Sexual offenders’ parental and adult attachments and preferences for therapists’ interpersonal qualities

This study explored sex offenders' parental and adult attachment difficulties and assessed the extent to which these were associated with preferences for therapists' interpersonal qualities. One-hundred and twelve adult male child sexual offenders were invited to provide self-report data on their attachment histories, adult attachments and preferences for therapists' interpersonal qualities. A weak relationship between childhood and adulthood secure attachment was found, suggesting that attachment at the time of offending may be more relevant than childhood attachment to the aetiology of sexual offending. Participants valued a range of therapists' qualities previously identified as important for positive treatment change. Therapist trust and genuineness were perceived as particularly important by those with attachment difficulties, demonstrating the need for these qualities in offender programmes where attachment difficulties would be expected. There were some differences in the preferences for therapists' qualities between participants with different adult attachment types, highlighting the importance of responsivity factors in treatment. © 2015 Taylor & Franci

Similarities and Differences In Adolescence-Onset Versus Adulthood-Onset Sexual Abuse Incidents

A sample of males who had first committed sexual offences against children in either adolescence (n= 230; M= 14.0 years, SD= 1.5) or adulthood (n= 280; M= 34.4 years, SD= 11.7) were compared on measures relating to the circumstances of their first known sexual abuse incident. Considerable diversity in the circumstances of these first incidents was observed for both groups. However, adulthood-onset sexual abuse most often occurred following a long-standing familial relationship with a female victim, and in a home setting. The first incident for adolescence-onset offenders also tended to occur in the context of a long-term relationship and against a female child in a home setting, but more commonly against a nonfamilial victim. Adulthood-onset offenders abused older children, were more likely to engage in penetrative sexual behaviors, and went on to abuse over a longer duration than adolescence-onset offenders. Adolescence-onset offences were more likely to be witnessed by a third party. Findings and their implications for prevention are considered from a situational crime prevention perspective. © 2015 Elsevier Ltd

An easy to control all-metal in-line-series ohmic RF MEMS switch

Copyright @ 2010 Springer-VerlagThe analysis, design and simulation of a novel easy to control all-metal in-line-series ohmic RF MEMS switch is presented, for applications where the operating frequency ranges from DC to 4 GHz. The proposed switch, due to its unique shape and size, assures high isolation and great linearity fulfilling the necessary requirements as concerns loss, power handling and power consumption. Simplicity has been set as the key success factor implying robustness and high fabrication yield. On the other hand, the specially designed cantilever-shape (hammerhead) allows distributed actuation force ensuring high controllability as well as reliability making the presented RF MEMS switch one of its kind

Predicting multiple victim versus single victim sexual abuse: an examination of distal factors and proximal factors associated with the first abuse incident

Official and confidential self-report data on 83 convicted adult male sexual abusers were analysed to examine whether sexual offending progression can be better predicted from distal antecedents, or from proximal antecedents and outcomes associated with the first sexual abuse incident. Fifty-six offenders who sexually abused more than one victim (multiple victim offenders; MVOs) were compared to 27 offenders who sexually abused a single victim only (single victim offenders; SVOs). MVOs were younger at the time of their first sexual abuse incident, and were more likely to first abuse male and non-familial children. With the exception of sexual attraction to male children, no differences were found between the two groups on distal antecedents. Proximal antecedents and outcomes associated with the first sexual abuse incident were significantly related to multiple victim offending. Logistic regression analysis identified the presence of sexual difficulties in the month prior to the first abuse incident, and sexual excitement immediately preceding the first incident, as significant unique predictors. Implications for risk assessment and risk management are discussed, and future research directions proposed

RF-MEMS switch actuation pulse optimization using Taguchi's method

Copyright @ 2011 Springer-VerlagReliability and longevity comprise two of the most important concerns when designing micro-electro-mechanical-systems (MEMS) switches. Forcing the switch to perform close to its operating limits underlies a trade-off between response bandwidth and fatigue life due to the impact force of the cantilever touching its corresponding contact point. This paper presents for first time an actuation pulse optimization technique based on Taguchi’s optimization method to optimize the shape of the actuation pulse of an ohmic RF-MEMS switch in order to achieve better control and switching conditions. Simulation results show significant reduction in impact velocity (which results in less than 5 times impact force than nominal step pulse conditions) and settling time maintaining good switching speed for the pull down phase and almost elimination of the high bouncing phenomena during the release phase of the switch

Three Years In--Changing Plan Features in the U.S. Health Insurance Marketplace

Background: A central objective of recent U.S. healthcare policy reform, most notably the Affordable Care Act\u27s (ACA) Health Insurance Marketplace, has been to increase access to stable, affordable health insurance. However, changing market dynamics (rising premiums, changes in issuer participation and plan availability) raise significant concerns about the marketplaces\u27 ability to provide a stable source of healthcare for Americans that rely on them. By looking at the effect of instability on changes in the consumer choice set, we can analyze potential incentives to switch plans among price-sensitive enrollees, which can then be used to inform policy going forward. Methods: Data on health plan features for non-tobacco users in 2512 counties in 34 states participating in federally-facilitated exchanges from 2014 to 2016 was obtained from the Centers for Medicaid & Medicare Services. We examined how changes in individual plan features, including premiums, deductibles, issuers, and plan types, impact consumers who had purchased the lowest-cost silver or bronze plan in their county the previous year. We calculated the cost of staying in the same plan versus switching to another plan the following year, and analyzed how costs vary across geographic regions. Results: In most counties in 2015 and 2016 (53.7 and 68.2%, respectively), the lowest-cost silver plan from the previous year was still available, but was no longer the cheapest plan. In these counties, consumers who switched to the new lowest-cost plan would pay less in monthly premiums on average, by $51.48 and$55.01, respectively, compared to staying in the same plan. Despite potential premium savings from switching, however, the majority would still pay higher average premiums compared to the previous year, and most would face higher deductibles and an increased probability of having to change provider networks. Conclusion: While the ACA has shown promise in expanding healthcare access, continued changes in the availability and affordability of health plans are likely to result in churning and switching among enrollees, which may have negative ramifications for their health going forward. Future healthcare policy reform should aim to stabilize marketplace dynamics in order to encourage greater care continuity and limit churning

Three years in – changing plan features in the U.S. health insurance marketplace

Abstract Background A central objective of recent U.S. healthcare policy reform, most notably the Affordable Care Act’s (ACA) Health Insurance Marketplace, has been to increase access to stable, affordable health insurance. However, changing market dynamics (rising premiums, changes in issuer participation and plan availability) raise significant concerns about the marketplaces’ ability to provide a stable source of healthcare for Americans that rely on them. By looking at the effect of instability on changes in the consumer choice set, we can analyze potential incentives to switch plans among price-sensitive enrollees, which can then be used to inform policy going forward. Methods Data on health plan features for non-tobacco users in 2512 counties in 34 states participating in federally-facilitated exchanges from 2014 to 2016 was obtained from the Centers for Medicaid & Medicare Services. We examined how changes in individual plan features, including premiums, deductibles, issuers, and plan types, impact consumers who had purchased the lowest-cost silver or bronze plan in their county the previous year. We calculated the cost of staying in the same plan versus switching to another plan the following year, and analyzed how costs vary across geographic regions. Results In most counties in 2015 and 2016 (53.7 and 68.2%, respectively), the lowest-cost silver plan from the previous year was still available, but was no longer the cheapest plan. In these counties, consumers who switched to the new lowest-cost plan would pay less in monthly premiums on average, by $51.48 and$55.01, respectively, compared to staying in the same plan. Despite potential premium savings from switching, however, the majority would still pay higher average premiums compared to the previous year, and most would face higher deductibles and an increased probability of having to change provider networks. Conclusion While the ACA has shown promise in expanding healthcare access, continued changes in the availability and affordability of health plans are likely to result in churning and switching among enrollees, which may have negative ramifications for their health going forward. Future healthcare policy reform should aim to stabilize marketplace dynamics in order to encourage greater care continuity and limit churning.https://deepblue.lib.umich.edu/bitstream/2027.42/144501/1/12913_2018_Article_3198.pd

Development of mental health quality indicators (MHQIs) for inpatient psychiatry based on the interRAI mental health assessment

Abstract Background Outcome quality indicators are rarely used to evaluate mental health services because most jurisdictions lack clinical data systems to construct indicators in a meaningful way across mental health providers. As a result, important information about the effectiveness of health services remains unknown. This study examined the feasibility of developing mental health quality indicators (MHQIs) using the Resident Assessment Instrument - Mental Health (RAI-MH), a clinical assessment system mandated for use in Ontario, Canada as well as many other jurisdictions internationally. Methods Retrospective analyses were performed on two datasets containing RAI-MH assessments for 1,056 patients from 7 facilities and 34,788 patients from 70 facilities in Ontario, Canada. The RAI-MH was completed by clinical staff of each facility at admission and follow-up, typically at discharge. The RAI-MH includes a breadth of information on symptoms, functioning, socio-demographics, and service utilization. Potential MHQIs were derived by examining the empirical patterns of improvement and incidence in depressive symptoms and cognitive performance across facilities in both sets of data. A prevalence indicator was also constructed to compare restraint use. Logistic regression was used to evaluate risk adjustment of MHQIs using patient case-mix index scores derived from the RAI-MH System for Classification of Inpatient Psychiatry. Results Subscales from the RAI-MH, the Depression Severity Index (DSI) and Cognitive Performance Scale (CPS), were found to have good reliability and strong convergent validity. Unadjusted rates of five MHQIs based on the DSI, CPS, and restraints showed substantial variation among facilities in both sets of data. For instance, there was a 29.3% difference between the first and third quartile facility rates of improvement in cognitive performance. The case-mix index score was significantly related to MHQIs for cognitive performance and restraints but had a relatively small impact on adjusted rates/prevalence. Conclusions The RAI-MH is a feasible assessment system for deriving MHQIs. Given the breadth of clinical content on the RAI-MH there is an opportunity to expand the number of MHQIs beyond indicators of depression, cognitive performance, and restraints. Further research is needed to improve risk adjustment of the MHQIs for their use in mental health services report card and benchmarking activities.http://deepblue.lib.umich.edu/bitstream/2027.42/112590/1/12913_2012_Article_2419.pd

Mapping for Conceptual Clarity: Exploring Implementation of Integrated Community-Based Primary Health Care from a Whole Systems Perspective.

Published source must be acknowledged with citationIntroduction: Studying implementation of integrated models of community-based primary health care requires a "whole systems" multidisciplinary approach to capture micro, meso and macro factors. However, there is, as yet, no clear operationalization of a "whole systems" approach to guide multidisciplinary research programs. Theoretical frameworks and approaches from diverse academic traditions specify different aspects of the health system in more depth. Enabling analysis across the system, when data and ideas are captured using different taxonomies, requires that we map terms and constructs across the models. Theory and methods: This paper uses concept mapping techniques to compare and contrast the theoretical frameworks and approaches used in the iCOACH project including: Ham's Ten Characteristics of the High-Performing Chronic Care System (capturing patient/carer and provider perspectives), the Organizational Context and Capabilities for Integrating Care framework (capturing the organizational perspective), and the Health Policy Monitor framework (capturing the policy system perspective). The aim of the paper is to link concepts across different theoretical framework to guide the iCOACH study. Results: A concept map was developed that identifies 8 overarching concepts across the heuristic models. A preliminary analysis of one of these overarching concepts, care coordination, demonstrates how different perspectives will assign different meanings, values, and drivers of seemingly similar ideas. For patients and carers care coordination is about having a responsive team of health care providers. Building relationships in teams that exist within and across different organizations is essential for providers to achieve care coordination, where managers and policy makers see care coordination as being more about creating linkages and addressing systems gaps. Discussion and conclusion: This work represents a first step towards development of a fully formed conceptual framework that includes key domains, concepts, and mechanisms of implementing integrated community-based primary health care.Published onlin