Data-Driven Change in Oregon Psychologists’ Knowledge and Attitudes about Prescriptive Authority

With over half of all states having considered legislating prescriptive authority, an immense amount of time and money has been invested. The literature is limited in terms of understanding if opinions toward prescriptive authority are grounded in knowledge and what implications that has for altering these opinions. Following a veto of a prescriptive authority bill in Oregon, 160 licensed Oregon clinical psychologists were surveyed regarding their attitudes and knowledge. In terms of knowledge, only 5.6% knew which three states/territories currently have prescriptive authority and 70.4% were unfamiliar with any of the prerequisites for postdoctoral training in psychopharmacology. Reflecting division, 42.8% were in favor, 20.1% were undecided, and 37.1% were in opposition to broadening privileges for psychologists. Further, only 15.1% expressed interest in pursuing training or 6.4% in becoming a prescriber. Data on access, training, and legislative costs were presented to participants in the education condition. These participants showed significant gains in their knowledge across all domains and their opinions shifted only in these specific areas leaving their general stance on the issue unchanged. In contrast to ardent supporters who argue that their “data should provide reassurance to psychologists spearheading legislative initiatives” because of high approval ratings (Sammons et al., 2000, p. 608), our data suggest disagreement amongst a group of professionals who are not particularly well-informed, nor interested in becoming prescribers. Future work should investigate whether expanding the data relevant to other facets of the argument contributes to further targeted change or an overall change in opinion toward prescriptive authority

Oregon Psychologists on Prescriptive Authority: Divided Views and Little Knowledge

With over half of all states having considered legislating prescriptive authority, an immense amount of time and money has been invested. The literature is limited in terms of understanding if opinions toward prescriptive authority are grounded in knowledge and what implications that has for altering these opinions. Following a veto of a prescriptive authority bill in Oregon, 399 licensed Oregon clinical psychologists were surveyed regarding their attitudes and knowledge. In terms of knowledge, only 6.5% knew which three states/territories currently have prescriptive authority and 70.4% were unfamiliar with any of the prerequisites for postdoctoral training in psychopharmacology. Reflecting division, 43.4% were in favor, 25.4% were undecided, and 31.2% were in opposition to broadening privileges for psychologists. Further, only 15.2% expressed interest in pursuing training or 6.7% in becoming prescribers. Data on access, training, and legislative costs were presented to participants in the education condition. These participants showed significant gains in their knowledge across all domains and their opinions shifted only in these specific areas leaving their general stance on the issue unchanged. In contrast to ardent supporters who argue that their “data should provide reassurance to psychologists spearheading legislative initiatives” because of high approval ratings (Sammons et al., 2000, p. 608), our data suggest disagreement amongst a group of professionals who are not particularly well-informed, nor interested in becoming prescribers. Future work should investigate whether expanding the data relevant to other facets of the argument contributes to further targeted change or an overall change in opinion toward prescriptive authority

Penggunaan Abu Batu Bara Pltu Mpanau sebagai Bahan Stabilisasi Tanah Lempung

Penelitian ini bertujuan memeriksa pengaruh stabilisasi tanah lempung menggunakan bahanstabilisasi Abu batu bara dan semen. Abu batu bara yang digunakan adalah abu bara hasilpembakaran dari PLTU Mpanau Kecamatan Tawaeli Kota Palu yang lolos saringan No.200, tanahlempung yang diuji memiliki indeks plastisitas lebih besar dari 20. Sifat yang diperiksa adalah:Perubahan batas cair, kepadatan maksimum dan nilai CBR. Proporsi rancangan campuran terdiridari abu batu bara adalah 10% dan 20% semen sebesar 4% dan 8% masing-masing terhadapberat kering tanah lempung,.Hasil penelitian menunjukkan bahwa campuran abu batu bara dansemen mampu menurunkan nilai indeks plastisitas tanah lempung dari 27,33% menjadi 10,37 %,meningkatkan nilai CBR tanah dari 4,46% menjadi 13,8% untuk CBR rendaman dan dari 5,6%menjadi 15,5% untuk CBR tanpa rendama

Development and feasibility testing of an education program to improve knowledge and self-care among Aboriginal and Torres Strait Islander patients with heart failure

INTRODUCTION: There is a 70% higher age-adjusted incidence of heart failure (HF) among Aboriginal and Torres Strait Islander people, three times more hospitalisations and twice as many deaths as among non-Aboriginal people. There is a need to develop holistic yet individualised approaches in accord with the values of Aboriginal community health care to support patient education and self-care. The aim of this study was to re-design an existing HF educational resource (Fluid Watchers-Pacific Rim) to be culturally safe for Aboriginal and Torres Strait Islander peoples, working in collaboration with the local community, and to conduct feasibility testing.  METHODS: This study was conducted in two phases and utilised a mixed-methods approach (qualitative and quantitative). Phase 1 used action research methods to develop a culturally safe electronic resource to be provided to Aboriginal HF patients via a tablet computer. An HF expert panel adapted the existing resource to ensure it was evidence-based and contained appropriate language and images that reflects Aboriginal culture. A stakeholder group (which included Aboriginal workers and HF patients, as well as researchers and clinicians) then reviewed the resources, and changes were made accordingly. In Phase 2, the new resource was tested on a sample of Aboriginal HF patients to assess feasibility and acceptability. Patient knowledge, satisfaction and self-care behaviours were measured using a before and after design with validated questionnaires. As this was a pilot test to determine feasibility, no statistical comparisons were made.  RESULTS: Phase 1: Throughout the process of resource development, two main themes emerged from the stakeholder consultation. These were the importance of identity, meaning that it was important to ensure that the resource accurately reflected the local community, with the appropriate clothing, skin tone and voice. The resource was adapted to reflect this, and members of the local community voiced the recordings for the resource. The other theme was comprehension; images were important and all text was converted to the first person and used plain language. Phase 2: Five Aboriginal participants, mean age 61.6±10.0 years, with NYHA Class III and IV heart failure were enrolled. Participants reported a high level of satisfaction with the resource (83.0%). HF knowledge (percentage of correct responses) increased from 48.0±6.7% to 58.0±9.7%, a 20.8% increase, and results of the self-care index indicated that the biggest change was in patient confidence for self-care, with a 95% increase in confidence score (46.7±16.0 to 91.1±11.5). Changes in management and maintenance scores varied between patients.  CONCLUSIONS: By working in collaboration with HF experts, Aboriginal researchers and patients, a culturally safe HF resource has been developed for Aboriginal and Torres Strait Islander patients. Engaging Aboriginal researchers, capacity-building, and being responsive to local systems and structures enabled this pilot study to be successfully completed with the Aboriginal community and positive participant feedback demonstrated that the methodology used in this study was appropriate and acceptable; participants were able to engage with willingness and confidence

Impact of supported employment on service costs and income of people with mental health needs

Background: A 12-month study of UK supported employment providers found that 77 (54.6%) of the participants in the study remained unemployed, 32 (22.7%) got jobs and 32 (22.7%) retained the jobs they held at the outset. Aims: To explore the impact of moving into employment on service use, earnings, benefits and tax allowances claimed. Methods: Service use and frequency were measured at baseline and 12 months. Comparisons paid particular attention to the differences between people entering work and those who remained unemployed. Costs were analysed from a government perspective (excluding earnings) and a societal perspective (excluding welfare benefits and taxes). Results: People who entered work reduced their consumption of mental health services (p<0.001). However, use of supported employment increased (p=0.04), in contrast to falling use by people who remained unemployed (p<0.001) and those who had been working for more than one year (p=0.002). The increase in earnings for those entering work (p=0.02) was not offset by a similar reduction in benefits. Conclusion: This indicates that mental health services may make savings as a result of their clients engaging in paid work. It raises questions about the optimal nature and organization of employment support for this service user group

Reliability of HIV rapid diagnostic tests for self-testing compared with testing by health-care workers: a systematic review and meta-analysis.

BACKGROUND: The ability of individuals to use HIV self-tests correctly is debated. To inform the 2016 WHO recommendation on HIV self-testing, we assessed the reliability and performance of HIV rapid diagnostic tests when used by self-testers. METHODS: In this systematic review and meta-analysis, we searched PubMed, PopLine, and Embase, conference abstracts, and additional grey literature between Jan 1, 1995, and April 30, 2016, for observational and experimental studies reporting on HIV self-testing performance. We excluded studies evaluating home specimen collection because patients did not interpret their own test results. We extracted data independently, using standardised extraction forms. Outcomes of interest were agreement between self-testers and health-care workers, sensitivity, and specificity. We calculated κ to establish the level of agreement and pooled κ estimates using a random-effects model, by approach (directly assisted or unassisted) and type of specimen (blood or oral fluid). We examined heterogeneity with the I2 statistic. FINDINGS: 25 studies met inclusion criteria (22 to 5662 participants). Quality assessment with QUADAS-2 showed studies had low risk of bias and incomplete reporting in accordance with the STARD checklist. Raw proportion of agreement ranged from 85·4% to 100%, and reported κ ranged from fair (κ 0·277, p<0·001) to almost perfect (κ 0·99, n=25). Pooled κ suggested almost perfect agreement for both types of approaches (directly assisted 0·98, 95% CI 0·96-0·99 and unassisted 0·97, 0·96-0·98; I2=34·5%, 0-97·8). Excluding two outliers, sensitivity and specificity was higher for blood-based rapid diagnostic tests (4/16) compared with oral fluid rapid diagnostic tests (13/16). The most common error that affected test performance was incorrect specimen collection (oral swab or finger prick). Study limitations included the use of different reference standards and no disaggregation of results by individuals taking antiretrovirals. INTERPRETATION: Self-testers can reliably and accurately do HIV rapid diagnostic tests, as compared with trained health-care workers. Errors in performance might be reduced through the improvement of rapid diagnostic tests for self-testing, particularly to make sample collection easier and to simplify instructions for use. FUNDING: The Bill & Melinda Gates Foundation and Unitaid

Power of the Southern melting pot: analysis of Joel Chandler Harris’s Uncle Remus as Southern folklore and cultural appropriation

In this paper, I address the controversy of origins surrounding Joel Chandler Harris’s Uncle Remus collections. Based on James O. Young’s definitions of appropriation, I establish Harris’s work as evidence of cultural content appropriation of European, African, and Native American folklore. Harris specifically appropriates European and African folklore to further his own Post-Civil War psyche, attempting to preserve the ideal Southern past. Such preservation efforts are literally significant for they provide examples of appropriation that are done not out of an attempt to oppress European and African culture, but to integrate it into the developing Southern culture. The visible Native American appropriation, however, stands as evidence to the use of appropriation as a method of taking power and oppressing a minority group

Personal epistemology: Implications for stress in college students

This research study investigated whether college students\u27 epistemological beliefs (i.e. certain knowledge, simple knowledge, fixed ability, quick learning, and omniscient authority) could predict negative stressors and/or reactions to stress in their college experience. Based on responses to two self-assessment inventories and a demographic survey; analysis of the data suggests that over and above contributions from demographics (i.e. gender, ethnicity, age, and education level), certain dimensions of epistemological beliefs contributed significantly to the prediction of negative stress in college students. This suggests that it is essential for educators to provide opportunities for students\u27 epistemological development; specifically, in the area of constructing knowledge. Students need opportunities to view themselves as sources of knowledge (i.e. knowledge is constructed internally), which leads to development of a higher level of cognitive processing

Adult attachment, social comparison, romantic relationship experience, and well-being

A review of the adult attachment literature revealed previous research findings to demonstrate attachment-based baseline differences in the well-being factor of life satisfaction but not to consider moderating factors nor fluctuations in life satisfaction experience. Furthermore, social cognitive processes highlighted within the subjective well-being literature, namely those captured within social comparison theory, have rarely been examined within an adult attachment perspective. The current thesis sought to address these gaps through investigating the predictive influences of moderating and mediating factors in associations between adult attachment and well-being. Across 5 studies, individuals’ relationship experiences (namely relationship status, satisfaction, and status-changing events), social comparison tendencies (both within general and relationship- and partner-specific contexts), and social-comparison ranking perceptions were each examined. Findings revealed that relationship experiences indeed appeared to moderate individuals’ attachment-based feelings of subjective well-being, with greater anxiety in particular suggestive of more maladaptive cognitive and affective experience (Study 1). Social comparison tendencies, both general and interpersonally-oriented, were also identified to differ on the basis of anxiety and avoidance, with adverse comparison habits found to partially mediate associations between anxiety and both life satisfaction and self-esteem (Studies 2 and 4). Lastly, attachment-based differences in social-ranking perceptions were identified (Study 5), with anxiety found to interact with relationship status while an interaction between anxiety, ranking perceptions and relationship length as predictor of life satisfaction was found to be approaching significance