Factors that influence the detection of psychological problems in adolescents attending general practices

Background Epidemiological studies indicate that the prevalence of psychological problems in patients attending primary care services may be as high as 25%. Aim To identify factors that influence the detection of psychological difficulties in adolescent patients receiving primary care in the UK. Design of study A prospective study of 13-16 year olds consecutively attending general practices. Setting General practices, Norfolk, UK. Method Information was obtained from adolescents and parents using the validated Strengths and Difficulties Questionnaire (SDQ) and from GF`s using the consultation assessment form. Results Ninety-eight adolescents were recruited by 13 GPs in Norfolk (mean age = 14.4 years, SD = 1.08; 38 males, 60 females). The study identified psychological difficulties in almost one-third of adolescents (31/98, 31.6%). Three factors significant to the detection of psychological disorders in adolescents were identified: adolescents' perceptions of difficulties according to the self-report SDQ, the severity of their problems as indicated by the self-report SDQ, and whether psychological issues were discussed in the consultation. GPs did not always explore psychological problems with adolescents, even if GPs perceived these to be present. Nineteen of 31 adolescents with psychological difficulties were identified by GPs (sensitivity = 61.2%, specificity = 85.1%). A management plan or follow-up was made for only seven of 19 adolescents identified, suggesting that ongoing psychological difficulties in many patients are not being addressed. Conclusions GPs are in a good position to identify psychological issues in adolescents, but GPs and adolescents seem reluctant to explore these openly. Open discussion of psychological issues in GP consultations was found to be the most important factor in determining whether psychological difficulties in adolescents are detected by GPs.

A general lagrangian approach for non-concave moral hazard problems

We establish a general Lagrangian for the moral hazard problem which generalizes the well known first order approach (FOA). It requires that besides the multiplier of the first order condition, there exist multipliers for the second order condition and for the binding actions of the incentive compatibility constraint. Some examples show that our approach can be useful to treat the finite and infinite state space cases. One of the examples is solved by the second order approach. We also compare our Lagrangian with 1\1irrlees'.

A general lagrangian approach for non-concave moral hazard problems

We establish a general Lagrangian for the moral hazard problem which generalizes the well known first order approach (FOA). It requires that besides the multiplier of the first order condition, there exist multipliers for the second order condition and for the binding actions of the incentive compatibility constraint. Some examples show that our approach can be useful to treat the finite and infinite state space cases. One of the examples is solved by the second order approach. We also compare our Lagrangian with 1\1irrlees'.

Graphical constraints: a graphical user interface for constraint problems

A constraint satisfaction problem is a classical artificial intelligence paradigm characterized by a set of variables (each variable with an associated domain of possible values), and a set of constraints that specify relations among subsets of these variables. Solutions are assignments of values to all variables that satisfy all the constraints. Many real world problems may be modelled by means of constraints. The range of problems that can use this representation is very diverse and embraces areas like resource allocation, scheduling, timetabling or vehicle routing. Constraint programming is a form of declarative programming in the sense that instead of specifying a sequence of steps to execute, it relies on properties of the solutions to be found, which are explicitly defined by constraints. The idea of constraint programming is to solve problems by stating constraints which must be satisfied by the solutions. Constraint programming is based on specialized constraint solvers that take advantage of constraints to search for solutions. The success and popularity of complex problem solving tools can be greatly enhanced by the availability of friendly user interfaces. User interfaces cover two fundamental areas: receiving information from the user and communicating it to the system; and getting information from the system and deliver it to the user. Despite its potential impact, adequate user interfaces are uncommon in constraint programming in general. The main goal of this project is to develop a graphical user interface that allows to, intuitively, represent constraint satisfaction problems. The idea is to visually represent the variables of the problem, their domains and the problem constraints and enable the user to interact with an adequate constraint solver to process the constraints and compute the solutions. Moreover, the graphical interface should be capable of configure the solver’s parameters and present solutions in an appealing interactive way. As a proof of concept, the developed application – GraphicalConstraints – focus on continuous constraint programming, which deals with real valued variables and numerical constraints (equations and inequalities). RealPaver, a state-of-the-art solver in continuous domains, was used in the application. The graphical interface supports all stages of constraint processing, from the design of the constraint network to the presentation of the end feasible space solutions as 2D or 3D boxes.

On the existence and stability of periodic orbits in non ideal problems: General results

In this work, motivated by non-ideal mechanical systems, we investigate the following O.D.E. ẋ = f (x) + εg (x, t) + ε2g (x, t, ε), where x ∈ Ω ⊂ ℝn, g, g are T periodic functions of t and there is a 0 ∈ Ω such that f (a 0) = 0 and f′ (a0) is a nilpotent matrix. When n = 3 and f (x) = (0, q (x 3) , 0) we get results on existence and stability of periodic orbits. We apply these results in a non ideal mechanical system: the Centrifugal Vibrator. We make a stability analysis of this dynamical system and get a characterization of the Sommerfeld Effect as a bifurcation of periodic orbits. © 2007 Birkhäuser Verlag, Basel.

Semiparametric Estimation in General Repeated Measures Problems

This paper considers a wide class of semiparametric problems with a parametric part for some covariate effects and repeated evaluations of a nonparametric function. Special cases in our approach include marginal models for longitudinal/clustered data, conditional logistic regression for matched case-control studies, multivariate measurement error models, generalized linear mixed models with a semiparametric component, and many others. We propose profile-kernel and backfitting estimation methods for these problems, derive their asymptotic distributions, and show that in likelihood problems the methods are semiparametric efficient. While generally not true, with our methods profiling and backfitting are asymptotically equivalent. We also consider pseudolikelihood methods where some nuisance parameters are estimated from a different algorithm. The proposed methods are evaluated using simulation studies and applied to the Kenya hemoglobin data.

A General Solution Framework for Component-Commonality Problems

Component commonality - the use of the same version of a component across multiple products - is being increasingly considered as a promising way to offer high external variety while retaining low internal variety in operations. However, increasing commonality has both positive and negative cost effects, so that optimization approaches are required to identify an optimal commonality level. As components influence to a greater or lesser extent nearly every process step along the supply chain, it is not surprising that a multitude of diverging commonality problems is being investigated in literature, each of which are developing a specific algorithm designed for the respective commonality problem being considered. The paper on hand aims at a general framework which is flexible and efficient enough to be applied to a wide range of commonality problems. Such a procedure based on a two-stage graph approach is presented and tested. Finally, flexibility of the procedure is shown by customizing the framework to account for different types of commonality problems.

Influence of social problems on management in general practice: multipractice questionnaire survey

Objectives: To find how often social problems influence clinical management in general practice, how management is changed, and how the characteristics of patients, doctors, and the doctor-patient relationship influence this management.

Zoning problems in changing rural communities : address, Seminars in public affairs, General extension division, Agricultural extension service, University of Minnesota, January 31, 1961, Cannon Falls, Minnesota.

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