The impact of psychiatric diagnosis on treatment adherence and duration among victimized children and adolescents in São Paulo, Brazil

OBJECTIVE: Despite the high prevalence of substance abuse and mood disorders among victimized children and adolescents, few studies have investigated the association of these disorders with treatment adherence, represented by numbers of visits per month and treatment duration. We aimed to investigate the effects of substance abuse and mood disorders on treatment adherence and duration in a special program for victimized children in São Paulo, Brazil. METHODS: A total of 351 participants were evaluated for psychiatric disorders and classified into one of five groups: mood disorders alone; substance abuse disorders alone; mood and substance abuse disorders; other psychiatric disorders; no psychiatric disorders. The associations between diagnostic classification and adherence to treatment and the duration of program participation were tested with logistic regression and survival analysis, respectively. RESULTS: Children with mood disorders alone had the highest rate of adherence (79.5%); those with substance abuse disorders alone had the lowest (40%); and those with both disorders had an intermediate rate of adherence (50%). Those with other psychiatric disorders and no psychiatric disorders also had high rates of adherence (75.6% and 72.9%, respectively). Living with family significantly increased adherence for children with substance abuse disorders but decreased adherence for those with no psychiatric disorders. The diagnostic correlates of duration of participation were similar to those for adherence. CONCLUSIONS: Mood and substance abuse disorders were strong predictive factors for treatment adherence and duration, albeit in opposite directions. Living with family seems to have a positive effect on treatment adherence for patients with substance abuse disorders. More effective treatment is needed for victimized substance-abusing youth

Metodología de evaluación de la gestión del conocimiento corporativo dentro del contexto del Modelo Suricata : aplicaciones

Programa de doctorado: Tecnologías de la Información y sus Aplicaciones

A partial dependence factorial analysis to deal with selection bias in observational studis

This thesis presents a creative and practical approach to dealing with the problem of selection bias. Selection bias may be the most important vexing problem in program evaluation or in any line of research that attempts to assert causality. Some of the greatest minds in economics and statistics have scrutinized the problem of selection bias, with the resulting approaches – Rubin’s Potential Outcome Approach(Rosenbaum and Rubin,1983; Rubin, 1991,2001,2004) or Heckman’s Selection model (Heckman, 1979) – being widely accepted and used as the best fixes. These solutions to the bias that arises in particular from self selection are imperfect, and many researchers, when feasible, reserve their strongest causal inference for data from experimental rather than observational studies. The innovative aspect of this thesis is to propose a data transformation that allows measuring and testing in an automatic and multivariate way the presence of selection bias. The approach involves the construction of a multi-dimensional conditional space of the X matrix in which the bias associated with the treatment assignment has been eliminated. Specifically, we propose the use of a partial dependence analysis of the X-space as a tool for investigating the dependence relationship between a set of observable pre-treatment categorical covariates X and a treatment indicator variable T, in order to obtain a measure of bias according to their dependence structure. The measure of selection bias is then expressed in terms of inertia due to the dependence between X and T that has been eliminated. Given the measure of selection bias, we propose a multivariate test of imbalance in order to check if the detected bias is significant, by using the asymptotical distribution of inertia due to T (Estadella et al. 2005) , and by preserving the multivariate nature of data. Further, we propose the use of a clustering procedure as a tool to find groups of comparable units on which estimate local causal effects, and the use of the multivariate test of imbalance as a stopping rule in choosing the best cluster solution set. The method is non parametric, it does not call for modeling the data, based on some underlying theory or assumption about the selection process, but instead it calls for using the existing variability within the data and letting the data to speak. The idea of proposing this multivariate approach to measure selection bias and test balance comes from the consideration that in applied research all aspects of multivariate balance, not represented in the univariate variable- by-variable summaries, are ignored. The first part contains an introduction to evaluation methods as part of public and private decision process and a review of the literature of evaluation methods. The attention is focused on Rubin Potential Outcome Approach, matching methods, and briefly on Heckman’s Selection Model. The second part focuses on some resulting limitations of conventional methods, with particular attention to the problem of how testing in the correct way balancing. The third part contains the original contribution proposed , a simulation study that allows to check the performance of the method for a given dependence setting and an application to a real data set. Finally, we discuss, conclude and explain our future perspectives.

Gesù continuatore di Giovanni. Studio storico-esegetico sulla relazione tra Gesù di Nazaret e Giovanni il Battista

L’enigma della relazione tra Gesù e Giovanni il Battista ha da sempre stimolato l’immaginazione storica degli studiosi, suscitando una varietà di ipotesi e valutazioni, spesso assai diverse. Ciò nonostante, tutti concordano su un punto: che, almeno nella sua fase maggiore in Galilea, il ministero di Gesù fosse una realtà essenzialmente autonoma, diversa, originale e irriducibile rispetto alla missione di Giovanni. In controtendenza con questa “impostazione predefinita”, il presente studio sostiene la tesi secondo cui Gesù portò avanti la sua missione come intenzionale e programmatica prosecuzione dell’opera prematuramente interrotta di Giovanni. Nella prima parte, si esamina approfonditamente quale memoria della relazione sia conservata nelle fonti più antiche, cioè Q (qui analizzata con particolare attenzione) e Marco – a cui si aggiunge Matteo, che, in ragione dello stretto legame storico-sociologico con Q, offre un esempio illuminante di rinarrazione della memoria altamente originale eppure profondamente fedele. La conclusione è che la memoria più antica della relazione Gesù-Giovanni è profondamente segnata da aspetti di accordo, conformità e allineamento. Nella seconda parte si esaminano una serie di tradizioni che attestano che Gesù era percepito pubblicamente in relazione al Battista e che egli stesso condivideva e alimentava tale percezione riallacciandosi a lui in polemica con i suoi avversari, e dipingendolo come una figura di capitale importanza nella predicazione e nell’insegnamento a seguaci e discepoli. Infine, si argomenta l’esistenza di ampie e sostanziali aree di accordo tra i due a livello di escatologia, istruzioni etiche e programma sociale, missione penitenziale verso i peccatori e attività battesimale. L’ipotesi che Gesù portasse avanti l’attività riformatrice di Giovanni, in termini di una campagna purificatoria “penitenziale-battesimale-esorcistica” in preparazione dell’avvento di Dio, consente infine di armonizzare in modo soddisfacente i due aspetti più caratteristici dell’attività di Gesù (normalmente giustapposti, quando non contrapposti): escatologia e miracoli, il Gesù profeta e il Gesù taumaturgo.

Evaluating Counseling Outcomes

Defines the range of interventions considered under the rubric of counseling for the elderly. Uses evaluation of treatments for depression among the elderly to exemplify the current state of outcome-evaluation research.

Assessing Nursing Assistants' Knowledge of Behavioral Approaches to Mental Health Problems

Nurse's aides are the primary caregivers in nursing homes, a major receiving site for elders with behavioral and psychiatric problems. We describe the development, psychometric properties, and utility of a brief instrument designed to assess aides' knowledge of three specific mental health problems (depression, agitation, and disorientation) and behavioral approaches to them. The instrument was administered to 191 nurse's aides and 21 clinicians with training in behavioral management and experience with older residents. The nurse's aides averaged 11 of 17 correct answers, and the clinicians averaged 15 of 17 correct answers. Implications for staff training and consultation activities in nursing homes are discussed.

Randomized comparisons among health informatics students identify hypertutorial features as improving web-based instruction.

Hypertutorials optimize five features - presentation, learner control, practice, feedback, and elaborative learning resources. Previous research showed graduate students significantly and overwhelmingly preferred Web-based hypertutorials to conventional "Book-on-the-Web" statistics or research design lessons. The current report shows that the source of hypertutorials' superiority in student evaluations of instruction lies in their hypertutorial features. Randomized comparisons between the two methodologies were conducted in two successive iterations of a graduate level health informatics research design and evaluation course. The two versions contained the same text and graphics, but differed in the presence or absence of hypertutorial features: Elaborative learning resources, practice, feedback, and amount of learner control. Students gave high evaluations to both Web-based methodologies, but consistently rated the hypertutorial lessons as superior. Significant differences localized in the hypertutorial subscale that measured student responses to hypertutorial features.

Commentary on “Connecting the Dots: Families and Children with Special Needs in a Rural Community”

Starks et al. discuss an evaluation of educational initiatives to improve rural systems of care for children with special needs. Akin to the medical home neighborhood concept, building a holistic medical "village" entails improving collaboration, sharing accountability, and helping families to navigate the health care system. The article suggests that policymakers should include patient experiences of care in program evaluation, and they should build a community infrastructure for shared information and efficient communication.

Family Preservation Journal, 1997, Volume 2, Issue 2. (Entire issue)

Entire issue (large pdf file) Articles include: A Model for Family Preservation Case Assessment. Kam-fong Monit Cheung, Patrick Leung and Sharon Alpert Behavioral Outcomes of Home-Based Services for Children and Adolescents with Serious Emotional Disorders. Edwin Morris, Lourdes Suarez, John C. Reid A Multi-Faceted, Intensive Family Preservation Program Evaluation. Michael Raschick Targeting Families to Receive Intensive Family Preservation Services: Assessing the Use of Imminent Risk of Placement as a Service Criterion. Elaine Walton and Ramona W. Denby

A model for use by local public health departments to evaluate pandemic influenza plans

The events of the 1990's and early 2000's demonstrated the need for effective planning and response to natural and man-made disasters. One of those potential natural disasters is pandemic flu. Once defined, the CDC stated that program, or plan, effectiveness is improved through the process of program evaluation. (Centers for Disease Control and Prevention, 1999) Program evaluation should be accomplished not only periodically, but in the course of routine administration of the program. (Centers for Disease Control and Prevention, 1999) Accomplishing this task for a "rare, but significant event" is challenging. (Herbold, John R., PhD., 2008) To address this challenge, the RAND Corporation (under contract to the CDC) developed the "Facilitated Look-Backs" approach that was tested and validated at the state level. (Aledort et al., 2006).^ Nevertheless, no comprehensive and generally applicable pandemic influenza program evaluation tool or model is readily found for use at the local public health department level. This project developed such a model based on the "Facilitated Look-Backs" approach developed by RAND Corporation. (Aledort et al., 2006) Modifications to the RAND model included stakeholder additions, inclusion of all six CDC program evaluation steps, and suggestions for incorporating pandemic flu response plans in seasonal flu management implementation. Feedback on the model was then obtained from three LPHD's—one rural, one suburban, and one urban. These recommendations were incorporated into the final model. Feedback from the sites also supported the assumption that this model promotes the effective and efficient evaluation of both pandemic flu and seasonal flu response by reducing redundant evaluations of pandemic flu plans, seasonal flu plans, and funding requirement accountability. Site feedback also demonstrated that the model is comprehensive and flexible, so it can be adapted and applied to different LPHD needs and settings. It also stimulates evaluation of the major issues associated with pandemic flu planning. ^ The next phase in evaluating this model should be to apply it in a program evaluation of one or more LPHD's seasonal flu response that incorporates pandemic flu response plans.^

Malaria prevention in Kenyan women of childbearing age

The objective of this program is to reduce malaria incidence in Kenya. Malaria poses a large public health challenge in Kenya, and although public health efforts have traditionally been focused on treatment of infected patients, due to increased drug resistance and lack of drug-adherence, prevention strategies are needed. This program targets Kenyan women, the likely caretakers in the home, and promotes malaria prevention behaviors through health education. ^ A planning group will be assembled and a needs assessment will be performed, verifying risk factors and conditions associated with malaria, as well as personal and external determinants. Behavioral and environmental outcomes will be determined, and performance objectives for each outcome will be established. Matrices of change objectives will be created, and detailed methods and strategies will be linked to each change objective. Program elements include media, education, and incentives. All materials used in this program will be subjected to pre-test to ensure cultural relevance and fidelity. Matrices of change objectives will be created for program adopters and implementers, as well as correlating methods and strategies associated with each change objective. Performance objectives will also be compiled for program maintainers. A program evaluation plan will follow "Pre-Post Comparison Group" design. Outcome evaluation and process evaluation will be conducted. The sample population will be screened based on age and gender so as to maintain comparability to the target population. Measurements will be taken before the program to establish baseline, directly following the program to determine short-term effects, and three months after the program is completed to determine long-term effects. ^ One limitation of this program is selection bias, due to the nature of quasi-experimental studies. Thorough screening prior to sample selection will minimize selection bias and ensure group homogeneity. Another limitation is attrition, and this will be minimized where possible through the use of incentives. In cases where loss to follow-up is not avoidable, such as death or natural disasters, the attrition effect will be estimated using structural equation modeling after reviewing the sample size, differential attrition and total attrition. ^ This intervention is based heavily on health promotion theories, but it is important to remember that in the field, the program plan will likely include only the necessary practical strategies. The target population, Kenyan women of childbearing age, will be significant in decreasing the malaria disease burden in Kenya.^

Comportamiento hidrológico de cuencas de media montaña españolas: efectos de los procesos de acumulación / fusión de nieve en terrenos permeables sobre la infiltración y régimen de caudales Alto Tajo

La infiltración de agua en el suelo y la recarga profunda del agua subterránea contenida en los acuíferos es un proceso lento en relación con otros fenómenos hidrológicos. La redacción de esta tesis ha pretendido contribuir al estudio de la influencia que el almacenamiento de la precipitación sólida en forma de manto de nieve y su eventual fusión puedan tener sobre dicho proceso en áreas de media montaña (1.000 – 2.000 m.) en las que con gran frecuencia se sitúan las cabeceras de los ríos peninsulares. Para ello se ha partido del análisis de las diferentes variables intervinientes durante un determinado periodo temporal y sobre un espacio geográfico concreto, por lo que su metodología es de naturaleza empírica. La extensión del periodo (2002/03 a 2010/11) ha venido condicionada por la disponibilidad de los valores de algunas de sus principales variables, como han sido el equivalente en agua de la nieve acumulada y los caudales procedentes de su fusión. Éstos se han obtenido como resultado de la aplicación del modelo ASTER, desarrollado en el programa de Evaluación de los Recursos Hídricos procedentes de la Innivación (ERHIN), calibrado – entre otros- con datos de precipitaciones, temperatura y caudales provenientes a su vez del Sistema Automático de Información Hidrológica (SAIH). Ambos programas fueron implantados por la Administración en las diferentes Confederaciones Hidrográficas y en determinados Organismos de cuenca actuales, en cuyo desarrollo participó el autor de esta tesis. En cuanto a la zona de estudio se ha procedido a su elección considerando las posibles áreas de media montaña en las que la presencia de la nieve fuera hidrológicamente significativa y estuvieran constituidas litológicamente por afloramientos permeables que no impidieran la infiltración en el terreno y la formación de acuíferos de cierta relevancia. El interés se centró discrecionalmente en la cuenca del Tajo, tanto por el carácter estratégico de la misma -como suministradora en la actualidad de excedentes a otras cuencas deficitarias- como por el valor representativo de sus condiciones climáticas y orográficas en relación con otras cuencas hidrográficas peninsulares. Para ello se partió de las cabeceras de ríos identificadas por el programa ERHIN por su interés nivológico para la implantación del modelo ASTER y de las Masas de Agua Subterráneas MASb (antes Unidades Hidrogeológicas UUHH) definidas en los planes hidrológicos. La intersección en el territorio de ambos criterios condujo, finalmente, a la zona del Alto Tajo, en la que se cumplen ambos requisitos. El tramo quedó concretado en el comprendido entre las cabeceras de los ríos Tajo y Guadiela y la cola de los embalses de Entrepeñas y Buendía respectivamente, puntos de cierre para la calibración llevada a cabo en la modelización ASTER. Gran parte de éste discurre, en su parte alta, sobre rocas carbonatadas (calizas y dolomías del Jurásico y Cretácico), relacionados con las MASb de Tajuña-Montes Universales, Molina de Aragón y Sigüenza-Maranchón. Los valores diarios de las reservas de agua en forma de nieve, evapotranspiración y caudales procedentes de la fusión se han obtenido a partir de los resultados del mencionado modelo, procediéndose al cálculo de la infiltración por balance hídrico durante el periodo de estudio considerado, teniendo en cuenta los valores de precipitación, evapotranspiración y aportaciones de caudales. Esto ha requerido el estudio previo de las condiciones hidrogeológicas de la zona seleccionada con objeto de conocer las posibles interconexiones subterráneas que pudieran alterar los saldos entre las variables intervinientes anteriormente citadas. Para ello se ha llevado a cabo la recopilación y análisis de la información hidrogeológica correspondiente a la documentación de los planes hidrológicos del Tajo (Plan Hidrológico de la cuenca del Tajo RD 1664/1998 y el actual Plan Hidrológico de la parte española de la Demarcación Hidrográfica del Tajo RD 270/2014) y de los estudios previos realizados por el organismo de cuenca y el Instituto Geológico y Minero de España (lGME) fundamentalmente. En relación con la MASb Tajuña-Montes Universales -cuya extensión supera la zona seleccionada- dichos estudios consideran su estructura geológica y distribución litológica, con intercalaciones impermeables que actúan como barreras, dividiendo a éstas en Subunidades e identificando las zonas de drenaje de sus respectivos acuíferos. También se ha considerado la documentación y estudios previos del Plan Hidrológico Nacional sobre las Unidades Hidrogeológicas compartidas entre ámbitos geográficos de diferentes planes hidrológicos. Se concluye que las divisorias hidrográficas de las cabeceras son sensiblemente coincidentes o abarcan las Subunidades Montes Universales meridionales, Priego, Cifuentes, Zaorejas, u Montes Universales septentrionales, que drenan hacia el Tajo/Guadiela (bien directamente, bien a través de afluentes como el Gallo, Ablanquejo, Cabrillas, Cuervo…), MASb Molina de Aragón, que drena al Tajo a través del río Gallo y MASb Sigüenza—Maranchón, que drena su parte correspondiente hacia el Tajo a través del Ablanquejo. Se descartan – salvo la pequeña salvedad del manantial de Cifuentes- las conexiones hidrogeológicas con otras MASb o Subunidades por lo que las cabeceras del Tajo y del Guadiela pueden considerarse como un Sistema independiente donde las precipitaciones no evaporadas escurren superficialmente o se infiltran y descargan hacia los embalses de Entrepeñas y Buendía. La cuantificación diaria y acumulada de los balances hídricos ha permitido calcular la evolución aproximada de las reservas de agua subterránea desde la fecha inicial. Originalmente los balances se realizaron de forma separada en las cabeceras del Tajo y del Guadiela, cuyos valores acumulados manifestaron una tendencia creciente en la primera y decreciente en la segunda. Dicha situación se equilibra cuando el balance se practica conjuntamente en ambas, apreciándose en la variación del volumen de agua subterránea una evolución acorde hidrológicamente con los ciclos de verano/invierno y periodos de sequía, manteniéndose sus valores medios a largo/medio plazo, poniendo en evidencia la existencia de interconexiones subterráneas entre ambas cuencas. El balance conjunto, agregando la cabecera del Tajuña (que también comparte los materiales permeables de la MASb Tajuña-Montes Universales) no reveló la existencia de nuevas interrelaciones hidrogeológicas que influyeran en los balances hídricos realizados Tajo/Guadiela, confirmando las conclusiones de los estudios hidrogeológicos anteriormente analizados. Se ha procedido a confrontar y validar los resultados obtenidos de la evolución de las reservas de agua subterránea mediante los siguientes procedimientos alternativos: - Cálculo de los parámetros de desagüe de la curva de agotamiento correspondiente al volumen de agua subterránea drenante hacia el Tajo/Guadiela. Éste se ha realizado a partir de las aportaciones mensuales entrantes en los embalses de Entrepeñas y Buendía durante los meses de junio, julio, agosto y septiembre, cuyos valores responden al perfil típico de descargas de un acuífero. A partir de éstos se ha determinado el volumen drenante correspondiente al primero de junio de cada año de la serie histórica considerada. - Determinación del caudal base por el método Wallingford y deducción de los volúmenes drenantes. Estimación de las recarga anuales - Cuantificación de la recarga anual por el método Sanz, Menéndez Pidal de Navascués y Távara. Se obtuvieron valores de recarga muy aproximados entre los calculados por los dos últimos procedimientos citados. Respecto a las reservas de agua subterránea almacenadas siguen una evolución semejante en todos los casos, lo que ha permitido considerar válidos los resultados conseguidos mediante balance hídrico. Confirmada su solidez, se han buscado correlaciones simples entre el volumen de las reservas subterráneas (como indicador estimativo del efecto de la infiltración) y los volúmenes procedentes de la fusión. La conclusión es que estos últimos no tienen un efecto determinante a escala anual sobre la infiltración,recarga y variación de los volúmenes de agua subterránea, frente al peso de otras variables (precipitación y evapotranspiración). No obstante se ha encontrado una buena correlación múltiple entre la recarga estimada y la precipitación eficaz (precipitación menos evapotranspiración) y fusión, que ha permitido cuantificar la contribución de esta última. Posteriormente se ha recurrido a la selección de los episodios más intensos de acumulación /fusión en las cabeceras del Tajo y Guadiela. Y se procedió a la comparación entre los resultados obtenidos por aplicación del modelo de simulación en los mismos periodos (normalmente de varios días de duración) con datos reales y con datos ficticios de temperatura que anularan o disminuyeran la presencia de nieve, apreciándose una gran sensibilidad del efecto de la temperatura sobre la evapotranspiración y estableciéndose nuevamente correlaciones lineales entre los volúmenes de fusión y el incremento de reservas subterráneas. Las mismas confirman el efecto “favorecedor” de la acumulación de agua en forma de nieve y su posterior licuación, sobre sobre la infiltración de agua en el suelo y almacenamiento subterráneo. Finalmente se establecieron varios escenarios climáticos (+1ºC; +3ºC; +1ºC y – 10% precipitación; y 3ºC – 10% precipitación) compatibles con las previsiones del IPCC para mediados y finales del presente siglo, determinándose mediante simulación ASTER los correspondientes valores de fusión. La correlación establecida a escala anual ha permitido evaluar el efecto de la disminución del volumen de fusión - en los diferentes escenarios – sobre la recarga, pronosticando un descenso de los caudales de estiaje y la desaparición del “efecto nieve” sobre la infiltración y recarga con un aumento de 3ºC de temperatura. Teniendo en cuenta las condiciones de representatividad de la zona elegida, resulta verosímil la extensión de las anteriores conclusiones a otras cabeceras fluviales enclavadas en áreas de media montaña situadas entre 1000 a 2000m y sus efectos aguas abajo.Water infiltration into the soil and groundwater recharge deep water in aquifers is slow relative to other hydrological phenomena. The wording of this thesis aims to contribute to the study of the influence that the storage of solid precipitation as snow cover and its eventual melting may have on this process in mid-mountain areas (1000 - 2,000 m) where very often the headwaters of the peninsular rivers are located. For this party analysis of the different variables involved has over a given time period and a particular geographical area, so that their methodology is empirical in nature. The extension of the period (2002/03 to 2010/11) has been conditioned by the availability of the values of some of its key variables, as were the water equivalent of the snow and flows from melting. These have been obtained as a result of the application of ASTER model, developed in the program Evaluation of Water Resources from the Innivation (ERHIN), calibrated - among others data of rainfall, temperature and flow from turn System Automatic Hydrological Information (SAIH). Both programs were implemented by the Administration in the different Water Boards and to undertakings for current basin, in which the author participated development of this thesis. As for the study area has proceeded at its option considering the possible areas of midmountain in the presence of snow outside hydrological meaningful and they were lithology consisting of permeable outcrops that did not prevent infiltration into the ground and forming aquifers of some significance. We were interested discretion in the Tagus basin, therefore the strategic nature of it, as currently supplying surplus to other basins deficit- as the representative value of its climate and terrain conditions in relation to other peninsular river basins . To do this we started from the headwaters identified by the ERHIN program for its implementation snow interest to the ASTER model and Ground Water Bodies MASb (before UUHH Hydrogeological Units) defined in hydrological plans. The intersection in the territory of both criteria led eventually to the Alto Tajo, in which both requirements are met. The section was finalized in the period between the headwaters of the Tagus and Guadiela rivers and reservoirs end Entrepeñas and Buendia respectively checking points for calibration performed in ASTER modeling. Much of it runs on carbonate rocks (limestones and dolomites of Jurassic and Cretaceous) related MASb of Tajuña -Montes Universal, Molina de Aragón and Sigüenza-Maranchón. The daily values of water reserves in the form of snow, evapotranspiration and flow from melting were obtained from the results of this model, proceeding to the calculation of infiltration water balance during the study period considered, taking into account values of precipitation, evapotranspiration and input flow. This has required the prior examination of the hydrogeological conditions of your required in order to know the possible underground interconnections that could alter the balance between the intervening variables aforementioned area. For this we have carried out the collection and analysis of hydrogeological information relevant documentation Tagus river management plans (Hydrological Plan Tajo Basin RD 1664/1998 and the current Hydrological Plan of the Spanish part of the River Basin Tagus RD 270/2014) and previous studies by the basin organization and the Geological Survey of Spain (IGME) mainly. Regarding the MASb Tajuña- Montes Universal - whose length exceeds the area selected - these studies consider its geological structure and lithology distribution with waterproof collations that act as barriers, dividing it into subunits and identifying areas draining their respective aquifers. It has also considered the documentation and previous studies of the National Hydrological Plan on shared among different geographical areas management plans Hydrogeological Units. We conclude that river dividing the headers are substantially coincident or covering Subunits southern Universal Montes, Priego Cifuentes, Zaorejas and northern Universal Mounts, which drain into the Tagus / Guadiela (either directly or through tributaries such as Gallo, Ablanquejo , whitecaps , Raven ...), MASb Molina de Aragón which drains through the Tajo del Gallo and MASb Sigüenza- Maranchón river that drains into the Tagus using the Ablanquejo . Discarded - except the small exception of spring Cifuentes -hydrogeological connections with other MASb or Subunits so the headwaters of the Tagus and Guadiela be considered as a separate system, where rainfall not evaporated runs on surface or infiltrates and eventually discharged into reservoirs Entrepeñas and Buendia. The daily and cumulative quantification of water balances allowed us to compute the approximate evolution of groundwater reserves from its initial date. Initially balances were performed separately in the headwaters of the Tagus and Guadiela, whose cumulative values showed an increasing trend in the first and decreasing in the second. This situation is balanced when the balance is practiced together in both , appreciating the change in volume of groundwater hydrological evolution commensurate with the cycles of summer / winter and drought periods , keeping their average long / medium term values and putting in shows the existence of underground interconnections between the two basins. The overall balance, adding header Tajuña (which also shares the permeable materials MASb Tajuña -Montes Universal ) did not reveal the existence of new hydrogeological interrelationships that influenced water balances made Tajo / Guadiela, confirming the findings of the hydrogeological studies previously analyzed. We proceeded to confront and validate the results of the evolution of groundwater reserves by the following alternative procedures: - Calculate the parameters drain depletion curve corresponding to the volume of groundwater draining into the Tajo / Guadiela. This has been made from monthly inflows in the reservoirs of Entrepeñas and Buendia during the months of June, July, August and September, whose values match the typical profile of an aquifer discharges. From these has been determined for the first of June each year of the time series considered drainage volume - Determination of base flow by Wallingford method and deduction of drainage volumes. Estimate of annual recharge - Quantification of the annual recharge by the method Sanz Menéndez Pidal of Navascués and Távara. Very approximate values recharge between calculated for the last two mentioned methods were obtained. Concerning groundwater reserves stored follow a similar pattern in all cases, allowing consider valid the results achieved through water balance. Confirmed its robustness, simple correlations were sought between the volume of groundwater reserves (as estimated indicator of the effect of infiltration) and volumes from the melting. The conclusion is that the latter do not have a decisive effect on the annual scale infiltration, recharge and variation in volumes of groundwater, against the weight of other variables (precipitation and evapotranspiration). However found a good multiple correlation between the estimated recharge and effective precipitation (precipitation minus evapotranspiration) and fusion, which allowed quantify the contribution of the latter. Subsequently it has resorted to the selection of the most intense episodes of accumulation / melting in the headwaters of the Tagus and Guadiela. And we proceeded to the comparison between the results obtained by application of the simulation model in the same periods (usually several days) with real data and fictitious temperature data to annul or decrease the presence of snow, appreciating a great sensitivity of the effect of temperature on evapotranspiration and establishing linear correlations between the volumes of melting and increased groundwater reserves again. They confirm the “flattering " effect of water accumulation as snow and subsequent liquefaction of the infiltration of water into the soil and underground storage. Finally various climate scenarios (+1ºC; +3ºC; +1ºC y – 10% precipitation; y 3ºC – 10% precipitation) were established consistent with IPCC projections for mid - to late - century, determined through simulation ASTER corresponding values of melting. The correlation established on an annual scale has allowed to evaluate the effect of decreasing the volume of melt - in different scenarios - on recharge, predicting a decline in low flows and the disappearance of "snow effect" on infiltration and recharge with an increase of 3°C temperature. Given the conditions of representativeness of the chosen area, plausible extension of the above findings to other landlocked headwaters in mid-mountain areas located between 1000 to 2000m and its downstream effects.

Examining the Impact of Child Psychologists' Stigmatization of Parents on Treatment Outcomes Through a Developmental Lens

The purpose of this paper is to examine how child psychologists' specialized training inhuman development may make them more prone to stigmatize the parents of their young clients. The stigmatization of parents may lead to fewer parents seeking treatment for their children and to poorer treatment outcomes for those who work with a child psychologist. The process of stigmatization is summarized to provide context for the method through which parents receive stigma. A commonly used theory of child development, Erik Erikson's stages of ego development, is outlined to provide background on how child psychologists may interpret and evaluate a child'sdevelopment. Child psychologists' may identify parenting practices that seem to hinder or stunt children's emotional development, which would make the psychologist more aptto stigmatize and isolate parents from the treatment process. To demonstrate the unique ways in which a child psychologist may stigmatize parents of children at different developmental stages two case studies are included. Finally, a theoretical model of treatment is described that may be more inclusive, and less stigmatizing of parents. This model outlines how the parents' concerns about and observations of their children should be validated and reflected in the treatment process. This treatment modality would allow for child psychologists to more actively involve parents in treatment and provide more education and support around their children's unique emotional development needs. Through this treatment model and child psychologists' awareness of and attempts to reduce the stigmatization of parents, treatment outcomes for young clients may improve.

Evidence-Based Practice in the Juvenile Justice System: Balancing Clinical Expertise with Best Available Research and Client Variables

Each year, thousands of adolescents are processed through the juvenile justice system -- a system that is complicated, expensive, and inadequately addressing the needs of the youth in its care. While there is extensive literature available in support of interventions for youthful offenders that are clinically superior to current care and more cost-effective than the existing structure, there is a gap between research and practice that is preventing their implementation. The use of Evidence-Based Practice in Psychology (EBPP) as defined by the American Psychological Association is presented as one method to bridge this gap. This paper identifies and discusses each of five barriers to effective use of EBPP: cost, fragmentation of the mental health system, historical and systemic variables, research methodology, and clinician variables. These barriers are first defined and then illustrated using examples from the author's experience working in the juvenile justice field. Finally, recommendations for the field are presented.

Cross-Disciplinary Collaboration Behavior of Practitioners in the Treatment of Anxiety Disorders

Current research on the collaborative behaviors of conventional and alternative health care providers for the treatment of anxiety is lacking. While there are multiple studies looking at alternative health care integration into primary care, none of them look at anxiety specifically. The purpose of this paper is to provide a preliminary exploration of possible barriers to collaboration between conventional and alternative health care providers for the treatment of anxiety. Quantitative data on collaboration behavior patterns were obtained with an anonymous survey. Data from the surveys were analyzed using a chi-square analysis. Along with these numerical data narrative data from the survey and interviews were collected in order to assess beliefs about the barriers to collaboration from different health care providers. The results indicate that conventional providers collaborate the least with alternative providers and alternative providers collaborate the least with conventional providers. The descriptive results regarding the barriers to collaboration from the study illustrated a common theme, specifically, the lack of education of conventional providers on alternative health care practices on anxiety. This is an exploratory study: therefore it would be beneficial for future researchers to look deeper into the beliefs of health care providers on the barriers to collaboration, possibly identifying the specific barriers to collaboration for each type of healthcare provider.