The Interactive Child Distress Screener: development and preliminary feasibility testing

Background Early identification of child emotional and behavioral concerns is essential for the prevention of mental health problems; however, few suitable child-reported screening measures are available. Digital tools offer an exciting opportunity for obtaining clinical information from the child’s perspective. Objective The aim of this study was to describe the initial development and pilot testing of the Interactive Child Distress Screener (ICDS). The ICDS is a Web-based screening instrument for the early identification of emotional and behavioral problems in children aged between 5 and 12 years. Methods This paper utilized a mixed-methods approach to (1) develop and refine item content using an expert review process (study 1) and (2) develop and refine prototype animations and an app interface using codesign with child users (study 2). Study 1 involved an iterative process that comprised the following four steps: (1) the initial development of target constructs, (2) preliminary content validation (face validity, item importance, and suitability for animation) from an expert panel of researchers and psychologists (N=9), (3) item refinement, and (4) a follow-up validation with the same expert panel. Study 2 also comprised four steps, which are as follows: (1) the development of prototype animations, (2) the development of the app interface and a response format, (3) child interviews to determine feasibility and obtain feedback, and (4) refinement of animations and interface. Cognitive interviews were conducted with 18 children aged between 4 and 12 years who tested 3 prototype animated items. Children were asked to describe the target behavior, how well the animations captured the intended behavior, and provide suggestions for improvement. Their ability to understand the wording of instructions was also assessed, as well as the general acceptability of character and sound design. Results In study 1, a revised list of 15 constructs was generated from the first and second round of expert feedback. These were rated highly in terms of importance (mean 6.32, SD 0.42) and perceived compatibility of items (mean 6.41, SD 0.45) on a 7-point scale. In study 2, overall feedback regarding the character design and sounds was positive. Children’s ability to understand intended behaviors varied according to target items, and feedback highlighted key objectives for improvements such as adding contextual cues or improving character detail. These design changes were incorporated through an iterative process, with examples presented. Conclusions The ICDS has potential to obtain clinical information from the child’s perspective that may otherwise be overlooked. If effective, the ICDS will provide a quick, engaging, and easy-to-use screener that can be utilized in routine care settings. This project highlights the importance of involving an expert review and user codesign in the development of digital assessment tools for children

Treatment acceptability of paradoxical interventions: the role of dissonance

Paradoxical interventions are psychotherapeutic directives that appear counterintuitive in comparison to more conventional treatment approaches. Concerns regarding the potential manipulative nature and ethical viability of these interventions have been expressed in the literature. This survey study was designed to test the impact of two experimentally manipulated variables (reactance potential of the client, presence or absence of a therapeutic rationale), presented as components of written therapy vignettes, on psychologists\u27 ratings of treatment acceptability of a paradoxical intervention. It was hypothesized that cognitive dissonance would mediate this relationship. The paradoxical strategy was predicted to be perceived as contradictory to psychologists\u27 usual treatment approaches, thus arousing psychological discomfort;Respondents were administered a 63-item mail survey instrument with one clinical vignette as a reaction stimulus. Each vignette included a paradoxical intervention and varied client reactance potential (high or low levels) and the therapeutic rationale (present or absent from the intervention). Two-hundred and eight usable surveys were returned from five-hundred and forty-five licensed psychologists, located in four states, yielding a response rate of 38.2%;Multi-item scales were developed to measure respondent experience containing paradoxical interventions, dissonance arousal, treatment acceptability, and dissonance reduction. Multiple regression analyses showed that demographic variables were not predictive of dissonance arousal or treatment acceptability scores. The effects of the rationale and reactance manipulations were not significant. Regression analyses indicated that higher levels of experience with paradoxical interventions were associated with lower levels of dissonance arousal and higher levels of treatment acceptability. Predicted two-way interactions of experience X dissonance arousal and experience X treatment acceptability were found. A rationale X reactance X experience interaction was significant for dissonance arousal scores;Post-hoc analyses suggested that the proposed mediational role of cognitive dissonance did fit the data as hypothesized. A majority of respondents reported that they indeed had used paradoxical interventions, that they had received training and supervision in the use of such interventions, and that such training and supervision is an important condition for the use of paradoxical interventions

The completeness of electronic medical record data for patients with type 2 diabetes in primary care and its implications for computer modelling of predicted clinical outcomes.

Background: Computer models predicting outcomes among patients with Type 2 Diabetes (T2D) can be used as disease management program evaluation tools. The clinical data required as inputs for these models can include annually updated measurements such as blood pressure and glycated haemoglobin (HbA1c). These data can be extracted from primary care physician office systems but there are concerns about their completeness. Objectives/methods: This study addressed the completeness of routinely collected data extracted from 12 primary care practices in Australia. Data on annual availability of blood pressure, weight, total cholesterol, HDL-cholesterol and HbA1c values for regular patients were extracted in 2103 and analysed for temporal trends over the period 2000 to 2012. An ordinal logistic regression model was used to evaluate associations between patient characteristics and completeness of their records. Primary care practitioners were surveyed to identify barriers to recording data and strategies to improve its completeness. Results: Over the study period completeness of data improved substantially from less than 20% for some parameters up to a level of approximately 80% complete, except for the recording of weight. T2D patients with Ischaemic Heart Disease were more likely to have their blood pressure recorded (OR 1.6, p=0.02). Practitioners’ responses suggest they were not experiencing any major barriers to using their electronic medical record system but did agree with some suggested strategies to improve record completeness. Conclusion: The completeness of routinely collected data suitable for input into computerised predictive models is improving although other dimensions of data quality need to be addressed

Recruitment of Activation Receptors at Inhibitory NK Cell Immune Synapses

Natural killer (NK) cell activation receptors accumulate by an actin-dependent process at cytotoxic immune synapses where they provide synergistic signals that trigger NK cell effector functions. In contrast, NK cell inhibitory receptors, including members of the MHC class I-specific killer cell Ig-like receptor (KIR) family, accumulate at inhibitory immune synapses, block actin dynamics, and prevent actin-dependent phosphorylation of activation receptors. Therefore, one would predict inhibition of actin-dependent accumulation of activation receptors when inhibitory receptors are engaged. By confocal imaging of primary human NK cells in contact with target cells expressing physiological ligands of NK cell receptors, we show here that this prediction is incorrect. Target cells included a human cell line and transfected Drosophila insect cells that expressed ligands of NK cell activation receptors in combination with an MHC class I ligand of inhibitory KIR. The two NK cell activation receptors CD2 and 2B4 accumulated and co-localized with KIR at inhibitory immune synapses. In fact, KIR promoted CD2 and 2B4 clustering, as CD2 and 2B4 accumulated more efficiently at inhibitory synapses. In contrast, accumulation of KIR and of activation receptors at inhibitory synapses correlated with reduced density of the integrin LFA-1. These results imply that inhibitory KIR does not prevent CD2 and 2B4 signaling by blocking their accumulation at NK cell immune synapses, but by blocking their ability to signal within inhibitory synapses

Stories from Queensland farmers: 'why we don't seek help for mental health'

Farming as an occupation and lifestyle has many inherent stressors and farmers demonstrate suicide rates twice that of the general population (Arnautovska, McPhedran, & De Leo, 2014). There are also reports that indicate farmers may show fewer help-seeking behaviours, although research to date has failed to uncover clear reasons for this. Mental health help-seeking includes behaviours directed towards seeking help from health professionals for issues relating to mental health or distress (Rickwood & Thomas, 2012); if this occurs in a timely manner then negative consequences may be minimised. There is an urgent need to identify factors specific to farmers that make mental health help seeking difficult. The research presented here is part of a program of research aiming to understand the barriers and facilitators of mental health help-seeking in farmers from regional communities. The present research draws on findings from semi‐structured interviews with 10 farmers residing in Queensland. The interviews were analysed drawing on the techniques of Braun and Clarke (2006). Several key factors were identified as having the potential to directly or indirectly influence mental health help-seeking including, the weather (with a strong focus on drought), finances, support, health services, mental health literacy and stigma. This paper discusses these factors from the farmer perspective. The findings from this study advance knowledge in understanding what factors may influence mental health help-seeking in Queensland farmers. The outcomes have implications for developing and providing intervention to reduce barriers, and reinforce or strengthen facilitators of mental health help-seeking in farmers

1′,5-Dinitro-2′-phenyl-2′,3′,5′,6′,7′,7a’-hexa­hydro­spiro­[indoline-3,3′-1′H-pyrrolizin]-2-one

In the title cyclo­adduct, C20H18N4O5, the rings of the pyrrolizine system adopt envelope conformations. A centrosymmetric dimer is formed via inter­molecular N—H⋯O hydrogen bonds between the indolinone rings

The roles of need for cognition and psychological reactance as client variables in perceptions of paradoxical interventions with and without the provision of a rationale

The present study adds to the available understanding of the use of paradoxical interventions in several ways. First, this study will explore the role of need for cognition as an individual difference variable that may moderate perceptions of counselors who administer paradoxical interventions. Given that there is no literature available on the role of need for cognition in such a process, an analogue design would provide an excellent method for isolating this variable and examining its effects (Heppner, Kivlighan, & Wampold, 1992). Secondly, this study will provide new information to the currently inconclusive literature on whether or not to provide an explanation of the rationale for paradoxical interventions. The powerful analogue method maximizes internal validity and can be used to "refine" knowledge obtained from less internally valid field studies (Gelso, 1979, as cited in Heppner et al., 1992). More controlled experimentation examining the perceptions of counselors providing and not providing rationales for symptom prescription will be obtained using the analogue design. Specifically, the client variables of need for cognition and psychological reactance are hypothesized to moderate subjects' perceptions of counselors, and that these perceptions will vary depending on whether or not a rationale is given for a paradoxical intervention. The results of this experiment may provide new insights for the interpretations of previous research on rationale provision. Thirdly, a regression analysis will be used to analyze the data on subjects' level of psychological reactance. The literature examining the role of reactance has traditionally treated this individual difference variable as a categorical variable, defining high and low levels of reactance with median splits of the distribution and losing valuable explanatory information. This research treats reactance as a continuous variable in analyzing reactance as a mediating variable in perceptions of counselors

Farmer opinion on the process of health and welfare planning in Austria, Denmark, Germany, Norway and Switzerland

This report serves as a deliverable from the ANIPLAN project, with the original title ‘Evaluation report on state of the art regarding animal health and welfare planning in the participating countries’ (Deliverable 5.1). We chose to focus on the farmers’ perspective in each country, and ask the farmers who had participated in our project how they perceived the process of animal health and welfare planning. We did that using a questionnaire which each participant used in an interview with the farmer, asking some specific questions with the aim to evaluate how the farmers had experienced the ANIPLAN approach. We found that this focus was important as a supplement to other outcomes from the project, such as reduction of medicines (Ivemeyer et al., 2011) and improvement of animal based parameters (Gratzer et al., 2011). Furthermore potential scenarios for implementation of this concept into practice can be developed from the farmers responses