This study responds to the call for more ecologically valid psycholinguistic research (Spivey & Cardon, 2015) by examining how readers incidentally acquire multifaceted vocabulary knowledge while reading a long, authentic text. Using eye tracking, we explore how the processing of unfamiliar words changes with repeated exposure and how the repeated exposure and processing affect word learning. In two sessions, native and non-native English speakers read five chapters of an authentic English novel containing Dari words. After reading, participants received a comprehension test and three surprise vocabulary tests. Growth curve modeling revealed a non-linear decrease in reading times that followed an S shaped curve. Number of exposures was the strongest predictor of vocabulary learning (form and meaning), while total reading time independently contributed to the learning of word meaning. Thus, both quantity and quality of lexical processing aid incremental vocabulary development and may reveal themselves differently in readers’ eye movement records.

BackgroundOver past decades, improvements in longer-term clinical and personal outcomes for individuals experiencing serious mental illness (SMI) have been moderate, although recovery has clearly been shown to be possible. Recovery experiences are inherently personal, and recovery can be complex and non-linear; however, there are a broad range of potential recovery contexts and contributors, both non-professional and professional. Ongoing refinement of recovery-oriented models for mental health (MH) services needs to be fostered.DiscussionThis descriptive paper outlines a service-wide Integrated Recovery-oriented Model (IRM) for MH services, designed to enhance personally valued health, wellbeing and social inclusion outcomes by increasing access to evidenced-based psychosocial interventions (EBIs) within a service context that supports recovery as both a process and an outcome. Evolution of the IRM is characterised as a series of five broad challenges, which draw together: relevant recovery perspectives; overall service delivery frameworks; psychiatric and psychosocial rehabilitation approaches and literature; our own clinical and service delivery experience; and implementation, evaluation and review strategies. The model revolves around the person's changing recovery needs, focusing on underlying processes and the service frameworks to support and reinforce hope as a primary catalyst for symptomatic and functional recovery. Within the IRM, clinical rehabilitation (CR) practices, processes and partnerships facilitate access to psychosocial EBIs to promote hope, recovery, self-agency and social inclusion. Core IRM components are detailed (remediation of functioning; collaborative restoration of skills and competencies; and active community reconnection), together with associated phases, processes, evaluation strategies, and an illustrative IRM scenario. The achievement of these goals requires ongoing collaboration with community organisations.ConclusionsImproved outcomes are achievable for people with a SMI. It is anticipated that the IRM will afford MH services an opportunity to validate hope, as a critical element for people with SMI in assuming responsibility and developing skills in self-agency and advocacy. Strengthening recovery-oriented practices and policies within MH services needs to occur in tandem with wide-ranging service evaluation strategies.Electronic supplementary materialThe online version of this article (doi:10.1186/s12888-016-1164-3) contains supplementary material, which is available to authorized users.

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IMPORTANCEDigital health programs may have the potential to prevent hospitalizations among patients with chronic diseases by supporting patient self-management, symptom monitoring, and coordinated care. OBJECTIVE To compare the effect of an internet-based self-management and symptom monitoring program targeted to patients with 2 or more chronic diseases (internet chronic disease management [CDM]) with usual care on hospitalizations over a 2-year period. DESIGN, SETTING, AND PARTICIPANTS This single-blinded randomized clinical trial included patients with multiple chronic diseases from 71 primary care clinics in small urban and rural areas throughout British Columbia, Canada. Recruitment occurred between October 1, 2011, and March 23, 2015. A volunteer sample of 456 patients was screened for eligibility. Inclusion criteria included daily internet access, age older than 19 years, fluency in English, and the presence of 2 or more of the following 5 conditions: diabetes, heart failure, ischemic heart disease, chronic kidney disease, or chronic obstructive pulmonary disease. A total of 230 patients consented to participate and were randomized to receive either the internet CDM intervention (n = 117) or usual care (n = 113). One participant in the internet CDM group withdrew from the study after randomization, resulting in 229 participants for whom data on the primary outcome were available.INTERVENTIONS Internet-based self-management program using telephone nursing supports and integration within primary care compared with usual care over a 2-year period. MAIN OUTCOMES AND MEASURESThe primary outcome was all-cause hospitalizations at 2 years.Secondary outcomes included hospital length of stay, quality of life, self-management, and social support. Additional outcomes included the number of participants with at least 1 hospitalization, the number of participants who experienced a composite outcome of all-cause hospitalization or death, the time to first hospitalization, and the number of in-hospital days. RESULTS Among 229 participants included in the analysis, the mean (SD) age was 70.5 (9.1) years, and 141 participants (61.6%) were male; data on race and ethnicity were not collected because there was no planned analysis of these variables. The internet CDM group had 25 fewer hospitalizations compared with the usual care group (56 hospitalizations vs 81 hospitalizations, respectively [30.9% reduction]; relative risk [RR], 0.68; 95% CI, 0.43-1.10; P = .12). The intervention group also had 229 fewer in-hospital days compared with the usual care group (282 days vs 511 days, respectively; RR, 0.52; 95% CI, 0.24-1.10; P = .09). Components of self-management and social support improved in the intervention group. Fewer participants in the internet CDM vs usual care group had at least 1 (continued) Key Points Question Does a digital health intervention that uses the internet to support patient self-management and self-monitoring and is implemented in primary care clinics reduce hospitalizations among patients with multiple chr...

This interpretive ethnographic study describes the experiences of northern British Columbian Aboriginal mothers raising adolescents with fetal alcohol spectrum disorder (FASD) and provides an understanding of how the mothers interpreted and responded to their adolescents' FASD. The all-encompassing theoretical perspectives of postcolonialism provided the conceptual guide for this study. This ontological stance facilitates discourse on the social and historical context of this research focused on northern British Columbian Aboriginal mothers. Using semistructured interviews and participant observation, eight participants were interviewed three times over a period of several months. Data were analyzed using an interpretive analysis to generate an overarching cultural theme, Mothering from the Margins. The theme conveyed how study participants understood FASD and how they were raising their adolescents within the social and historical context unique to postcolonial societies.

For rural communities the improvement in rehabilitation outcomes might be attributable to a more benign form of the illness and the availability of higher levels of social capital.

BackgroundAn ongoing service evaluation project was initiated following the establishment of a new, purpose-built, 20-bed sub-acute Intermediate Stay Mental Health Unit (ISMHU). This paper: provides an overview of the targeted 6-week program, operating within an Integrated Recovery-oriented Model (IRM); characterises the clients admitted during the first 16 months; and documents their recovery needs and any changes.MethodsA brief description of the unit’s establishment and programs is initially provided. Client needs and priorities were identified collaboratively using the Mental Health Recovery Star (MHRS) and addressed through a range of in-situ, individual and group interventions. Extracted client and service data were analysed using descriptive statistics, paired t-tests examining change from admission to discharge, and selected correlations.ResultsThe initial 154 clients (165 admissions, average stay = 47.86 days) were predominately male (72.1%), transferred from acute care (75.3%), with schizophrenia or related disorders (74.0%). Readmission rates within 6-months were 16.2% for acute and 3.2% for sub-acute care. Three MHRS subscales were derived, together with stage-of-change categories. Marked improvements in MHRS Symptom management and functioning were identified (z-change = −1.15), followed by Social-connection (z-change = −0.82) and Self-belief (z-change = −0.76). This was accompanied by a mean reduction of 2.59 in the number of pre-action MHRS items from admission to discharge (z-change = 0.98). Clinician-rated Health of the Nation Outcome Scales (HoNOS) improvements were smaller (z-change = 0.41), indicative of illness chronicity. Staff valued the elements of client choice, the holistic and team approach, program quality, review processes and opportunities for client change. Addressing high-levels of need in the 6-week timeframe was raised as a concern.ConclusionsThis paper demonstrates that a recovery-oriented model can be successfully implemented at the intermediate level of care. It is hoped that ongoing evaluations support the enthusiasm, commitment and feedback evident from staff, clients and carers.Electronic supplementary materialThe online version of this article (doi:10.1186/s12913-016-1939-8) contains supplementary material, which is available to authorized users.

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