Mainstreaming Mental Health Care in 42 Countries.

Abstract-Global consensus and national policies have emphasized deinstitutionalization, or a shift in providing mental health care from institutional to community settings. Yet, psychiatric hospitals and asylums receive the majority of mental health funding in many countries, at odds with research evidence that suggests that services should be delivered in the community. Our aim is to investigate the norms, actors, and strategies that influence the uptake of deinstitutionalization internationally. Our study is informed by prior literature on management and implementation science. The success and failure of mental health care operations depend on identifying and overcoming challenges related to implementing innovations within national contexts. We surveyed 78 experts spanning 42 countries on their knowledge and experiences in expanding community-based mental health care and/or downsizing institution-based care. We also asked them about the contexts in which said methods were implemented in a country. We found that mental health care, whether it is provided in institutions or in the community, does not seem to be standardized across countries. Our analysis also showed that moving deinstitutionalization forward requires meaningful engagement of three types of actors: government officials, health care professionals, and local experts. Progress toward deinstitutionalization depends on the partnerships formed among these actors and with diverse stakeholders, which have the potential to garner resources and to scale-up pilot projects. In conclusion, different countries have adapted deinstitutionalization in ways to meet idiosyncratic situations and population needs. More attention should be given to the management and implementation strategies that are used to augment treatment and preventive services

Cross-national diffusion of mental health policy

Background: Following the tenets of world polity and innovation diffusion theories, I focus on the coercive and mimetic forces that influence the diffusion of mental health policy across nations. International organizations’ mandates influence government behavior. Dependency on external resources, namely foreign aid, also affects governments’ formulation of national policy. And finally, mounting adoption in a region alters the risk, benefits, and information associated with a given policy. Methods: I use post-war, discrete time data spanning 1950 to 2011 and describing 193 nations’ mental health systems to test these diffusion mechanisms. Results: I find that the adoption of mental health policy is highly clustered temporally and spatially. Results provide support that membership in the World Health Organization (WHO), interdependence with neighbors and peers in regional blocs, national income status, and migrant sub-population are responsible for isomorphism. Aid, however, is an insufficient determinant of mental health policy adoption. Conclusion: This study examines the extent to which mental, neurological, and substance use disorder are addressed in national and international contexts through the lens of policy diffusion theory. It also adds to policy dialogues about non-communicable diseases as nascent items on the global health agend

The Sloan Digital Sky Survey Reverberation Mapping Project: Velocity Shifts of Quasar Emission Lines

Quasar emission lines are often shifted from the systemic velocity due to various dynamical and radiative processes in the line-emitting region. The level of these velocity shifts depends both on the line species and on quasar properties. We study velocity shifts for the line peaks of various narrow and broad quasar emission lines relative to systemic using a sample of 849 quasars from the Sloan Digital Sky Survey Reverberation Mapping (SDSS-RM) project. The coadded (from 32 epochs) spectra of individual quasars have sufficient signal-to-noise ratio (SNR) to measure stellar absorption lines to provide reliable systemic velocity estimates, as well as weak narrow emission lines. The sample also covers a large dynamic range in quasar luminosity (~2 dex), allowing us to explore potential luminosity dependence of the velocity shifts. We derive average line peak velocity shifts as a function of quasar luminosity for different lines, and quantify their intrinsic scatter. We further quantify how well the peak velocity can be measured for various lines as a function of continuum SNR, and demonstrate there is no systematic bias in the line peak measurements when the spectral quality is degraded to as low as SNR~3 per SDSS pixel. Based on the observed line shifts, we provide empirical guidelines on redshift estimation from [OII]3728, [OIII]5008, [NeV]3426, MgII, CIII], HeII1640, broad Hbeta, CIV, and SiIV, which are calibrated to provide unbiased systemic redshifts in the mean, but with increasing intrinsic uncertainties of 46, 56, 119, 205, 233, 242, 400, 415, and 477 km/s, in addition to the measurement uncertainties. These more realistic redshift uncertainties are generally much larger than the formal uncertainties reported by the redshift pipelines for spectroscopic quasar surveys, and demonstrate the infeasibility of measuring quasar redshifts to better than ~200 km/s with only broad lines.Comment: matched to the published version; minor changes and conclusions unchange

The Properties of Radio Galaxies and the Effect of Environment in Large Scale Structures at z∼1z\sim1

In this study we investigate 89 radio galaxies that are spectroscopically-confirmed to be members of five large scale structures in the redshift range of $0.65 \le z \le 0.96$. Based on a two-stage classification scheme, the radio galaxies are classified into three sub-classes: active galactic nucleus (AGN), hybrid, and star-forming galaxy (SFG). We study the properties of the three radio sub-classes and their global and local environmental preferences. We find AGN hosts are the most massive population and exhibit quiescence in their star-formation activity. The SFG population has a comparable stellar mass to those hosting a radio AGN but are unequivocally powered by star formation. Hybrids, though selected as an intermediate population in our classification scheme, were found in almost all analyses to be a unique type of radio galaxies rather than a mixture of AGN and SFGs. They are dominated by a high-excitation radio galaxy (HERG) population. We discuss environmental effects and scenarios for each sub-class. AGN tend to be preferentially located in locally dense environments and in the cores of clusters/groups, with these preferences persisting when comparing to galaxies of similar colour and stellar mass, suggesting that their activity may be ignited in the cluster/group virialized core regions. Conversely, SFGs exhibit a strong preference for intermediate-density global environments, suggesting that dusty starbursting activity in LSSs is largely driven by galaxy-galaxy interactions and merging.Comment: 28 pages, 10 figures, accepted to MNRA

Cultural Context Index: A Geospatial Measure of Social Determinants of Health in the United States

Minority populations will continue to grow in the United States. Such pluralism necessitates iterative, geospatial measurements of cultural contexts. Our objective in this study was to create a measure of social determinants of health in geographic areas with varying ethnic, linguistic, and religious diversity in the United States. We extracted geographic information systems data based on community characteristics that have known associations with population health disparities from 2015 to 2019. We used principal component analysis to construct a Cultural Context Index (CCI). We created the CCI for 73,682 census tracts across 50 states and five inhabited territories. We identified hot and cold spots that are the highest and lowest CCI quintile, respectively. Hot spots census tracts were mostly located in metropolitan areas (84.8%), in the Southern census region (41.5%), and also had larger Black and Hispanic populations. The census tracts with the greatest need for culturally competent health care also had the sickest populations. Census tracts with a CCI rank of 5 (\u27greatest need\u27) had higher prevalences of self-reported poor physical health (17.2%) and poor mental health (17.4%), compared to either the general population (13.9% and 14.5%) or to CCI rank of 1 (\u27lowest need\u27) (11.9% and 10.8%). The CCI can pinpoint census tracts with a need for culturally competent health care and inform supply-side policy planning as healthcare and social service providers will inevitably come in contact with consumers from different backgrounds

Incentives to change: effects of performance-based financing on health workers in Zambia

Background: Performance-based financing (PBF) has been implemented in a number of countries with the aim of transforming health systems and improving maternal and child health. This paper examines the effect of PBF on health workers’ job satisfaction, motivation, and attrition in Zambia. It uses a randomized intervention/control design to evaluate before–after changes for three groups: intervention (PBF) group, control 1 (C1; enhanced financing) group, and control 2 (C2; pure control) group. Methods: Mixed methods are employed. The quantitative portion comprises of a baseline and an endline survey. The survey and sampling scheme were designed to allow for a rigorous impact evaluation of PBF or C1 on several key performance indicators. The qualitative portion seeks to explain the pathways underlying the observed differences through interviews conducted at the beginning and at the three-year mark of the PBF program. Results: Econometric analysis shows that PBF led to increased job satisfaction and decreased attrition on a subset of measures, with little effect on motivation. The C1 group also experienced some positive effects on job satisfaction. The null results of the quantitative assessment of motivation cohere with those of the qualitative assessment, which revealed that workers remain motivated by their dedication to the profession and to provide health care to the community rather than by financial incentives. The qualitative evidence also provides two explanations for higher overall job satisfaction in the C1 than in the PBF group: better working conditions and more effective supervision from the District Medical Office. The PBF group had higher satisfaction with compensation than both control groups because they have higher compensation and financial autonomy, which was intended to be part of the PBF intervention. While PBF could not address all the reasons for attrition, it did lower turnover because those health centers were staffed with qualified personnel and the personnel had role clarity. Conclusions: In Zambia, the implementation of PBF schemes brought about a significant increase in job satisfaction and a decrease in attrition, but had no significant effect on motivation. Enhanced health financing also increased stated job satisfaction

The Sloan Digital Sky Survey Reverberation Mapping Project: Ensemble Spectroscopic Variability of Quasar Broad Emission Lines

We explore the variability of quasars in the MgII and Hbeta broad emission lines and UV/optical continuum emission using the Sloan Digital Sky Survey Reverberation Mapping project (SDSS-RM). This is the largest spectroscopic study of quasar variability to date: our study includes 29 spectroscopic epochs from SDSS-RM over $6$ months, containing 357 quasars with MgII and 41 quasars with Hbeta . On longer timescales, the study is also supplemented with two-epoch data from SDSS-I/II. The SDSS-I/II data include an additional $2854$ quasars with MgII and 572 quasars with Hbeta. The MgII emission line is significantly variable ($\Delta f/f$ 10% on 100-day timescales), a necessary prerequisite for its use for reverberation mapping studies. The data also confirm that continuum variability increases with timescale and decreases with luminosity, and the continuum light curves are consistent with a damped random-walk model on rest-frame timescales of $\gtrsim 5$ days. We compare the emission-line and continuum variability to investigate the structure of the broad-line region. Broad-line variability shows a shallower increase with timescale compared to the continuum emission, demonstrating that the broad-line transfer function is not a $\delta$-function. Hbeta is more variable than MgII (roughly by a factor of $1.5$), suggesting different excitation mechanisms, optical depths and/or geometrical configuration for each emission line. The ensemble spectroscopic variability measurements enabled by the SDSS-RM project have important consequences for future studies of reverberation mapping and black hole mass estimation of $1<z<2$ quasars.Comment: 20 pages, 25 figures. ApJ accepted: minor revisions following referee repor

Biases in Virial Black Hole Masses: An SDSS Perspective

We compile black hole (BH) masses for $\sim 60,000$ quasars in the redshift range $0.1 \lesssim z \lesssim 4.5$ included in the Fifth Data Release of the Sloan Digital Sky Survey (SDSS), using virial BH mass estimators based on the \hbeta, \MgII, and \CIV emission lines. We find that: (1) within our sample, the widths of the three lines follow log-normal distributions, with means and dispersions that do not depend strongly on luminosity or redshift;(2) the \MgII- and \hbeta-estimated BH masses are consistent with one another; and (3) the \CIV BH mass estimator may be more severely affected by a disk wind component than the \MgII and \hbeta estimators, giving a positive bias in mass correlated with the \CIV-\MgII blueshift. Most SDSS quasars have virial BH masses in the range $10^8-10^9 M_\odot$. There is a clear upper mass limit of $\sim 10^{10} M_\odot$ for active BHs at $z \gtrsim 2$, decreasing at lower redshifts. Making the reasonable assumptions that the underlying BH mass distribution decreases with mass and that the Eddington ratio distribution at fixed BH mass has non-zero width, we show that the measured virial BH mass distribution and Eddington ratio distribution are subject to Malmquist bias. A radio quasar subsample (with $1.5\lesssim z\lesssim 2.3$) has mean virial BH mass larger by $\sim 0.12$ dex than the whole sample. A broad absorption line (BAL) quasar subsample (with $1.7\lesssim z\lesssim 2.2$) has identical virial mass distribution as the nonBAL sample, with no mean offset. (Abridged)Comment: Updated virial mass measurements; improved presentation of the MC simulation; added new discussion sections; conclusions unchanged. The full table1 is available at http://www.astro.princeton.edu/~yshen/BH_mass/datafile1.txt.tar.g

Comparing Survival Rates and Mortality in Operative Versus Nonoperative Treatment For Femoral Neck Fractures among alzheimer\u27s Disease Patients: a Retrospective Cohort Study

INTRODUCTION: Addressing femoral neck fractures resulting from ground-level falls in older adults with Alzheimer\u27s disease (AD) involves a personalized treatment plan. There is considerable ongoing debate concerning the relative advantages and disadvantages of surgical treatment (internal fixation or arthroplasty) vs nonoperative treatment for femoral neck fractures in older persons with AD. METHODS: This retrospective cohort study compared the mortality, hazard ratio, and survival rate between operative and nonoperative treatments, controlling for patients\u27 demographic information and baseline health status. The study population consisted of Optum beneficiaries diagnosed with AD who experienced an initial femoral neck fracture claim between January 1, 2012, and December 31, 2017. Kaplan-Meier survival curves were applied to compare the treatment groups\u27 post-fracture survival rates and mortality. Cox regression was used to examine the survival period by controlling the covariates. RESULTS: Out of the 4157 patients with AD with femoral neck fractures, 59.8% were women (n = 2487). The median age was 81 years. The 1-year survival rate for nonoperative treatment (70.19%) was lower than that for internal fixation (75.27%) and arthroplasty treatment (82.32%). Compared with the nonoperative group, arthroplasty surgical treatment had significant lower hazard risk of death (arthroplasty hazard ratio: 0.850, 95% CI: 0.728-0.991, DISCUSSION: The findings suggest that the operative treatment group experiences higher survival rates and lower mortality rates than the nonoperative group. This paper provides insights into treatment outcomes of older adults with AD receiving medical care for femoral neck fractures