSL enable meaningful measures of clinical effectiveness and facilitate appropriate access to treatment when required

Fetal liver blood flow distribution: role in human developmental strategy to prioritize fat deposition versus brain development

Among primates, human neonates have the largest brains but also the highest proportion of body fat. If placental nutrient supply is limited, the fetus faces a dilemma: should resources be allocated to brain growth, or to fat deposition for use as a potential postnatal energy reserve? We hypothesised that resolving this dilemma operates at the level of umbilical blood distribution entering the fetal liver. In 381 uncomplicated pregnancies in third trimester, we measured blood flow perfusing the fetal liver, or bypassing it via the ductus venosus to supply the brain and heart using ultrasound techniques. Across the range of fetal growth and independent of the mother's adiposity and parity, greater liver blood flow was associated with greater offspring fat mass measured by dual-energy X-ray absorptiometry, both in the infant at birth (r = 0.43, P<0.001) and at age 4 years (r = 0.16, P = 0.02). In contrast, smaller placentas less able to meet fetal demand for essential nutrients were associated with a brain-sparing flow pattern (r = 0.17, p = 0.02). This flow pattern was also associated with a higher degree of shunting through ductus venosus (P = 0.04). We propose that humans evolved a developmental strategy to prioritize nutrient allocation for prenatal fat deposition when the supply of conditionally essential nutrients requiring hepatic inter-conversion is limited, switching resource allocation to favour the brain if the supply of essential nutrients is limited. Facilitated placental transfer mechanisms for glucose and other nutrients evolved in environments less affluent than those now prevalent in developed populations, and we propose that in circumstances of maternal adiposity and nutrient excess these mechanisms now also lead to prenatal fat deposition. Prenatal developmental influences play important roles in the human propensity to deposit fa

Ancestral alleles and population origins: Inferences depend on mutation rate

Previous studies have found that at most human loci, ancestral alleles are African, in the sense that they reach their highest frequency there. Conventional wisdom holds that this reflects a recent African origin of modern humans. This paper challenges that view by showing that the empirical pattern (of elevated allele frequencies within Africa) is not as pervasive as has been thought. We confirm this African bias in a set of mainly protein-coding loci, but find a smaller bias in Alu insertion polymorphisms, and an even smaller bias in noncoding loci. Thus, the strong bias that was originally observed must reflect some factor that varies among data sets - something other than population history. This factor may be the per-locus mutation rate: the African bias is most pronounced in loci where this rate is high. The distribution of ancestral alleles among populations has been studied using 2 methods. One of these involves comparing the fractions of loci that reach maximal frequency in each population. The other compares the average frequencies of ancestral alleles. The first of these methods reflects history in a manner that depends on the mutation rate. When that rate is high, ancestral alleles at most loci reach their highest frequency in the ancestral population. When that rate is low, the reverse is true. The other method - comparing averages - is unresponsive. Average ancestral allele frequencies are affected neither by mutation rate nor by the history of population size and migration. In the absence of selection and ascertainment bias, they should be the same everywhere. This is true of one data set, but not of 2 others. This also suggests the action of some factor, such as selection or ascertainment bias, that varies among data sets. © The Author 2007. Published by Oxford University Press on behalf of the Society for Molecular Biology and Evolution. All rights reserved