Longitudinal Impact of a Family Critical Time Intervention on Children in High-Risk Families Experiencing Homelessness: A Randomized Trial

A randomized trial compared effects of a Family Critical Time Intervention (FCTI) to usual care for children in 200 newly homeless families in which mothers had diagnosable mental illness or substance problems. Adapted from an evidence‐based practice to prevent chronic homelessness for adults with mental illnesses, FCTI combines housing and structured, time‐limited case management to connect families leaving shelter with community services. Families were followed at five time points over 24 months. Data on 311 children—99 ages 1.5–5 years, 113 ages 6–10 years, and 99 ages 11–16 years—included mother‐, teacher‐, and child‐reports of mental health, school experiences, and psychosocial well‐being. Analyses used hierarchical linear modeling to investigate intervention effects and changes in child functioning over time. Referral to FCTI reduced internalizing and externalizing problems in preschool‐aged children and externalizing for adolescents 11–16. The intervention led to declines in self‐reported school troubles for children 6–10 and 11–16. Both experimental and control children in all age groups showed reductions in symptoms over time. Although experimental results were scattered, they suggest that FCTI has the potential to improve mental health and school outcomes for children experiencing homelessness.     

Reducing the risk of bias in health behaviour change trials: Improving trial design,reporting or bias assessment criteria? A review and case study

Objective: It has been suggested that randomised controlled trials (RCTs) of health behaviour change (HBC) interventions are less rigorously designed than – for example– drug trials. This study presents an approach to clarifying whether this is due to poor trial design, incomplete trial reporting and/or the inappropriateness of commonly applied risk of bias assessment criteria.

Design: First, a framework of key sources of bias and common strategies for reducing bias risk is developed based on a literature review. Second, we describe the design of a multi-site RCT evaluating the cost-effectiveness of an HIV-treatment adherence intervention (case study). The choices made by the multidisciplinary team trying to minimise the risk of bias are compared against the risk of bias framework.

Main outcome measures: Implementation of common strategies for reducing the risk of bias in the case study; alternative or additional strategies applied; a justification for each deviation from the risk of bias framework.

Results: Most of the common strategies for reducing the risk of bias could be implemented. Alternative strategies were developed for minimising the risk of performance bias and contamination. Several additional, domain-specific risk of bias strategies were implemented.

Conclusions: The literature provides useful guidance for reducing the risk of bias in HBC trials. Yet, the case study suggests that HBC trial designers may face specific challenges that require alternative/additional measures for reducing the risk of bias. Using the risk of bias justification table (RATIONALE) could lead to better-designed HBC trials, more comprehensive trial reports and the data necessary for evaluating the appropriateness of commonly applied risk of bias assessment criteria to HBC trials.     

Teaching ethics: More than an honor code

An honor code is certainly a good place to start teaching engineering students about ethics, but teaching students to live honorably requires far more effort than memorizing a code of ethics statement or applying it just to academic performance. In the School of Engineering at Grand Valley State University, we have followed the model provided by the United States Military Academy at West Point. For our students this involves an introduction to the Honor Code as part of a larger Honor Concept at the very beginning of their studies and then making it an integral part of their preparation as engineers. The challenge is significant because the culture at large does not support living with an Honor Concept. This paper will begin with a discussion of the cultural context in which we must teach, because that context has changed significantly in the years since many faculty members were students themselves. The rest of the paper will detail the approach that we have taken to teach ethics as an engineer’s way of life. “The shortest and surest way to live with honor in the world is to be in reality what we would appear to be. All human virtues increase and strengthen themselves by the practice and experience of them.” Plato An earlier version of this paper was presented at the 2005 conference, Ethics and Social Responsibility in Engineering and Technology, Linking Workplace Ethics and Education, co-hosted by Gonzaga University and Loyola Marymount University, Los Angeles, CA, USA, 9–10 June 2005.     

Engineering ethics, individuals, and organizations

This article evaluates a family of criticism of how engineering ethics is now generally taught. The short version of the criticism might be put this way: Teachers of engineering ethics devote too much time to individual decisions and not enough time to social context. There are at least six version of this criticism, each corresponding to a specific subject omitted. Teachers of engineering ethics do not (it is said) teach enough about: 1) the culture of organizations; 2) the organization of organizations; 3) the legal environment of organizations; 4) the role of professions in organizations; 5) the role of organizations in professions; or 6) the political environment of organizations. My conclusion is that, while all six are worthy subjects, there is neither much reason to believe that any of them are now absent from courses in engineering ethics nor an obvious way to decide whether they (individually or in combination) are (or are not) now being given their due. What we have here is a dispute about how much is enough. Such disputes are not to be settled without agreement concerning how we are to tell we have enough of this or that. Right now we seem to lack that agreement—and not to have much reason to expect it any time soon. An earlier version of this paper was presented at the 2005 conference, Ethics and Social Responsibility in Engineering and Technology, Linking Workplace Ethics and Education, co-hosted by Gonzaga University and Loyola Marymount University, Los Angeles, CA, USA, 9–10 June 2005.     

Transdiagnostic Internet treatment for anxiety disorders: A randomized controlled trial

Clinician-guided Internet-based cognitive behavioural therapy (iCBT) programs are clinically effective at treating specific anxiety disorders. The present study examined the efficacy of a transdiagnostic Internet-based cognitive behavioural treatment (iCBT) program to treat more than one anxiety disorder within the same program (the Anxiety Program). Eighty six individuals meeting diagnostic criteria for generalized anxiety disorder (GAD), panic disorder, and/or social phobia were randomly assigned to a treatment group, or to a waitlist control group. Treatment consisted of CBT based online educational lessons and homework assignments, weekly email or telephone contact from a clinical psychologist, access to a moderated online discussion forum, and automated emails. An intention-to-treat model using the baseline-observation-carried-forward principle was employed for data analyses. Seventy-five percent of treatment group participants completed all 6 lessons within the 8 week program. Post-treatment data was collected from 38/40 treatment group and 38/38 control group participants, and 3-month follow-up data was collected from 32/40 treatment group participants. Relative to controls, treatment group participants reported significantly reduced symptoms of anxiety as measured by the Generalized Anxiety Disorder - 7 Item, Social Phobia Screening Questionnaire, and the Panic Disorder Severity Rating Scale - Self Report Scale, but not on the Penn State Worry Questionnaire, with corresponding between-groups effect sizes (Cohen’s d) at post-treatment of 0.78, 0.43, 0.43, and 0.20, respectively. The clinician spent a total mean time of 46 min per person over the program, participants rated the procedure as moderately acceptable, and gains were sustained at follow-up. Modifications to the Anxiety program, based on post-treatment feedback from treatment group participants, were associated with improved outcomes in the control group. These results indicate that transdiagnostic programs for anxiety disorders may be successfully administered via the Internet.     

Efficacy of self-administered treatments for pathological academic worry: A randomized controlled trial

Research on treatments for reducing pathological worry is limited. In particular, academic worry is a common theme in generalized anxiety disorder (GAD) samples as well as non-clinical student samples. Given the high cost of anxiety disorders to society, research is needed to examine the efficacy of self-administered treatments designed to reduce pathological worry. The primary goal of this study was to investigate the benefits of three self-administered interventions for reducing academic worry. College students (N = 113) experiencing clinically significant academic worry were randomized to either: (a) worry exposure (WE); (b) expressive writing (EW); (c) relaxation consisting of pulsed audio-photic stimulation (APS); or (d) waitlist control (WLC). Participants were instructed to practice their interventions three times per week for one month and completed home practice logs online to track treatment adherence. Academic worry, general anxiety, and perceived stress were assessed at baseline and post-treatment. Academic worry and general anxiety were also assessed at a three-month follow-up. Those assigned to the WE and APS conditions showed significant improvement relative to EW and WLC at post-treatment. All treatment conditions showed continued improvement by follow-up, with no between-group differences. Treatment and public health implications are discussed.     

CBL、PBL及Seminar结合的立体教学模式的应用和思考——临床医学八年制呼吸科床旁教学实践中的应用

临床医学八年制内科学床旁教学应用传统的教学模式及基于案例的学习（CBL）单一教学方法难以满足教学要求.将CBL与基于问题的学习（PBL）及研讨会（Seminar）结合的立体教学模式应用于呼吸科的床旁教学实践中,激发了学生学习的积极性、创新性,培养了学生良好的团队合作精神和临床思维模式,提高了学生们解决临床问题的能力,并能加深师生互动交流,达到教学相长的目的.     

医学教育发展的困局与突破

受“大跃进”思维模式影响,我国高等教育由精英化快速过渡到大众化,医学教育呈现出急剧膨胀的发展态势,在教育理念、培养体系、办学模式、学制结构、专业设置、教育质量等方面出现了许多新情况、新问题,陷入了发展困局.面对困局必须更新教育观念,加强统筹协调,推动医学教育科学发展.     

Shaping Medical Students' Attitudes Toward Ethically Important Aspects of Clinical Research: Results of a Randomized,Controlled Educational Intervention

The effects of research ethics training on medical students' attitudes about clinical research are examined. A preliminary randomized controlled trial evaluated 2 didactic approaches to ethics training compared to a no-intervention control. The participant-oriented intervention emphasized subjective experiences of research participants (empathy focused). The criteria-oriented intervention emphasized specific ethical criteria for analyzing protocols (analytic focused). Compared to controls, those in the participant-oriented intervention group exhibited greater attunement to research participants' attitudes related to altruism, trust, quality of relationships with researchers, desire for information, hopes about participation and possible therapeutic misconception, importance of consent forms, and deciding quickly about participation. The participant-oriented group also agreed more strongly that seriously ill people are capable of making their own research participation decisions. The criteria-oriented intervention did not affect learners' attitudes about clinical research, ethical duties of investigators, or research participants' decision making. An empathy-focused approach affected medical students' attunement to research volunteer perspectives, preferences, and attributes, but an analytically oriented approach had no influence. These findings underscore the need to further examine the differential effects of empathy-versus analytic-focused approaches to the teaching of ethics.     

Strategy instruction for writing composition at school and at home

Abstract

The objectives of this study are 1) to analyze the effectiveness of a writing composition intervention program aimed to increase children's writing performance and other personal variables; 2) to analyze whether implementation in the environment (school and home) or responsible figures (parents and teachers) produced different effects in program effectiveness; and 3) to check whether increasing parental involvement in doing homework was sufficient to improve children's outcomes or whether prior family training is required to enable them to be efficient. The sample consisted of 112 students (5th-6th grade) and their families. 26 of them made up the EFP group (mothers implementing a writing program), 25 of them were assigned to the PAD group (mothers increasing help with writing homework), 35 to the PRO group (teachers applying a writing program) and 26 to the OC group (ordinary curriculum). We analyze the results and present and discuss our conclusions.