What Happens After the Demonstration Phase? The Sustainability of Canada's At Home/Chez Soi Housing First Programs for Homeless Persons with Mental Illness

This research examined the sustainability of Canada's At Home/Chez Soi Housing First (HF) programs for homeless persons with mental illness 2 years after the end of the demonstration phase of a large (more than 2000 participants enrolled), five‐site, randomized controlled trial. Qualitative interviews were conducted with 142 participants (key informants, HF staff, and persons with lived experience) to understand sustainability outcomes and factors that influenced those outcomes. Also, a self‐report HF fidelity measure was completed for nine HF programs that continued after the demonstration project. A cross‐site analysis was performed, using the five sites as case studies. The findings revealed that nine of the 12 HF programs (75%) were sustained, and that seven of the nine programs reported a high level of fidelity (achieving an overall score of 3.5 or higher on a 4‐point scale). The sites varied in terms of the level of systems integration and expansion of HF that were achieved. Factors that promoted or impeded sustainability were observed at multiple ecological levels: broad contextual (i.e., dissemination of research evidence, the policy context), community (i.e., partnerships, the presence of HF champions), organizational (i.e., leadership, ongoing training, and technical assistance), and individual (i.e., staff turnover, changes, and capacity). The findings are discussed in terms of the implementation science literature and their implications for how evidence‐based programs like HF can be sustained.     

Direct to confusion: lessons learned from marketing BRCA testing

Myriad Genetics holds a patent on testing for the hereditary breast and ovarian cancer genes, BRCA1 and BRCA2, and therefore has a forced monopoly on this critical genetic test. Myriad launched a Direct-to-Consumer (DTC) marketing campaign in the Northeast United States in September 2007 and plans to expand that campaign to Florida and Texas in 2008. The ethics of Myriad's patent, forced monopoly and DTC campaign will be reviewed, as well as the impact of this situation on patient access and care, physician liability, and the future of DTC campaigns for genetic testing.     

Institutional Approaches to Research Integrity in Ghana

Science and Engineering Ethics - Research misconduct (RM) remains an important problem in health research despite decades of local, national, regional, and international efforts to eliminate it....     

A study of syntactic processing in aphasia I: behavioral (psycholinguistic) aspects

This paper presents the results of a study of syntactically based comprehension in aphasic patients. We studied 42 patients with aphasia secondary to left hemisphere strokes and 25 control participants. We measured off-line, end-of-sentence, performance (accuracy and reaction time) in two tasks that require comprehension--enactment and sentence-picture matching--and in grammaticality judgment, with whole sentence auditory presentation. We also used sentence-picture matching and grammaticality judgment as tasks in two self-paced listening studies with the same patients to measure on-line performance. In each task and presentation format, we presented sentences that tested the ability to assign and interpret three structural contrasts chosen to examine different basic syntactic operations: actives and passives, subject and object extracted relative clauses, and reflexive pronouns and matched sentences without these elements. We examined these behavioral data to determine patterns of impairment in individual patients and in groups of patients, using correlational analyses, factor analyses, and analyses of variance. The results showed that almost no individual patients had stable deficits referable to the ability to interpret individual syntactic structures, that a variety of structural features contributed to sentence processing complexity both on-line and off-line, that correct responses were associated with normal on-line and errors with abnormal performance, and that the major determinant of performance is a factor that affected performance on all sentence types. The results indicate that the major cause of aphasic impairments of syntactically based comprehension are intermittent reductions in the processing capacity available for syntactic, interpretive, and task-related operations.     

Presidential Debate Viewing and Michael Moore's Fahrenheit 9–11: A Study of Affect-as-Transfer and Passionate Reasoning

Extant research on presidential debate viewing focuses primarily on the cognitive outcomes (e.g., knowledge gain) associated with this particular mediated communication event. This study expands effects-based research on political debate viewing by focusing on citizens' discrete emotional reactions to candidates (e.g., joy and anger). In addition, the influence of a 2004 Bush-Kerry presidential debate is analyzed in coordination with the consumption of Michael Moore's controversial film, Fahrenheit 9-11. A 2 (view Fahrenheit 9-11, did not view Fahrenheit 9-11) X 3 (low, medium, or high likelihood of elaboration) independent groups design was used for this study. The study finds evidence of both affect-as-transfer and passionate reasoning. In addition, there is clear support for goal oriented emotional reactions to candidates strongly predicting overall confidence in candidates' policy positions.     

Assessing the Role of Spirituality in Coping Among African Americans Diagnosed with Cancer

Spirituality plays an important role in cancer coping among African Americans. The purpose of this study was to report on the initial psychometric properties of instruments specific to the cancer context, assessing the role of spirituality in coping. Items were developed based on a theoretical model of spirituality and qualitative patient interviews. The instruments reflected connections to self, others, God, and the world. One hundred African American cancer survivors completed the instruments by telephone. The instruments showed adequate internal reliability, mixed convergent validity, discriminant validity, and interpretable factor structures.     

Dynamically oriented group therapy with alcoholics: Making it work despite the prevailing bias

A bias exists in the psychiatric community against dynamically oriented group therapy with alcoholics. The basis for this bias lies primarily in negative experiences of practitioners who have attempted to use traditional therapy with alcoholic patients who continued to drink. At Appleton Outpatient Clinic, we have found that dynamically oriented group therapy is a highly suitable treatment modality for alcoholic patients when negative biases of treators can be addressed and when initial preparatory work is done with patients. This preparatory work includes: (a) building a working alliance around abstinence and providing adequate supports to make this possible; (b) explicit contracting that establishes clear treatment goals and consequences should the goals not be met; (c) preparatory short-termgroup experiences.This paper was presented at the 1988 annual meeting of the American Group Psychotherapy Association.     

Problem solving by reference to rules or previous episodes: The effects of organized training,analogical models,and subsequent complexity of experience

Subjects learned a microcomputer drawing package under different conditions of training organization and practice complexity. Training instructions were presented in either a random or an organized order, and with or without an analogical model of the software package. Practice trials varied in visual and logical complexity. Performance on paper-arid-pencil and problem-solving tests was better following the model than following the no-model condition when practice trials were logically complex; the reverse was true when they were logically simple. Performance on the test of problem solving was also better following organized training than following randomly ordered training when practice trials were visually complex; the reverse was true following visually simple practice. We propose that the subjects performed the tasks by engaging in either episodebased or rule-based processing, and that performance was optimized when the processing used at encoding and retrieval was the same. The acquisition of skill in solving real problems is explained as procedural compilation.