Building and Maintaining Clinical Programs

This paper describes the basic elements of practice development and management within the academic medical setting. These include assessment of the market environment, both in the community and within the medical setting, product development, marketing, budget basics, quality, managed care negotiations, and finding time to do research in a financially-driven health care system.     

Mental health service utilization among Puerto Rican children ages 4 through 16

This paper examines those children receiving mental health services in Puerto Rico, their demographic and psychosocial characteristics, and describes service providers and nature of facilities. The survey was done on a probability sample of children ages 4 through 16 across the island of Puerto Rico (N=777). Need for services was clinically defined as presence of a DSM-III diagnosis and functional impairment. The overall rate of service utilization for Puerto Rican children was 6% (26.2% of definite cases and 5.1% of probable cases). In most cases services were provided by psychologists and/or social workers, and they were mainly provided in schools and general medical facilities. In over 60% of the children assessed as cases, who did not receive services, the reason, given by the parent was that they considered the problem not serious. Factors associated with service utilization were measures of psychopathology, teacher's perceived need, and parental rates of criticism and hostility. These findings suggest that there is a need for more research on the motivating factors for service use (impairment and parental criticism). Teachers could benefit from receiving special training to help them readily recognize behavioral problems in children, communicate them to parents and set up services alternatives.     

Evaluating children's mental health service systems: An analysis of critical behaviors and events

A lack of studies which evaluate system change by tracking client outcomes is noted in the children's mental health area. This deficit may be a result of the inability of researchers to define outcomes and to draw conclusions about which measures reflect the efficacy of services and service delivery systems. This paper reviews five social validation surveys which examined children's mental health outcome measures. Based on the results of the five surveys, a model of critical behaviors and events is presented. This model will assist evaluators and researchers in understanding which critical events and behaviors should be measured to assess the impact of community-based mental health services for children.     

Looking at remembering: Eye movements,pupil size,and autobiographical memory

To examine the relationship between visual imagery and autobiographical memory, eye position and pupil size were recorded while participants first searched for memories and then reconstructed the retrieved memories (Experiment 1), or only searched for memories (Experiment 2). In Experiment 1, we observed that, although recollective experience was not associated with the number of fixations per minute, memories that took longer to retrieve were linked to increased pupil size. In Experiment 2, we observed that directly retrieved memories were recalled more quickly and were accompanied by smaller pupils than generatively retrieved memories. After correcting for response time, retrieval mode also produced an effect, showing that decreased pupil size is not simply due to directly retrieved memories being recalled more quickly. These findings provide compelling evidence that objective measures, such as pupil size, can be used alongside subjective measures, such as self-reports, to distinguish between directly retrieved and generatively retrieved memories.     

From sport to eco: A case study of driver inputs on electric vehicle efficiency

This study focuses on driver-induced changes to vehicle energy and emissions performance by altering drivetrain configurations. It defines and examines the motivations for the use of drive modes in plug-in hybrid electric vehicles (PHEVs). Drive modes are defined as user-selectable drivetrain configurations that allow drivers to change vehicle performance aspects such as altering its propulsion status from electric to gas, changing the steering responsiveness, suspension stiffness, and regenerative braking strength. Despite the direct impact they have on the vehicle’s energy usage, greenhouse gas emissions, and local air emissions, the impact of drive modes are not traditionally measured as part of the vehicle’s performance and certification tests. The impact of drive mode choice can explain a portion of the discrepancy between PHEVs expected and on road performance as a recent study by the authors found that the use of certain modes can result in a 15–30% increase in total energy usage in a vehicle traveling at freeway speeds.This is the first study to examine the motivations for the use of these drive modes and provides an overview of PHEV drive modes, classifying them into two main mode categories (propulsion adjustment and driver experience) and eight different mode types based on their intended purpose. This is followed by a logistic regression of 11 indicators for mode usage taken from a survey of over 4,500 PHEV owning households, showing that gender and the number of long-distance trips were the most commonly associated with usage across mode types.     

调节模式对选择超载的影响及其机制：一个有中介的调节模型

当前,选择超载领域研究的焦点已从验证其是否存在,转向至其何时存在,即边界条件的探讨。本研究基于调节模式理论,分别以决策后悔和延迟选择作为选择超载的指标,开展两个实验探查选择超载存在的调节模式条件及所涉及的内在机制。实验1以决策后悔作指标,运用量表测试法操纵调节模式,初步探讨调节模式对选择超载的影响,结果发现调节模式调节了选项集与决策后悔的关系,即对评估模式的个体来说,面对大选项集比小选项集时体验到更强的后悔情绪,出现了选择超载,而对运动模式的个体而言,两种条件下的决策后悔无显著差异;实验2以延迟选择作指标,通过任务启动法操纵调节模式,进一步探讨调节模式对选择超载的影响及其机制,结果发现调节模式调节了选项集与延迟选择的关系,即对评估模式的个体来说,面对大选项集比小选项集时更倾向于延迟选择,出现了选择超载,而对运动模式的个体而言,两种条件下的延迟选择偏好无显著差异,进一步有中介的调节模型分析表明选择难度可以部分解释这种效应。总之,通过采用不同方法操纵调节模式,选取不同的选择超载指标,数据结果都一致支持：评估模式的个体比运动模式的个体更容易出现选择超载,选择难度在其中发挥着一定的中介作用。     

Citizen Advocacy Observed: Tool or Tokenism?

Citizen advocacy, where a volunteer works in partnership with a vulnerable person, compliments self- and legal advocacy. In the context of mental health services, citizen advocacy is a tool for enabling and empowering people who use these services, and is founded on the recognition that mental health service users are frequently socially oppressed and disadvantaged. This article describes the development of a Citizen Advocacy service for people with mental health difficulties, and also the problems they brought to this service. The problems encountered in sustaining the service are noted and lessons are drawn for the future.