Prediction of Alcoholics Anonymous affiliation from pretreatment factors : methods and theory to inform provider referrals

Introduction: Treatment providers commonly emphasize and teach Alcoholics Anonymous (AA) philosophies and beliefs in treating alcohol disorders. The high rate of post-treatment relapse into harmful drinking suggests a need for extended care beyond initial treatment, and practitioners commonly refer clients to AA for aftercare. Although An abundance of correlational research suggests that greater AA affiliation is moderately and consistently associated with improved drinking outcomes, the vast majority of those who try AA drop out or substantially curtail affiliation ( disaffiliation ) within a year.Despite this, AA generally is believed to represent an affordable and effective adjunct and extension of initial treatment. Objective: The purpose of this study is to predict AA affiliation using information available at treatment and to advance knowledge surrounding affiliative processes. Literature from previous research and theory is used to develop hypotheses and a model of affiliation involving domains of motivation, coping skills and cultural fit. Methods: Using the Project MATCH data, two classification methods (binary logistic regression and artificial neural networks) are used to test hypotheses and predict AA affiliation at one-year post-treatment. Affiliation was operationalized to include dimensions of (1) meeting attendance or exposure, and (2) level of involvement or participation in AA activities. The affiliation construct was measured using the Alcoholics Anonymous Involvement scale (AAI) administered at 12 months post-treatment (N = 1,506). The study attempts to optimize classification accuracy on a dichotomous response variable that includes disaffiliates or moderate to high affiliates class membership. Results: Significance tests of 58 predictor variables suggested that the pretreatment AAI, divorced and separated marital statuses, age.treatment assignment, treatment site (representing inpatient or outpatient subjects),guilt/worry surrounding drinking and religiosity are significant predictors of affiliation.Prior affiliation (the pretreatment AAI) is a good predictor of affiliation. Despiteconsiderable prior theory and empirical evidence, motivation, severity, self-efficacy and external help-seeking measures were not significant predictors. Results are explained using theories borrowed from the organizational culture and climate literature. Attempts To predict affiliation were moderately successful (kappa = .42, sensitivity = 74%,specificity = 68%)

Assessment of digital image correlation measurement errors: methodology and results

Optical full-field measurement methods such as Digital Image Correlation (DIC) are increasingly used in the field of experimental mechanics, but they still suffer from a lack of information about their metrological performances. To assess the performance of DIC techniques and give some practical rules for users, a collaborative work has been carried out by the Workgroup “Metrology” of the French CNRS research network 2519 “MCIMS (Mesures de Champs et Identification en Mécanique des Solides / Full-field measurement and identification in solid mechanics, http://www.ifma.fr/lami/gdr2519)”. A methodology is proposed to assess the metrological performances of the image processing algorithms that constitute their main component, the knowledge of which being required for a global assessment of the whole measurement system. The study is based on displacement error assessment from synthetic speckle images. Series of synthetic reference and deformed images with random patterns have been generated, assuming a sinusoidal displacement field with various frequencies and amplitudes. Displacements are evaluated by several DIC packages based on various formulations and used in the French community. Evaluated displacements are compared with the exact imposed values and errors are statistically analyzed. Results show general trends rather independent of the implementations but strongly correlated with the assumptions of the underlying algorithms. Various error regimes are identified, for which the dependence of the uncertainty with the parameters of the algorithms, such as subset size, gray level interpolation or shape functions, is discussed

Medicaid Prior Authorization Policies for Medication Treatment of Attention-Deficit/Hyperactivity Disorder in Young Children, United States, 2015

Objectives: In 2011, the American Academy of Pediatrics updated its guidelines for the diagnosis and treatment of children with attention-deficit/hyperactivity disorder (ADHD) to recommend that clinicians refer parents of preschoolers (aged 4-5) for training in behavior therapy and subsequently treat with medication if behavior therapy fails to sufficiently improve functioning. Data available from just before the release of the guidelines suggest that fewer than half of preschoolers with ADHD received behavior therapy and about half received medication. About half of those who received medication also received behavior therapy. Prior authorization policies for ADHD medication may guide physicians toward recommended behavior therapy. Characterizing existing prior authorization policies is an important step toward evaluating the impact of these policies on treatment patterns. We inventoried existing prior authorization policies and characterized policy components to inform future evaluation efforts. Methods: A 50-state legal assessment characterized ADHD prior authorization policies in state Medicaid programs. We designed a database to capture data on policy characteristics and authorization criteria, including data on age restrictions and fail-first behavior therapy requirements. Results: In 2015, 27 states had Medicaid policies that prevented approval of pediatric ADHD medication payment without additional provider involvement. Seven states required that prescribers indicate whether nonmedication treatments were considered before Medicaid payment for ADHD medication could be approved. Conclusion: Medicaid policies on ADHD medication treatment are diverse; some policies are tied to the diagnosis and treatment guidelines of the American Academy of Pediatrics. Evaluations are needed to determine if certain policy interventions guide families toward the use of behavior therapy as the first-line ADHD treatment for young children.Temple University. James E. Beasley School of LawLawIn 2011, the American Academy of Pediatrics updated its guidelines for diagnosing and treating children with attention deficit/hyperactivity disorder, which is also known as ADHD. That same year, around 6.4 million US children ages 4-17 had been diagnosed with ADHD. The new guidelines recommend that clinicians refer parents for training in behavior therapy first, and then treat with medication if that therapy fails to improve the child’s functioning. Data from the before the release of those guidelines showed that fewer than half of preschoolers with ADHD received behavior therapy. Prior authorization policies for ADHD medication could guide physicians toward recommending behavior therapy. This study, by researchers from CDC and the Center for Public Health Law Research, used policy surveillance to inventory state Medicaid prior authorization policies for ADHD medication. Explore the policy surveillance data on ADHD medication prior authorization policies at LawAtlas.org. As of 2015, 27 states had Medicaid policies that prevented approval of pediatric ADHD medication payment without additional provider involvement. Seven states required prescribers to indicate whether non-medication treatments were considered BEFORE Medicaid payment for ADHD medication could be approved. The study finds a diverse landscape of Medicaid policies – some tied to diagnosis, others tied to AAP guidelines. The authors suggest that this study is a first step to understanding how policy interventions may guide families toward the use of behavior therapy as a first-line in ADHD treatment for young children

Assessing satisfaction with social care services among black and minority ethnic and white British carers of stroke survivors in England

Overall satisfaction levels with social care are usually high but lower levels have been reported among black and minority ethnic (BME) service users in England. Reasons for this are poorly understood. This qualitative study therefore explored satisfaction with services among informal carer participants from five different ethnic groups. Fifty-seven carers (black Caribbean, black African, Asian Indian, Asian Pakistani and white British) were recruited from voluntary sector organisations and a local hospital in England, and took part in semi-structured interviews using cognitive interviewing and the critical incident technique. Interviews took place from summer 2013 to spring 2014. Thematic analysis of the interviews showed that participants often struggled to identify specific ‘incidents’, especially satisfactory ones. When describing satisfactory services, participants talked mostly about specific individuals and relationships. Unsatisfactory experiences centred on services overall. When rating services using cognitive interviewing, explicit comparisons with expectations or experiences with other services were common. Highest satisfaction ratings tended to be justified by positive personal characteristics among practitioners, trust and relationships. Lower level ratings were mostly explained by inconsistency in services, insufficient or poor care. Lowest level ratings were rare. Overall, few differences between ethnic groups were identified, although white British participants rated services higher overall giving more top ratings. White British participants also frequently took a more overall view of services, highlighting some concerns but still giving top ratings, while South Asian carers in particular focused on negative aspects of services. Together these methods provide insight into what participants mean by satisfactory and unsatisfactory services. Cognitive interviewing was more challenging for some BME participants, possibly a reflection of the meaningfulness of the concept of service satisfaction to them. Future research should include comparisons between BME and white participants’ understanding of the most positive parts of satisfaction scales and should focus on dissatisfied participants

Qualitative focus group study investigating experiences of accessing and engaging with social care services: perspectives of carers from diverse ethnic groups caring for stroke survivors

OBJECTIVES: Informal carers, often family members, play a vital role in supporting stroke survivors with post-stroke disability. As populations age, numbers of carers overall and those from minority ethnic groups in particular, are rising. Carers from all ethnic groups, but especially those from black and minority ethnic groups frequently fail to access support services, making understanding their experiences important. The study therefore explored the experiences of carers of stroke survivors aged 45+ years from 5 ethnic groups in accessing and receiving social care services after hospital discharge. DESIGN: This qualitative study used 7 recorded focus groups with informal carers of stroke survivors. Data were analysed thematically focusing on similarities and differences between ethnic groups. SETTING: Carers were recruited from voluntary sector organisations supporting carers, stroke survivors and black and minority ethnic groups in the UK. PARTICIPANTS: 41 carers from 5 ethnic groups (Asian Indian, Asian Pakistani, black African, black Caribbean, white British) participated in the focus groups. RESULTS: Several interconnected themes were identified including: the service gap between hospital discharge and home; carers as the best person to care and cultural aspects of caring and using services. Many themes were common to all the included ethnic groups but some related to specific groups. CONCLUSIONS: Across ethnic groups there were many similarities in the experiences of people caring for stroke survivors with complex, long-term care needs. Accessing services demands effort and persistence on carers' part. If carers believe services are unsatisfactory or that they, rather than formal services, should be providing support for stroke survivors, they are unlikely to persist in their efforts. Cultural and language differences add to the challenges black and minority ethnic group carers face

Perceptions of the role of general practice and practical support measures for carers of stroke survivors: a qualitative study.

BACKGROUND: Informal carers frequently suffer adverse consequences from caring. General practice teams are well positioned to support them. However, what carers of stroke survivors want and expect from general practice, and the practical support measures they might like, remain largely unexplored.The aims of this study are twofold. Firstly it explores both the support stroke carers would like from general practice and their reactions to the community based support proposed in the New Deal. Secondly, perceptions of a general practice team are investigated covering similar topics to carer interviews but from their perspective. METHODS: Semi-structured interviews were conducted with 13 stroke carers and 10 members of a general practice team. Carers' experiences and expectations of general practice and opinions of support measures from recent government policy were explored. General practice professionals were asked about their perceived role and their perceptions of carers' support needs. Interviews were content analysed. RESULTS: Carers' expectations of support from general practice were low and they neither received nor expected much support for themselves. General practice was seen as reactive primarily because of time constraints. Some carers would appreciate emotional support but others did not want additional services. Responses to recent policy initiatives were mixed with carers saying these might benefit other carers but not themselves.General practice professionals' opinions were broadly similar. They recognise carers' support needs but see their role as reactive, focussed on stroke survivors, rather than carers. Caring was recognised as challenging. Providing emotional support and referral were seen as important but identification of carers was considered difficult. Time constraints limit their support. Responses to recent policy initiatives were positive. CONCLUSIONS: Carers' expectations of support from general practice for themselves are low and teams are seen as reactive and time constrained. Both the carers and the general practice team participants emphasised the valuable role of general practice team in supporting stroke survivors. Research is needed to determine general practice teams' awareness and identification of carers and of the difficulties they encounter supporting stroke carers. Carer policy initiatives need greater specificity with greater attention to diversity in carer needs

The position of graptolites within Lower Palaeozoic planktic ecosystems.

An integrated approach has been used to assess the palaeoecology of graptolites both as a discrete group and also as a part of the biota present within Ordovician and Silurian planktic realms. Study of the functional morphology of graptolites and comparisons with recent ecological analogues demonstrates that graptolites most probably filled a variety of niches as primary consumers, with modes of life related to the colony morphotype. Graptolite coloniality was extremely ordered, lacking any close morphological analogues in Recent faunas. To obtain maximum functional efficiency, graptolites would have needed varying degrees of coordinated automobility. A change in lifestyle related to ontogenetic changes was prevalent within many graptolite groups. Differing lifestyle was reflected by differing reproductive strategies, with synrhabdosomes most likely being a method for rapid asexual reproduction. Direct evidence in the form of graptolithophage 'coprolitic' bodies, as well as indirect evidence in the form of probable defensive adaptations, indicate that graptolites comprised a food item for a variety of predators. Graptolites were also hosts to a variety of parasitic organisms and provided an important nutrient source for scavenging organisms

Exploring the Potential Role of Family History of Hypertension on Racial Differences in Sympathetic Vascular Transduction

The prevalence of hypertension in Non-Hispanic Black (BL) men surpasses all other racial groups. Our laboratory has previously demonstrated exaggerated vasoconstrictor and blood pressure (BP) responses to spontaneous bursts of muscle sympathetic nerve activity (MSNA; sympathetic vascular transduction) in young, healthy BL men compared to their Non-Hispanic White (WH) counterparts. Because a family history of hypertension (FHH) further compounds cardiovascular risk, we wanted to begin to explore the potential impact of a positive (+) FHH on sympathetic vascular transduction. Whether a +FHH influences sympathetic vascular transduction in WH and/or BL men remains unknown. PURPOSE: To begin to explore if +FHH influences sympathetic vascular transduction within and between racial groups. METHODS: 22 men, nine with a +FHH (4 BL men) and 13 without a FHH (-FHH; 6 BL men) were recruited. Beat-to-beat BP (Finometer), femoral artery blood flow (Doppler ultrasound), and MSNA were measured during a 20-minute quiet rest. The mean BP and leg vascular conductance (LVC; blood flow/mean BP) responses to spontaneous bursts of MSNA were quantified via a signal averaging technique. RESULTS: Resting heart rate, BP, and MSNA were not significantly different between groups (all p\u3e0.05). As previously demonstrated by our laboratory, the BL men exhibited an augmented sympathetic vascular transduction compared to the WH men (e.g., peak BP response, WH men: Δ4.1±0.3, BL men: Δ5.6±0.7 mmHg, p=0.04). When accounting for FHH within the groups, the peak BP (WH +FHH: Δ4.4±0.6 vs. WH -FHH: Δ3.8±0.4 mmHg, p=0.4) and nadir LVC responses (WH +FHH: Δ-0.5±0.07 vs. WH -FHH: Δ-0.5±0.09 ml·min-¹·mmHg-¹, p=0.7) were not significantly different between WH men +FHH and WH men –FHH. Likewise, the BL men +FHH exhibited similar peak BP (BL +FHH: Δ6.2±0.7 vs. BL -FHH: Δ5.3±1.1 mmHg, p=0.5) and nadir LVC (BL +FHH: Δ-1.1±0.44 vs. BL -FHH: Δ-0.6±0.10 ml·min-¹·mmHg-¹, p=0.2) responses to bursts of MSNA compared to the BL men –FHH. CONCLUSION: These preliminary findings do not support a role for +FHH in augmented sympathetic vascular transduction, therefore suggesting that racial differences in sympathetic vascular transduction are independent of FHH

A tale of two towns: A comparative study exploring the possibilities and pitfalls of social capital among people seeking recovery from substance misuse

Background: Social capital has become an influential concept in debating and understanding the modern world. Within the drug and alcohol sector, the concept of ‘recovery capital’ has gained traction with researchers suggesting that people who have access to such capital are better placed to overcome their substance use-related problems than those who do not (Cloud and Granfield, 2008), leading to requests for interventions that focus on building social capital networks (Neale & Stevenson, 2015). While accepting that the concept of social capital has enormous potential for addressing the problems associated with drug use, this paper also considers its ‘dark side’. Methods: Data were drawn from semi-structured interviews with 180 participants including 135 people who use drugs and 45 people who formerly used drugs. Results: High levels of trust, acquired through the establishment of dense social networks, are required to initiate recovery. However, these ‘strong bonds’ may also lead to the emergence of what is perceived by others as an exclusive social network that limits membership to those who qualify and abide by the ‘rules’ of the recovery community, particularly around continuous abstinence. Conclusions: Depending on the nature of the networks and the types of links participants have into them being socially connected can both inhibit and encourage recovery. Therefore, the successful application of social capital within the drugs and alcohol field requires a consideration of not only the presence or absence of social connections but their nature, the value they produce, and the social contexts within which they are developed

Genome-wide DNA methylation map of human neutrophils reveals widespread inter-individual epigenetic variation

The extent of variation in DNA methylation patterns in healthy individuals is not yet well documented. Identification of inter-individual epigenetic variation is important for understanding phenotypic variation and disease susceptibility. Using neutrophils from a cohort of healthy individuals, we generated base-resolution DNA methylation maps to document inter-individual epigenetic variation. We identified 12851 autosomal inter-individual variably methylated fragments (iVMFs). Gene promoters were the least variable, whereas gene body and upstream regions showed higher variation in DNA methylation. The iVMFs were relatively enriched in repetitive elements compared to non-iVMFs, and were associated with genome regulation and chromatin function elements. Further, variably methylated genes were disproportionately associated with regulation of transcription, responsive function and signal transduction pathways. Transcriptome analysis indicates that iVMF methylation at differentially expressed exons has a positive correlation and local effect on the inclusion of that exon in the mRNA transcript