Innovations in mental health services implementation: a report on state-level data from the U.S. Evidence-Based Practices Project

BACKGROUND: The Evidence-Based Practice (EBP) Project has been investigating the implementation of evidence-based mental health practices (Assertive Community Treatment, Family Psychoeducation, Integrated Dual Diagnosis Treatment, Illness Management and Recovery, and Supported Employment) in state public mental health systems in the United States since 2001. To date, Project findings have yielded valuable insights into implementation strategy characteristics and effectiveness. This paper reports results of an effort to identify and classify state-level implementation activities and strategies employed across the eight states participating in the Project. METHODS: Content analysis and Greenhalgh et al's (2004) definition of innovation were used to identify and classify state-level activities employed during three phases of EBP implementation: Pre-Implementation, Initial Implementation and Sustainability Planning. Activities were coded from site visit reports created from documents and notes from key informant interviews conducted during two periods, Fall 2002 – Spring 2003, and Spring 2004. Frequency counts and rank-order analyses were used to examine patterns of implementation activities and strategies employed across the three phases of implementation. RESULTS: One hundred and six discreet implementation activities and strategies were identified as innovative and were classified into five categories: 1) state infrastructure building and commitment, 2) stakeholder relationship building and communications, 3) financing, 4) continuous quality management, and 5) service delivery practices and training. Implementation activities from different categories were employed at different phases of implementation. CONCLUSION: Insights into effective strategies for implementing EBPs in mental health and other health sectors require qualitative and quantitative research that seeks to: a) empirically test the effects of tools and methods used to implement EBPs, and b) establish a stronger evidence-base from which to plan, implement and sustain such efforts. This paper offers a classification scheme and list of innovative implementation activities and strategies. The classification scheme offers potential value for future studies that seek to assess the effects of various implementation processes, and helps establish widely accepted standards and criteria that can be used to assess the value of innovative activities and strategies

Little Ice Age wetting of interior Asian deserts and the rise of the Mongol Empire

Quaternary Science Reviews, 131 (2016) 33-50. doi:10.1016/j.quascirev.2015.10.03

Ice core and climate reanalysis analogs to predict Antarctic and Southern Hemisphere climate changes

A primary goal of the SCAR (Scientific Committee for Antarctic Research) initiated AntClim21 (Antarctic Climate in the 21st Century) Scientific Research Programme is to develop analogs for understanding past, present and future climates for the Antarctic and Southern Hemisphere. In this contribution to AntClim21 we provide a framework for achieving this goal that includes: a description of basic climate parameters; comparison of existing climate reanalyses; and ice core sodium records as proxies for the frequencies of marine air mass intrusion spanning the past ∼2000 years. The resulting analog examples include: natural variability, a continuation of the current trend in Antarctic and Southern Ocean climate characterized by some regions of warming and some cooling at the surface of the Southern Ocean, Antarctic ozone healing, a generally warming climate and separate increases in the meridional and zonal winds. We emphasize changes in atmospheric circulation because the atmosphere rapidly transports heat, moisture, momentum, and pollutants, throughout the middle to high latitudes. In addition, atmospheric circulation interacts with temporal variations (synoptic to monthly scales, inter-annual, decadal, etc.) of sea ice extent and concentration. We also investigate associations between Antarctic atmospheric circulation features, notably the Amundsen Sea Low (ASL), and primary climate teleconnections including the SAM (Southern Annular Mode), ENSO (El Nîno Southern Oscillation), the Pacific Decadal Oscillation (PDO), the AMO (Atlantic Multidecadal Oscillation), and solar irradiance variations