Assessing childhood difficulties: Comparing the SDQ and the BASC-2

This study of the Behavior Assessment System for Children, Second Edition (BASC-2), had two objectives. First, was to compare the Strengths and Difficulties Questionnaire (SDQ) and the BASC-2. Participants were students from SBISD, identified as having difficulties, assessed with the BASC-2 and completed the SDQ. Based on the small sample (N=8), scores from the SDQ and the BASC-2 were found to correlate highly with one another on most conceptually similar scales. With both Parent and Teacher raters, diagnostic concordance was high for nearly all behavior and emotional problem scales. While the diagnostic concordance of the SDQ and BASC-2 looks promising, results need to be replicated with a larger sample. ^ The second objective was to assess the BASC-2 inter-informant concordance (parent, teacher and child). Participants were 145 students, 3-17 years, 78.6% male, 28% Hispanic, 37% White, 34% Black, and 64% were economically disadvantaged. Of the four dyads, teacher-teacher pairs had the highest correlations and agreement levels, especially on externalizing scale items, regardless of the subjects' age group, gender or ethnicity. ^ Overall, parent-teacher pairs had low to moderate concordance for most scale items, with slightly higher agreement for externalizing problems, with better concordance for preschool children, very low correlations with girls' ratings, but moderate correlations with boy ratings. Correlational results were generally moderate for teachers and parents of White children and low for teachers and parents of Hispanic and Black children. ^ Parent-child self-reports had low concordance for nearly all scale items evaluated, particularly with girl self-raters, but moderate with the boys. Conversely, Teacher-Girl pairs had larger correlations than with Boy. Parents reported substantially higher frequency of disorder endorsement than reported by the children, regardless of the child's ethnicity or gender. While generally low, Teachers and Black students had higher concordance on internalizing measures than Hispanic or White students. Parents of Black students had higher frequency of disorder endorsements than other ethnicities. ^ The difference in format and lack of externalizing measures on the self-report version (SRP) hinders inter-rater comparisons. Future studies using the revised, BASC-2 with children in a school-based setting are needed to assess further its rater reliability. ^

Uncertainty analysis of cost effectiveness in a tailored intervention to promote screening for colorectal cancer

Background. Screening for colorectal cancer (CRC) is considered cost effective but screening compliance in the US remains low. There have been very few studies on economic analyses of screening promotion strategies for colorectal cancer. The main aim of the current study is to conduct a cost effectiveness analysis (CEA) and examine the uncertainty involved in the results of the CEA of a tailored intervention to promote screening for CRC among patients of a multispeciality clinic in Houston, TX. ^ Methods. The two intervention arms received a PC based tailored program and web based educational information to promote CRC screening. The incremental cost of implementing a tailored PC based program was compared to the website based education and the status quo of no intervention for each unit of effect after 12 months of delivering the intervention. Uncertainty analysis in the point estimates of cost and effect was conducted using nonparametric bootstrapping. ^ Results. The cost of implementing a web based educational intervention was $36.00 per person and the cost of the tailored PC based interactive intervention was $43.00 per person. The additional cost per person screened for the web-based strategy was $2374 and the effect of the tailored intervention was negative. ^

Tobacco use and related psychosocial risk factors among youth in urban India: Assessment of Project MYTRI follow-up surveys

Project MYTRI (Mobilizing Youth for Tobacco-Related Initiatives in India) was a large 2-year randomized school-based trial with a goal to reduce and prevent tobacco use among students in 6th and 8th grades in Delhi and Chennai in India (n=32 schools). Baseline analyses in 2004 showed that 6th grade students reported more tobacco use than 8 th grade students, opposite of what is typically observed in developed countries like the US. The present study aims to study differences in tobacco use and psychosocial risk factors between the 6th grade cohort and 8th grade cohort, in a compliant sub-sample of control students that were present at all 3 surveys from 2004-06. Both in 2004 and 2005, 6th grade cohort reported significantly greater prevalence of ever use of all tobacco products (cigarettes, bidis, chewing tobacco, any tobacco). These significant differences in ever use of any tobacco between cohorts were maintained by gender, city and socioeconomic status. The 6th grade cohort also reported significantly greater prevalence of current use of tobacco products (cigarettes, chewing tobacco, any tobacco) in 2004. Similar findings were observed for psychosocial risk factors for tobacco use, where the 6th grade cohort scored higher risk than 8th grade cohort on scales for intentions to smoke or chew tobacco and susceptibility to smoke or chew tobacco in 2004 and 2005, and for knowledge of health effects of tobacco in all three years.^ The evidence of early initiation of tobacco use in our 6th grade cohort in India indicates the need to target prevention programs and other tobacco control measures from a younger age in this setting. With increasing proportions of total deaths and lost DALYs in India being attributable to chronic diseases, addressing tobacco use among younger cohorts is even more critical. Increase in tobacco use among youth is a cause for concern with respect to future burden of chronic disease and tobacco-related mortality in many developing countries. Similarly, epidemiological studies that aim to predict future death and disease burden due to tobacco should address the early age at initiation and increasing prevalence rates among younger populations. ^

Mandating the HPV vaccine

Background. HPV is the underlying cause of cervical cancer, a malignant tumor of the female genital tract. Each year, cervical cancer is newly diagnosed in approximately 10,000 women, and over 3,000 women die from the malignancy. In addition, HPV is implicated as a cause of other cancers involving the genital tract, male and female, and the head and neck. ^ Gardasil, a vaccine against HPV, was licensed by the FDA in June 2006. Early study results have shown Gardasil to be safe and effective at preventing HPV infections that are commonly associated with the development of cervical cancer, as well as other HPV-related cancers and genital warts. The vaccine is most effective when administered in childhood, before initial exposure to HPV, which typically occurs shortly after the onset of sexual activity. Accordingly, the CDC's Advisory Committee on Immunization Practices (ACIP) has recommended routine vaccination of females aged 11-12 years. ^ Taking the ACIP recommendation one step further, many states have considered school-based mandates of the HPV vaccine in an attempt to reduce the burden of HPV-related illness, in particular to reduce the disparately high incidence of cervical cancer in medically underserved populations. These mandate attempts have sparked heated debate—highlighting public concerns regarding adolescent sexuality, corporate greed, and vaccines in general. ^ Methods. My research focuses on publicly available sources of information such as medical journals, government reports (federal and state), NGO reports, newspapers, and books. I begin with a background discussion of HPV, cervical cancer, and the HPV vaccine. I then discuss public health policy issues related to vaccines, vaccine mandates, and HPV-related illness. Specifically, I discuss the public health benefit of previous vaccine mandates, the legality of vaccine mandates, and the undue corporate influence on the politics of instituting HPV vaccine mandates. In addition, I examine some of the causes behind the anti-vaccine movement and the controversy surrounding adolescent sexuality as it pertains to the HPV vaccine. In the final section, I focus on the recent failed attempt by Governor Rick Perry to mandate the HPV vaccine in Texas. A retrospective analysis of Governor Perry's policy decisions is undertaken and recommendations are made regarding future attempts to mandate the HPV vaccine, or other vaccines under development for similar sexually transmitted viral diseases such as HIV and herpes simplex. ^ Results. In Texas, as in other states across the country, HPV vaccine mandates faced opposition from those who, while they may support mandates of other vaccines, oppose mandates for the HPV vaccine based largely on the idea that HPV is a sexually transmitted disease—they see responsible sexual behavior as the appropriate method for preventing HPV-related illness. A second major group of opposition comes from those who are generally opposed to all vaccine mandates, due to concerns that mandates are intended primarily for the financial benefit of the pharmaceutical industry or due to concerns—largely unfounded—that vaccines pose a greater health threat than the illnesses they are designed to prevent. ^ Conclusion. In order to reduce opposition to vaccine mandates, care must be taken to educate the public regarding the benefits of vaccination by mobilizing the public health sector, avoid the impression that the decision to institute mandates is rash or pressured by allowing time for open debate, and minimize lobbying efforts by vaccine manufacturers. ^

The prevention of catheter related bloodstream infections in a pediatric population

Catheter related bloodstream infections are a significant barrier to success in many inpatient healthcare facilities. The goal of this study was to analyze and determine if an evidence based methodology to reduce the number of catheter related bloodstream infections in a pediatric inpatient healthcare facility had significant impact on the infection rate. Catheter related bloodstream infection rates were compared before and after program implementation. The patient population was selected based upon a recommendation in the 2010 National Healthcare Safety Network report on device related infections. This report indicated a need for more data on pediatric populations requiring admission to a long term care facility. The study design is a retrospective cohort study. Catheter related bloodstream infection data was gathered between 2008 and 2011. In October of 2008 a program implementation began to reduce the number of catheter related bloodstream infections. The key components of this initiative were to implement a standardized catheter maintenance checklist, introduce the usage of a chlorhexadine gluconate based product for catheter maintenance and skin antisepsis, and a multidisciplinary education plan that focused on hand hygiene and aseptic technique. The catheter related bloodstream infection rate in 2008 was 21.21 infections per 1000 patient-line days. After program implementation the 2009 catheter related bloodstream infection rate dropped to 1.11 per 1000 patient-line days. The infection rates in 2010 and 2011 were 2.19 and 1.47 respectively. Additionally, this study demonstrated that there was a potential cost savings of $620,000 to $1,240,000 between 2008 and 2009. In conclusion, an evidence based program based upon CDC guidelines can have a significant impact on catheter related bloodstream infection rates. ^

Las escuelas pianísticas en Argentina : una aproximación preliminar

El presente trabajo forma parte de una investigación en curso sobre "La escuela pianística argentina", proyecto aprobado y subsidiado por la Agencia Nacional de Investigaciones Científi cas y Técnicas (Proyecto Picto Artes 00043-2007) y la Secretaría de Ciencia, Técnica y Posgrado de la UNCuyo. En él pretendemos aproximarnos en nuestro camino hacia la demostración de la existencia de una escuela pianística argentina, partiendo de la teoría expuesta por Piero Rattalino en su libro de 1983 Le grandi scuole pianistiche, en la que elabora un árbol genealógico-pianístico que engloba, a partir de Mozart, Clementi y Beethoven la evolución de la técnica pianística desde los comienzos del pianoforte hasta llegar a los grandes pianistas-pedagogos del SXX.

Deprivation of Education in Urban Areas: A Basic Profile of Slum Children in Delhi, India

This paper showed the basic educational status of slum children between 5 and 14 years old. The attendance ratio of slum children is much lower than that of children in Delhi as a whole. Parental perception of education and financing education are the major constraints. Even if children are attending schools, the majority of them are over-aged. There are both demand and supply side reasons for discouraging slum children from attending schooling. As opposed to school-based surveys in previous literature, children in slums are more likely to go to government schools rather than low-fee paying private schools. Some policies are suggested.

Modular extensions for modular (Logic) languages

We address the problem of developing mechanisms for easily implementing modular extensions to modular (logic) languages. By(language) extensions we refer to different groups of syntactic definitions and translation rules that extend a language. Our use of the concept of modularity in this context is twofold. We would like these extensions to be modular, in the sense above, i.e., we should be able to develop different extensions mostly separately. At the same time, the sources and targets for the extensions are modular languages, i.e., such extensions may take as input sepárate pieces of code and also produce sepárate pieces of code. Dealing with this double requirement involves interesting challenges to ensure that modularity is not broken: first, combinations of extensions (as if they were a single extensión) must be given a precise meaning. Also, the sepárate translation of múltiple sources (as if they were a single source) must be feasible. We present a detailed description of a code expansion-based framework that proposes novel solutions for these problems. We argüe that the approach, while implemented for Ciao, can be adapted for other Prolog-based systems and languages.

Identification of logically related heap regions

This paper introduces a novel technique for identifying logically related sections of the heap such as recursive data structures, objects that are part of the same multi-component structure, and related groups of objects stored in the same collection/array. When combined withthe lifetime properties of these structures, this information can be used to drive a range of program optimizations including pool allocation, object co-location, static deallocation, and region-based garbage collection. The technique outlined in this paper also improves the efficiency of the static analysis by providing a normal form for the abstract models (speeding the convergence of the static analysis). We focus on two techniques for grouping parts of the heap. The first is a technique for precisely identifying recursive data structures in object-oriented programs based on the types declared in the program. The second technique is a novel method for grouping objects that make up the same composite structure and that allows us to partition the objects stored in a collection/array into groups based on a similarity relation. We provide a parametric component in the similarity relation in order to support specific analysis applications (such as a numeric analysis which would need to partition the objects based on numeric properties of the fields). Using the Barnes-Hut benchmark from the JOlden suite we show how these grouping methods can be used to identify various types of logical structures allowing the application of many region-based program optimizations.

Towards description and optimization of abstract machines in an extension of prolog

Competitive abstract machines for Prolog are usually large, intricate, and incorpórate sophisticated optimizations. This makes them difñcult to code, optimize, and, especially, maintain and extend. This is partly due to the fact that efñciency considerations make it necessary to use low-level languages in their implementation. Writing the abstract machine (and ancillary code) in a higher-level language can help harness this inherent complexity. In this paper we show how the semantics of basic components of an efficient virtual machine for Prolog can be described using (a variant of) Prolog which retains much of its semantics. These descriptions are then compiled to C and assembled to build a complete bytecode emulator. Thanks to the high level of the language used and its closeness to Prolog the abstract machine descriptions can be manipulated using standard Prolog compilation and optimization techniques with relative ease. We also show how, by applying program transformations selectively, we obtain abstract machine implementations whose performance can match and even exceed that of highly-tuned, hand-crafted emulators.

Removing superfluous versions in polyvariant specialization of prolog programs.

Polyvariant specialization allows generating múltiple versions of a procedure, which can then be separately optimized for different uses. Since allowing a high degree of polyvariance often results in more optimized code, polyvariant specializers, such as most partial evaluators, can genérate a large number of versions. This can produce unnecessarily large residual programs. Also, large programs can be slower due to cache miss effects. A possible solution to this problem is to introduce a minimization step which identifies sets of equivalent versions, and replace all occurrences of such versions by a single one. In this work we present a unifying view of the problem of superfluous polyvariance. It includes both partial deduction and abstract múltiple specialization. As regards partial deduction, we extend existing approaches in several ways. First, previous work has dealt with puré logic programs and a very limited class of builtins. Herein we propose an extensión to traditional characteristic trees which can be used in the presence of calis to external predicates. This includes all builtins, librarles, other user modules, etc. Second, we propose the possibility of collapsing versions which are not strictly equivalent. This allows trading time for space and can be useful in the context of embedded and pervasive systems. This is done by residualizing certain computations for external predicates which would otherwise be performed at specialization time. Third, we provide an experimental evaluation of the potential gains achievable using minimization which leads to interesting conclusions.

Experiments in context-sensitive analysis of modular programs

Several models for context-sensitive analysis of modular programs have been proposed, each with different characteristics and representing different trade-offs. The advantage of these context-sensitive analyses is that they provide information which is potentially more accurate than that provided by context-free analyses. Such information can then be applied to validating/debugging the program and/or to specializing the program in order to obtain important performance improvements. Some very preliminary experimental results have also been reported for some of these models which provided initial evidence on their potential. However, further experimentation, which is needed in order to understand the many issues left open and to show that the proposed modes scale and are usable in the context of large, real-life modular programs, was left as future work. The aim of this paper is two-fold. On one hand we provide an empirical comparison of the different models proposed in previous work, as well as experimental data on the different choices left open in those designs. On the other hand we explore the scalability of these models by using larger modular programs as benchmarks. The results have been obtained from a realistic implementation of the models, integrated in a production-quality compiler (CiaoPP/Ciao). Our experimental results shed light on the practical implications of the different design choices and of the models themselves. We also show that contextsensitive analysis of modular programs is indeed feasible in practice, and that in certain critical cases it provides better performance results than those achievable by analyzing the whole program at once, specially in terms of memory consumption and when reanalyzing after making changes to a program, as is often the case during program development.

Efficient local unfolding with ancestor stacks for full prolog

The integration of powerful partial evaluation methods into practical compilers for logic programs is still far from reality. This is related both to 1) efficiency issues and to 2) the complications of dealing with practical programs. Regarding efnciency, the most successful unfolding rules used nowadays are based on structural orders applied over (covering) ancestors, i.e., a subsequence of the atoms selected during a derivation. Unfortunately, maintaining the structure of the ancestor relation during unfolding introduces significant overhead. We propose an efficient, practical local unfolding rule based on the notion of covering ancestors which can be used in combination with any structural order and allows a stack-based implementation without losing any opportunities for specialization. Regarding the second issue, we propose assertion-based techniques which allow our approach to deal with real programs that include (Prolog) built-ins and external predicates in a very extensible manner. Finally, we report on our implementation of these techniques in a practical partial evaluator, embedded in a state of the art compiler which uses global analysis extensively (the Ciao compiler and, specifically, its preprocessor CiaoPP). The performance analysis of the resulting system shows that our techniques, in addition to dealing with practical programs, are also significantly more efficient in time and somewhat more efficient in memory than traditional tree-based implementations.

Determinacy analysis for logic programs using mode and type information

We propose an analysis for detecting procedures and goals that are deterministic (i.e. that produce at most one solution), or predicates whose clause tests are mutually exclusive (which implies that at most one of their clauses will succeed) even if they are not deterministic (because they cali other predicates that can produce more than one solution). Applications of such determinacy information include detecting programming errors, performing certain high-level program transformations for improving search efñciency, optimizing low level code generation and parallel execution, and estimating tighter upper bounds on the computational costs of goals and data sizes, which can be used for program debugging, resource consumption and granularity control, etc. We have implemented the analysis and integrated it in the CiaoPP system, which also infers automatically the mode and type information that our analysis takes as input. Experiments performed on this implementation show that the analysis is fairly accurate and efncient.

A model for inter-module analysis and optimizing compilation

Recent research into the implementation of logic programming languages has demonstrated that global program analysis can be used to speed up execution by an order of magnitude. However, currently such global program analysis requires the program to be analysed as a whole: sepárate compilation of modules is not supported. We describe and empirically evalúate a simple model for extending global program analysis to support sepárate compilation of modules. Importantly, our model supports context-sensitive program analysis and multi-variant specialization of procedures in the modules.