Midi-level measurement of social anxiety in psychiatric and non-psychiatric samples

This paper reports the development and assessment of midi-level behavioral measures of social anxiety in the context of two experiments, one studying an analog student sample, the other a psychiatric sample. Judgments on nine categories of clinically practical midi-level behaviors (e.g. Facial Expression, Orienting, Sense of Timing), based on a review of the literature on human ethology and on pilot research, were compared to global judgments of social anxiety and social skill and to physiological arousal. Intraclass correlations exceeded 0.80 for judgments of the global and midi-level behavioral ratings on both samples. Results of correlational analyses indicated that while there were several significant predictors of global skill and anxiety among the midis, the magnitude of the relationship between midis and globals was stronger for the patient than the student sample. Further analyses based on S's heart rate (HR) reactivity suggested that while global ratings did not significantly predict H R in a high social anxiety situation, one midi-level behavioral rating (self-manipulations) did. The clinical utility of the newly developed measures is discussed with particular attention to their practicality for behavior therapy.     

Centering culture in the treatment of opioid use disorder with American Indian and Alaska Native Communities: Contributions from a National Collaborative Board

American Indian/Alaska Native (AI/AN) communities are disproportionally impacted by the opioid overdose epidemic. There remains a dearth of research evaluating methods for effectively implementing treatments for opioid use disorder (OUD) within these communities. We describe proceedings from a 2-day Collaborative Board (CB) meeting tasked with developing an implementation intervention for AI/AN clinical programs to improve the delivery of medications to treat OUD (MOUD). The CB was comprised of Elders, cultural leaders, providers, individuals with lived experience with OUD, and researchers from over 25 communities, organizations, and academic institutions. Conversations were audio-recorded, transcribed, and coded by two academic researchers with interpretation oversight provided by the CB. These proceedings provided a foundation for ongoing CB work and a frame for developing the program-level implementation intervention using a strength-based and holistic model of OUD recovery and wellbeing. Topics of discussion posed to the CB included engagement and recovery strategies, integration of extended family traditions, and addressing stigma and building trust with providers and clients. Integration of traditional healing practices, ceremonies, and other cultural practices was recommended. The importance of centering AI/AN culture and involving family were highlighted as priorities for the intervention.     

Knowledge of Breast Cancer Genetics Among Breast Cancer Patients and First-Degree Relatives of Affected Individuals

The cloning of BRCA1, a susceptibility gene for inherited breast cancer, has made genetic screening possible for individuals and families whose medical histories are suggestive of an inherited predisposition to breast cancer. To date, few systematic attempts have been made to determine the level of knowledge about breast cancer genetics among women who are likely to seek BRCA1 screening when it becomes widely available. The present study attempted to assess the general knowledge about BRCA1 mutations in two groups: (1) first-degree relatives (FDRs) of breast cancer patients; and (2) women with a previous diagnosis of breast cancer. A self-administered, thirty-item questionnaire was developed through a pilot study. Ten of the items were objective, factual questions about breast cancer genetics. Responses to these questions were used to generate an overall knowledge score for each respondent. The study population was moderately knowledgeable about breast cancer genetics, with an average score of 5.35 out of 10. Counselors should not underestimate the importance of evaluating each counselee's existing knowledge about breast cancer, which can affect the provision and reception of genetic information. In particular, specific areas of knowledge that may be confusing or misunderstood were identified and these topics are discussed in detail.     

Challenging racism, sexism, and social injustice: support for urban adolescents' critical consciousness development

This mixed-model study examined the relationship between urban adolescents' perceived support for challenging racism, sexism, and social injustice from peers, family, and community members and their critical consciousness development. These relationships were examined by relating participants' qualitative perceptions of support for challenging racism, sexism, and social injustice to quantitative data obtained from Likert-type measures of the reflection and action components of critical consciousness. Perceived support for challenging racism, sexism, and social injustice had a significant impact upon the reflection component of critical consciousness; the significance criterion was supported by effect size estimates. Support for challenging racism, sexism, and social injustice was not significantly related to the action component of critical consciousness. Participants perceived the most support for challenging racism, moderate support for challenging social injustice, and the least support for challenging sexism. Additionally, female participants perceived more support for challenging sexism than male participants. These results suggest that the informal interactions of urban adolescents play a role in shaping their critical consciousness, and hold implications for psychosocial interventions and research with marginalized populations.     

Family Functioning and the Course of Adolescent Bipolar Disorder

The symptoms of bipolar disorder affect and are affected by the functioning of family environments. Little is known, however, about the stability of family functioning among youth with bipolar disorder as they cycle in and out of mood episodes. This study examined family functioning and its relationship to symptoms of adolescent bipolar disorder, using longitudinal measures of family cohesion, adaptability, and conflict. Parent- and adolescent-reported symptom and family functioning data were collected from 58 families of adolescents with bipolar disorder (mean age = 14.48 ± 1.60; 33 female, 25 male) who participated in a 2-year randomized trial of family-focused treatment for adolescents (FFT-A). Cohesion and adaptability scores did not significantly change over the course of the study. Parent-reported conflict prior to psychosocial treatment moderated the treatment responses of families, such that high-conflict families participating in FFT-A demonstrated greater reductions in conflict over time than low-conflict families. Moreover, adolescent mania symptoms improved more rapidly in low-conflict than in high-conflict families. For all respondents, cohesion, adaptability, and conflict were longitudinally correlated with adolescents’ depression scores. Finally, decreases in parent-reported conflict also predicted decreases in adolescents’ manic symptoms over the 2-year study. Findings suggest that family cohesion, adaptability, and conflict may be useful predictors of the course of adolescent mood symptoms. Family conflict may be an important target for family intervention in early onset bipolar disorder.     

EFFECTS OF A SIGNALED DELAY TO REINFORCEMENT IN THE PREVIOUS AND UPCOMING RATIOS ON BETWEEN-RATIO PAUSING IN FIXED-RATIO SCHEDULES

Domestic hens responded under multiple fixed‐ratio fixed‐ratio schedules with equal fixed ratios. One component provided immediate reinforcement and the other provided reinforcement after a delay, signaled by the offset of the key light. The components were presented quasirandomly so that all four possible transitions occurred in each session. The delay was varied over 0, 4, 8, 16, and 32 s with fixed‐ratio 5 schedules, and over 0, 8 and 32 s with fixed‐ratio 1, 15 and 40 schedules. Main effects of fixed‐ratio value and delay duration were detected on between‐ratio pauses. Pauses were longer when the multiple‐schedule stimulus correlated with a delayed‐reinforcer component was presented, with the longest pauses occurring at the transition from a component with an immediate reinforcer to one with a delayed reinforcer. Pause durations were shortest during immediate components. Overall, both the presence or absence of a delay in the upcoming component, and the presence or absence of a delay in the preceding component affected pause length, but the upcoming delay had the larger effect. Thus changes in delay had similar effects to past reports of the effects of changes in response force, response requirement, and reinforcer magnitude in multiple fixed‐ratio fixed‐ratio schedules.     

An Ethical Framework for the Design,Development, Implementation,and Assessment of Drones Used in Public Healthcare

Science and Engineering Ethics - The use of drones in public healthcare is suggested as a means to improve efficiency under constrained resources and personnel. This paper begins by framing drones...     

Self-Reported Questionnaire Detects Family History of Cancer in a Pancreatic Cancer Screening Program

Pancreatic ductal adenocarcinoma (PDAC) is a leading cause of cancer death; approximately 5–10% of PDAC is hereditary. Self-administered health history questionnaires (HHQs) may provide a low-cost method to detail family history (FH) of malignancy. Pancreas Center patients were asked to enroll in a registry; 149 with PDAC completed a HHQ which included FH data. Patients with FH of PDAC, or concern for inherited PDAC syndrome, were separately evaluated in a Prevention Program and additionally met with a genetic counselor (GC) to assess PDAC risk (n?=?61). FH obtained through GC and HHQ were compared using Wilcoxon signed-rank sum and generalized linear mixed models with Poisson distribution. Agreement between GC and HHQ risk-assessment was assessed using kappa (κ) statistic. In the Prevention Program, HHQ was as precise in detecting FH of cancer as the GC (all p?>?0.05). GC and HHQ demonstrated substantial agreement in risk-stratification of the Prevention Program cohort (κ?=?0.73, 95% CI 0.59–0.87.) The sensitivity of the HHQ to detect a patient at elevated risk (i.e., moderate- or high-risk) of PDAC, compared to GC, was 82.9% (95% CI 67.3–92.3%) with a specificity of 95% (95% CI 73.1–99.7%). However, seven patients who were classified as average-risk by the HHQ were found to be at an elevated-risk of PDAC by the GC. In the PDAC cohort, 30/149 (20.1%) reported at least one first-degree relative (FDR) with PDAC. The limited sensitivity of the HHQ to detect patients at elevated risk of PDAC in the Prevention Program cohort suggests that a GC adds value in risk-assessment in this population. The HHQ may offer an opportunity to identify high-risk patients in a PDAC population.     

Social validity: Perceptions of check and connect with early literacy support

This article underscores the potential advantages of qualitative methods to illustrate the depth and complexity of social validity. This investigation evaluates the social validity of Check and Connect with Early Literacy Support (CCEL), through the perspectives of teachers and caregivers whose children participated in the intervention. Teachers from six classrooms and caregivers from six families participated in evaluating the social validity of this intervention using a combination of qualitative and quantitative methods. Participants completed the Treatment Acceptability Rating Scale—Revised (TARF-R; Reimers, T. M., Wacker, D. P., Cooper, L. J. & DeRaad, A. O. (1992). Clinical evaluation of the variables associated with treatment acceptability and their relation to compliance. Behavioral Disorders, 18(1), 67-76.), a quantitative measure of treatment acceptability (a component of social validity), and were interviewed using qualitative interviews and focus groups. Results were analyzed through ethnographic methodology and indicate complex, reciprocal relationships among factors related to social validity. This investigation is considered in light of recent efforts to develop a systematic approach to evaluate the adequacy of intervention research using qualitative methods.