Vermont's Choices for Care Medicaid Long-Term Services Waiver: Progress and Challenges as the Program Concluded Its Third Year

Based on case study interviews and state data, evaluates the impact of a waiver introduced in 2005 to improve Medicaid beneficiaries' access to home and community-based services while reducing the use of nursing home care and controlling costs

Recognising and responding to suicide risk in a community mental health setting

Despite the number of best practice guidelines for working with those at risk of suicide, there remains a paucity of research pertaining to the realities of clinical practice. The aim of this study was to develop a grounded theory of how clinicians respond to those at risk of suicide in UK community mental health settings. Semi-structured interviews were conducted with eleven members of staff including social workers, nurses, psychologists, psychiatrists and occupational therapists. A theory grounded in the resulting data was developed. Results: Anxiety, uncertainty and practitioners’ perceived responsibility for preventing suicide influenced their attributions in relation to a client’s distress. Findings indicated that clinicians most often attributed low responsibility to clients for both the cause and the solution. Therefore, clinicians sought solutions to suicidal presentations within services, rather than attending to contextual or environmental ‘triggers’ to offer a resolution, potentially increasing dependency on services. Feeling supported and an environment of psychological safety enhanced professionals’ capacity to tolerate the uncertainty inherent in this work which allowed professionals to ‘hand the responsibility back’. This highlights the importance of services creating an environment of psychological safety in order for clinicians to tolerate the uncertainty of working with those who present with suicide risk

MENTEE VOICE: MENTEE PERSPECTIVES OF THE EFFECTIVENESS OF YOUTH MENTORING PROGRAMS

The purpose of the study was to evaluate the effectiveness of youth mentoring programs from the mentee perspective. An extant survey instrument, the Youth Strength of Relationship (YSOR) was utilized to provide data necessary to address the study’s topic and research problem. The YSOR yielded a good level of internal reliability (George & Mallery, 2016) in addressing study participant perceptions of satisfaction with the mentoring program featured in the study. A nonprobability sampling approach was adopted, featuring a convenient, purposive methodology. The study’s sample of participants were youth mentees (n= 1,183) specifically accessed from a Central Florida agency that provides youth mentoring programs. A noteworthy, statistically significant level of overall study participant satisfaction with the mentoring program was achieved in the study. The research instrument domain of “comfort” manifested the highest mean score for study participant response effect of perceived satisfaction amongst the five domains. Study participant satisfaction levels were similar for both genders and all ethnicities represented in the study. The duration of the mentor/mentee match represented a statistically significant correlate and predictor of mentee overall satisfaction with the mentoring program featured in the study

The generation of gravitational waves. 2: The post-linear formalism revisited

Two different versions of the Green's function for the scalar wave equation in weakly curved spacetime (one due to DeWitt and DeWitt, the other to Thorne and Kovacs) are compared and contrasted; and their mathematical equivalence is demonstrated. The DeWitt-DeWitt Green's function is used to construct several alternative versions of the Thorne-Kovacs post-linear formalism for gravitational-wave generation. Finally it is shown that, in calculations of gravitational bremsstrahlung radiation, some of our versions of the post-linear formalism allow one to treat the interacting bodies as point masses, while others do not

Curbing the HIV Epidemic by Supporting Effective Engagement in HIV Care: Recommendations for Health Plans and Health Care Purchasers

The United States is poised to dramatically reduce the scope of its HIV epidemic, but this demands increased leadership and attention from health plans and health care purchasers (including Medicaid, Medicare, marketplaces, and other private purchasers). This new amfAR report identifies changes in policy and practice in clinics, communities, and health care programs to reduce unnecessary health spending, increase the effectiveness of services, and increase the integration of services. Done right, the same steps that lead to appropriate management of care by health plans and purchasers also will help to achieve national public health goals

Extractable nitrogen and microbial community structure respond to grassland restoration regardless of historical context and soil composition.

Grasslands have a long history of invasion by exotic annuals, which may alter microbial communities and nutrient cycling through changes in litter quality and biomass turnover rates. We compared plant community composition, soil chemical and microbial community composition, potential soil respiration and nitrogen (N) turnover rates between invaded and restored plots in inland and coastal grasslands. Restoration increased microbial biomass and fungal : bacterial (F : B) ratios, but sampling season had a greater influence on the F : B ratio than did restoration. Microbial community composition assessed by phospholipid fatty acid was altered by restoration, but also varied by season and by site. Total soil carbon (C) and N and potential soil respiration did not differ between treatments, but N mineralization decreased while extractable nitrate and nitrification and N immobilization rate increased in restored compared with unrestored sites. The differences in soil chemistry and microbial community composition between unrestored and restored sites indicate that these soils are responsive, and therefore not resistant to feedbacks caused by changes in vegetation type. The resilience, or recovery, of these soils is difficult to assess in the absence of uninvaded control grasslands. However, the rapid changes in microbial and N cycling characteristics following removal of invasives in both grassland sites suggest that the soils are resilient to invasion. The lack of change in total C and N pools may provide a buffer that promotes resilience of labile pools and microbial community structure

A review of social disinhibition after traumatic brain injury

Acquired social disinhibition refers to a debilitating behavioural syndrome commonly reported after a severe traumatic brain injury (TBI) and is characterized by inappropriate social behaviour, often described as immaturity and insensitivity towards others. These behaviours can have enduring effects on the social capability of the individual and their relationships with others. However, research into socially disinhibited behaviour after TBI has been thwarted by a lack of consensus in the literature on definition and measurement. This review provides an overview of our current understanding of the definition, measurement, prevalence, associated outcomes, neuropathology, and underlying mechanisms of social disinhibition after TBI. In addition, suggestions are made for future research to further our understanding of this syndrome with the eventual aim of rehabilitating problematic behaviours. It is concluded that an improved understanding of what causes disinhibited behaviour after TBI will be necessary for the development of effective treatment strategies aimed at the rehabilitation of underlying impairments