Modification indices for the 2-PL and the nominal response model

In this paper, it is shown that various violations of the 2-PL model and the nominal response model can be evaluated using the Lagrange multiplier test or the equivalent efficient score test. The tests presented here focus on violation of local stochastic independence and insufficient capture of the form of the item characteristic curves. Primarily, the tests are item-oriented diagnostic tools, but taken together, they also serve the purpose of evaluation of global model fit. A useful feature of Lagrange multiplier statistics is that they are evaluated using maximum likelihood estimates of the null-model only, that is, the parameters of alternative models need not be estimated. As numerical examples, an application to real data and some power studies are presented.     

Genetic Counseling: Clinical Geneticists' Views

Evaluation of genetic counseling requires a clear consensus about its objectives, which is not evident in published definitions and guidelines. This study aims to investigate clinical geneticists' beliefs and thoughts about their practice. Structured interviews with eight clinical geneticists addressed the aims, skills, and expectations of genetic counseling. Analysis of transcribed interviews revealed four key themes, with contradictory aspects: 1. Providing information that is objective, full, and accurate versus information that is contingent on circumstances and tailored to individual needs. 2. Eliciting emotion and dealing with it directly versus dampening down and containing emotion. 3. Communicating nondirectively versus directively. 4. Expecting to perform a range of sophisticated tasks while having minimal training in the necessary skills to achieve these. These results have implications for the nature of the professional role, the development of training required for it, and the evaluation of genetic counseling.     

Are General Practitioners Willing and Able to Provide Genetic Services for Common Diseases?

Primary care in the United Kingdom has been advocated as an optimal location for the provision of genetic services for common diseases. Little, however, is known about general practitioners' own views toward this suggestion or the possible demand for such services from patients. To assess general practitioners' attitudes to providing genetic services for common diseases, and to estimate the demand from patients for these services, we used a single-page postal questionnaire survey of all 359 general practitioners registered with the Oxfordshire Health Authority; 339 (94%) responded. These physicians reported that a mean 4.1 patients (95% CI, 3.3–4.9) out of every 1,000 consulting them were concerned about their own risk of a common disease associated with a diagnosis in a family member. Half of the general practitioners (95% CI, 45–56%) counseled about genetics in the last year. A majority of general practitioners accept the need to provide genetic services, but far fewer are competent to do so. Although 60% (95% CI, 55–65%) believed they should be involved with genetic screening for common diseases, only 29% (95% CI, 24–34%) felt sufficiently prepared to take family histories and draw pedigrees, and only 15% (95% CI, 11–19%) felt sufficiently prepared to counsel patients about their genetic test results. Given the necessary training and information, 63% (95% CI, 58–68%) and 64% (95% CI, 59–69%) were willing to provide these services. Even with training and information, not all would be willing to provide these services, and lack of time may be a major deterrent. Practice-enabling strategies, such as computerized aids in genetics, may be useful.     

Evaluation of family intervention through unobtrusive audio recordings: experiences in "bugging" children

Five children referred to a child-family intervention program wore a radio transmitter in the home during pre-intervention and termination assessments. The transmitter broadcast to a receiver-recording apparatus in the home (either activated by an interval timer at predetermined "random" times or by parents at predetermined "picked" times). "Picked" times were parent-selected situations during which problems typically occurred (e.g., bedtime). Parents activated the recorder regularly whether or not problems occurred. Child-deviant, parent-negative, and parent-commanding behaviors were significantly higher at the picked times during pretest than at random times. At posttest, behaviors in all three classes were substantially reduced at picked times, but not at random times. For individual subject data, reductions occurred in at least two of the three dependent variables for three of the five cases during random time assessments. In general, the behavioral outcome data corresponded to parent-attitude reports and parent-collected observation data.     

II. Genotype-environment interaction in the schizophrenia spectrum: qualitative observations

Previous reports from the Finnish Adoptive Family Study of Schizophrenia have documented significant interplay between genetics (G) and family rearing (E), leading to adoptee outcomes of schizophrenia spectrum disorders. Quantitative evidence for this interplay is significantly enhanced when both high genetic liability and severe environmental dysfunction are present. However, when either genetic liability is low or the rearing environment is healthy, the adoptees appear to be resiliently protected against a pathologic outcome. Nevertheless, exceptions to this pattern do occur. Six qualitative vignettes, together with quantitative measures and categorical diagnoses from the same families, illustrate how multiple methods partially confirm one another and also suggest where further exploration of gene-environment interaction is needed.     

Genetic Evaluation and Counseling of Couples with Recurrent Miscarriage: Recommendations of the National Society of Genetic Counselors

The objective of this document is to provide recommendations for genetic evaluation and counseling of couples with recurrent miscarriage (RM). The recommendations are the opinions of the multidisciplinary Inherited Pregnancy Loss Working Group (IPLWG), with expertise in genetic counseling, medical genetics, maternal fetal medicine, internal medicine, infectious disease, cytogenetics, and coagulation disorders. The IPLWG defines RM as three or more clinically recognized consecutive or non-consecutive pregnancy losses occurring prior to fetal viability (<24 weeks gestation). These recommendations are provided to assist genetic counselors and other health care providers in clinical decision-making, as well as to promote consistency of patient care, guide the allocation of medical resources, and increase awareness of the psychosocial and cultural issues experienced by couples with RM. The IPLWG was convened with support from the March of Dimes Western Washington State Chapter and the University of Washington Division of Medical Genetics. The recommendations are U.S. Preventive Task Force Class III, and are based on clinical experiences, review of pertinent English-language published articles, and reports of expert committees. This document reviews the suspected causes of RM, provides indications for genetic evaluation and testing, addresses psychosocial and cultural considerations, and provides professional and patient resources. These recommendations should not be construed as dictating an exclusive course of medical management, nor does the use of such recommendations guarantee a particular outcome. The professional judgment of a health care provider, familiar with the circumstances of a specific case, should always supersede these recommendations.     

Listener perceptions of stuttering and stuttering modification techniques

PurposeThe purpose of this study was to analyse naïve listener perceptions of speech containing unmodified stuttering, use of the pull-out technique, and use of preparatory-sets.MethodParticipants (N = 62) were randomly assigned to listen to one audio sample (unmodified stuttered speech, speech with pull-outs, or speech with preparatory-sets) and completed a survey assessing perceptions of the speaker’s speech and personality and the listener’s comfort level and willingness to social interact with the speaker.ResultsSurvey results revealed low perceptual ratings in all experimental conditions. Unmodified stuttered speech received significantly more positive ratings than the stuttering modification conditions in all measurements except for speech naturalness. Listeners reported being less willing to socially interact with those who use preparatory-sets than unmodified stuttered speech.ConclusionThe use of stuttering modification techniques did not improve listeners’ perceptions or willingness to interact with persons who stutter. Clinicians and those who stutter should be aware that the use of speech techniques will not decrease negative social interactions or stereotypes.     

Maintaining placement for troubled and disruptive adolescents in voluntary residential care: The role of reduced youth-to-staff ratio

We evaluated a program to protect the placements of 23 highly troublesome youth in voluntary residential care by reducing youth-to-staff ratios. Specifically, the youth were moved from regular program homes (with eight youth) to reduced ratio homes (with only four youth) instead of being terminated from the program. We provide evidence supporting the assertion that youth in the study sample were highly troublesome and at high risk for program failure and more restrictive placements. Placement in the reduced ratio homes protected the trouble youths' placement, resulting in an additional mean length of stay of 950 day without an increase in program restrictiveness. Further, the reduced ratio homes increased the chances of success in the program for the study sample to a level equivalent to that for the much less troubled comparison sample. Cost estimates are also provided.     

Lessons Learned: Providing Supportive Accountability in an Online Anxiety Intervention

Technology-delivered interventions have the potential to help address the treatment gap in mental health care but are plagued by high attrition. Adding coaching, or minimal contact with a nonspecialist provider, may encourage engagement and decrease dropout, while remaining scalable. Coaching has been studied in interventions for various mental health conditions but has not yet been tested with anxious samples. This study describes the development of and reactions to a low-intensity coaching protocol administered to N = 282 anxious adults identified as high risk to drop out of a web-based cognitive bias modification for interpretation intervention. Undergraduate research assistants were trained as coaches and communicated with participants via phone calls and synchronous text messaging. About half of the sample never responded to coaches’ attempts to schedule an initial phone call or did not answer the call, though about 30% completed the full intervention with their coach. Some anxious adults may choose technology-delivered interventions specifically for their lack of human contact and may fear talking to strangers on the phone; future recommendations include taking a more intensive user-centered design approach to creating and implementing a coaching protocol, allowing coaching support to be optional, and providing users with more information about how and why the intervention works.     

Downsizing and Supersizing: How Changes in Product Attributes Influence Consumer Preferences

This paper investigates how changing the value of one attribute while keeping other attributes constant influences consumers' judgments and behaviors. We find that in two options, a proportionally equal change in one attribute tilts people's preference toward the option with higher (or lower) absolute magnitude of change when the change is desirable (or undesirable). We propose that when individuals face an attribute change, they use a deliberative and effortful response, known as System 2, to detect the change. However, they rely less on this system to evaluate the changed options. Instead, a more automatic System 1 processing influences their decision by making them apply the bigger‐is‐better heuristic (bigger‐is‐worse for an undesirable change) to prefer the option with the highest (lowest) absolute magnitude of change. Six studies demonstrate this phenomenon in both lab and real settings and support our hypothesis. Copyright © 2013 John Wiley & Sons, Ltd.