Predictors of Treatment Outcome Among Asian Pathological Gamblers (PGs): Clinical,Behavioural, Demographic,and Treatment Process Factors

Research on predictors of treatment outcome among pathological gamblers (PGs) is inconclusive and dominated by studies from Western countries. Using a prospective longitudinal design, the current study examined demographic, clinical, behavioural and treatment programme predictors of gambling frequency at 3, 6 and 12-months, among PGs treated at an addiction clinic in Singapore. Measures included the Hospital anxiety and depression scale, gambling symptom assessment scale (GSAS), personal well-being index (PWI), treatment perception questionnaire and gambling readiness to change scale. Treatment response in relation to changes in symptom severity, personal wellbeing and abstinence were also assessed. Abstinence rates were 38.6, 46.0 and 44.4 % at 3, 6 and 12-months respectively. Significant reductions in gambling frequency, GSAS, and improvement in PWI were reported between baseline and subsequent outcome assessments, with the greatest change occurring in the initial three months. No demographic, clinical, behavioural or treatment programme variable consistently predicted outcome at all three assessments, though treatment satisfaction was the most frequent significant predictor. However, being unemployed, having larger than average debts, poor treatment satisfaction and attending fewer sessions at the later stages of treatment were associated with significantly poorer outcomes, up to 1-year after initiating treatment. These findings show promise for the effectiveness of a CBT-based treatment approach for the treatment of predominantly Chinese PGs. Clinical implications and suggestions for future research are discussed. Taken together, the findings suggest early treatment satisfaction is paramount in improving short-term outcomes, with baseline gambling behaviour and treatment intensity playing a more significant role in the longer term.     

Monitoring the coefficient of variation using a variable sample size and sampling interval control chart

This article proposes a CV chart by using the variable sample size and sampling interval (VSSI) feature to improve the performance of the basic CV chart, for detecting small and moderate shifts in the CV. The proposed VSSI CV chart is designed by allowing the sample size and the sampling interval to vary. The VSSI CV chart's statistical performance is measured by using the average time to signal (ATS) and expected average time to signal (EATS) criteria and is compared with that of existing CV charts. The Markov chain approach is employed in the design of the chart.     

Child‐caregiver Attachment Representations in a Non‐Western Context: The Feasibility and Cultural Equivalence of Story Stems in Urban Ghana

Story stem measures are an increasingly popular method for assessing the attachment representations of young children, but little is known of their cross‐cultural applicability. This study aimed to characterise the attachment representations in 73 five‐ to eight‐year‐old children in urban Ghana, West Africa, using the Manchester Child Attachment Story Task (MCAST) to test its feasibility, psychometric characteristics and concurrent associations with caregiver‐ and teacher‐rated child behaviour, and to conduct a qualitative thematic analysis of methodological observations. Among the classifiable cases (92 percent), all attachment classifications were observed, yielding a higher rate of secure attachment than in European samples. Inter‐rater reliability, internal consistency, and internal structure were reasonable and largely similar to European studies, although one structural difference was the separation of ‘child assuagement of distress’ from other secure‐related items. MCAST narratives were associated with teacher‐ and caregiver‐rated hyperactivity, but internal consistency was low in most Strengths and Difficulties Questionnaire scales. Possible culturally‐sensitive explanations for our psychometric and qualitative findings are discussed. Overall, story stems are a promising tool for accessing attachment representations in non‐Western samples, although modifications are likely to improve cross‐cultural equivalence when applied to non‐Western cultures. Further investigation is needed to link MCAST outcomes to parenting and socio‐emotional development.     

Disentangling the Bidirectional Relationships Across the Corporate Sustainable Development Indicators

Social Indicators Research - This study disentangles the relationships that exist between the four indicators of corporate sustainable development: economic, environmental, social, and governance....     

A direct procedure for monitoring the coefficient of variation using a variable sample size scheme

A variable sample size (VSS) scheme directly monitoring the coefficient of variation (CV), instead of monitoring the transformed statistics, is proposed. Optimal chart parameters are computed based on two criteria: (i) minimizing the out-of-control ARL (ARL₁) and (ii) minimizing the out-of-control ASS (ASS₁). Then the performances are compared between these two criteria. The advantages of the proposed chart over the VSS chart based on the transformed statistics in the existing literature are: the former (i) provides an easier alternative as no transformation is involved and (ii) requires less number of observations to detect a shift when ASS₁ is minimized.     

Assessing Participation and Effectiveness of the Peer-Led Approach in Youth Sexual Health Education: Systematic Review and Meta-Analysis in More Developed Countries

Sexual health education for young people is crucial not only for development of norms but also for protection against vulnerabilities during this stage in life. Although several systematic reviews have examined the effectiveness of peer-led sex education, none have focused on the extent of peer participation. The purpose of this review was to evaluate peer-led sexual health education interventions in more developed countries (MDCs). Electronic and manual searches across five social science, education, and medical databases were conducted. Fifteen articles were selected in total. Most (10 of 15) studies gave low or no responsibility to peers. The majority of articles found improvements in sexual health knowledge (13 of 14) and attitudes (11 of 15) at postintervention stages. Two studies showed improved self-efficacy, and three showed behavioral changes. A preliminary synthesis of effectiveness and level of participation was done. Meta-analysis revealed a large effect on knowledge change (Hedges’ g = 0.84, 95% confidence interval [CI]: 0.43 to 1.25) and a medium effect on attitude change (Hedges’ g = 0.49, 95% CI: 0.19 to 0.80). Peer-led interventions could be a powerful tool. This review shows that this approach is effective in changing knowledge and attitudes but not behaviors. Further research and action are needed to understand optimal implementation.     

Bayesian adaptive dose‐escalation designs for simultaneously estimating the optimal and maximum safe dose based on safety and efficacy

The main purpose of dose‐escalation trials is to identify the dose(s) that is/are safe and efficacious for further investigations in later studies. In this paper, we introduce dose‐escalation designs that incorporate both the dose‐limiting events and dose‐limiting toxicities (DLTs) and indicative responses of efficacy into the procedure. A flexible nonparametric model is used for modelling the continuous efficacy responses while a logistic model is used for the binary DLTs. Escalation decisions are based on the combination of the probabilities of DLTs and expected efficacy through a gain function. On the basis of this setup, we then introduce 2 types of Bayesian adaptive dose‐escalation strategies. The first type of procedures, called “single objective,” aims to identify and recommend a single dose, either the maximum tolerated dose, the highest dose that is considered as safe, or the optimal dose, a safe dose that gives optimum benefit risk. The second type, called “dual objective,” aims to jointly estimate both the maximum tolerated dose and the optimal dose accurately. The recommended doses obtained under these dose‐escalation procedures provide information about the safety and efficacy profile of the novel drug to facilitate later studies. We evaluate different strategies via simulations based on an example constructed from a real trial on patients with type 2 diabetes, and the use of stopping rules is assessed. We find that the nonparametric model estimates the efficacy responses well for different underlying true shapes. The dual‐objective designs give better results in terms of identifying the 2 real target doses compared to the single‐objective designs.     

New recursive estimators of the time-average variance constant

Estimation of the time-average variance constant (TAVC) of a stationary process plays a fundamental role in statistical inference for the mean of a stochastic process. Wu (2009) proposed an efficient algorithm to recursively compute the TAVC with \(O(1)\) memory and computational complexity. In this paper, we propose two new recursive TAVC estimators that can compute TAVC estimate with \(O(1)\) computational complexity. One of them is uniformly better than Wu’s estimator in terms of asymptotic mean squared error (MSE) at a cost of slightly higher memory complexity. The other preserves the \(O(1)\) memory complexity and is better then Wu’s estimator in most situations. Moreover, the first estimator is nearly optimal in the sense that its asymptotic MSE is \(2^{10/3}3^{-2} \fallingdotseq 1.12\) times that of the optimal off-line TAVC estimator.