Involvement in the US criminal justice system and cost implications for persons treated for schizophrenia

<p>Abstract</p> <p>Background</p> <p>Individuals with schizophrenia may have a higher risk of encounters with the criminal justice system than the general population, but there are limited data on such encounters and their attendant costs. This study assessed the prevalence of encounters with the criminal justice system, encounter types, and the estimated cost attributable to these encounters in the one-year treatment of persons with schizophrenia.</p> <p>Methods</p> <p>This post-hoc analysis used data from a prospective one-year cost-effectiveness study of persons treated with antipsychotics for schizophrenia and related disorders in the United States. Criminal justice system involvement was assessed using the Schizophrenia Patients Outcome Research Team (PORT) client survey and the victimization subscale of the Lehman Quality of Life Interview (QOLI). Direct cost of criminal justice system involvement was estimated using previously reported costs per type of encounter. Patients with and without involvement were compared on baseline characteristics and direct annual health care and criminal justice system-related costs.</p> <p>Results</p> <p>Overall, 278 (46%) of 609 participants reported at least 1 criminal justice system encounter. They were more likely to be substance users and less adherent to antipsychotics compared to participants without involvement. The 2 most prevalent types of encounters were being a victim of a crime (67%) and being on parole or probation (26%). The mean annual per-patient cost of involvement was $1,429, translating to 6% of total annual direct health care costs for those with involvement (11% when excluding crime victims).</p> <p>Conclusions</p> <p>Criminal justice system involvement appears to be prevalent and costly for persons treated for schizophrenia in the United States. Findings highlight the need to better understand the interface between the mental health and the criminal justice systems and the related costs, in personal, societal, and economic terms.</p

Antipsychotic adherence, switching, and health care service utilization among Medicaid recipients with schizophrenia

Objective: To evaluate health care resource utilization in patients with schizophrenia who continued newly prescribed antipsychotic medications, compared with those switching to different treatments. Methods: Adults with schizophrenia in the California Medicaid (MediCal) database who initiated treatment with index medications in 1998–2001, were classified as having: 1) abandoned antipsychotic medications; 2) switched to another medication; or 3) continued with the index antipsychotic, for up to 6 months after the index date. Results: Of 2300 patients meeting eligibility criteria, 1382 (60.1%) continued index medications, 480 (20.9%) switched, and 438 (19.0%) abandoned antipsychotic treatment. Utilization in several resource categories occurred significantly more frequently among patients whose regimens were switched (vs those continuing index medications). These included using psychiatric (24.2% vs 14.5%; P \u3c 0.001) or nonpsychiatric (31.5% vs 24.3%; P \u3c 0.05) emergency services; being admitted to a hospital (10.6% vs 7.4%; P \u3c 0.05); making nonpsychiatric outpatient hospital visits (43.3% vs 36.4%; P \u3c 0.05) or nonpsychiatric physician visits (62.7% vs 56.4%; P \u3c 0.05); and using other outpatient psychiatric (53.3% vs 40.7%; P \u3c 0.001) or nonpsychiatric (82.7% vs 74.6%; P \u3c 0.001) services. Conclusions: Switching antipsychotic medications is associated with significantly increased health care resource utilization (vs continuing treatment)

Uncertainty Assessment Of The Integrated Hydrological Ensemble Prediction System Designed For The Nattai River Catchment

An integrated hydrological ensemble prediction system (IHEPS) is providing a probabilistic assessment of future stream flow predicitons replacing the traditional forecasting method of a single deterministic flow forecast. The ensemble forecasting system includes multi model approaches where the hydrological forecasts model is driven by weather prediction model outputs to generate an ensemble stream flow forecast predictions. The performance of the IHEP systems intent to increase the credibility of the stream flow forecast predictions at the point of interest. However, quality of the stream flow forecast predictions are influenced by uncertainties originated from various sources in the forecasting chain. This paper identifies the uncertainty sources in IHEPS and describes the most suitable method to reduce their impact on the stream flow forecasts predictions. In order to undertake this assessment the uncertainty sources are separated into two fundamentally different types of uncertainties in hydrological forecast. The first type is due to a lack of knowledge about the behaviour of the hydrological system refers as a epistemic uncertainty in the forecasting chain the second type is due to randomness in the natural system known as a aleatory uncertainty. Both types of uncertainties are addressed with different approaches in order to address them. This paper presents the outcome of the uncertainty assessments of the IHEPS designed for the Nattai River catchment

Operator theory and function theory in Drury-Arveson space and its quotients

The Drury-Arveson space $H^2_d$, also known as symmetric Fock space or the $d$-shift space, is a Hilbert function space that has a natural $d$-tuple of operators acting on it, which gives it the structure of a Hilbert module. This survey aims to introduce the Drury-Arveson space, to give a panoramic view of the main operator theoretic and function theoretic aspects of this space, and to describe the universal role that it plays in multivariable operator theory and in Pick interpolation theory.Comment: Final version (to appear in Handbook of Operator Theory); 42 page

Nursing skill mix in European hospitals: cross-sectional study of the association with mortality, patient ratings, and quality of care

OBJECTIVES: To determine the association of hospital nursing skill mix with patient mortality, patient ratings of their care and indicators of quality of care. DESIGN: Cross-sectional patient discharge data, hospital characteristics and nurse and patient survey data were merged and analysed using generalised estimating equations (GEE) and logistic regression models. SETTING: Adult acute care hospitals in Belgium, England, Finland, Ireland, Spain and Switzerland. PARTICIPANTS: Survey data were collected from 13 077 nurses in 243 hospitals, and 18 828 patients in 182 of the same hospitals in the six countries. Discharge data were obtained for 275 519 surgical patients in 188 of these hospitals. MAIN OUTCOME MEASURES: Patient mortality, patient ratings of care, care quality, patient safety, adverse events and nurse burnout and job dissatisfaction. RESULTS: Richer nurse skill mix (eg, every 10-point increase in the percentage of professional nurses among all nursing personnel) was associated with lower odds of mortality (OR=0.89), lower odds of low hospital ratings from patients (OR=0.90) and lower odds of reports of poor quality (OR=0.89), poor safety grades (OR=0.85) and other poor outcomes (0.80<OR<0.93), after adjusting for patient and hospital factors. Each 10 percentage point reduction in the proportion of professional nurses is associated with an 11% increase in the odds of death. In our hospital sample, there were an average of six caregivers for every 25 patients, four of whom were professional nurses. Substituting one nurse assistant for a professional nurse for every 25 patients is associated with a 21% increase in the odds of dying. CONCLUSIONS: A bedside care workforce with a greater proportion of professional nurses is associated with better outcomes for patients and nurses. Reducing nursing skill mix by adding nursing associates and other categories of assistive nursing personnel without professional nurse qualifications may contribute to preventable deaths, erode quality and safety of hospital care and contribute to hospital nurse shortages.European Union's Seventh Framework Program (223468), National Institute of Nursing Research, National Institutes of Health (NR014855), Spanish Ministry of Science and Technology.S

A microscopic model for thin film spreading

A microscopic, driven lattice gas model is proposed for the dynamics and spatio-temporal fluctuations of the precursor film observed in spreading experiments. Matter is transported both by holes and particles, and the distribution of each can be described by driven diffusion with a moving boundary. This picture leads to a stochastic partial differential equation for the shape of the boundary, which agrees with the simulations of the lattice gas. Preliminary results for flow in a thermal gradient are discussed.Comment: 4 pages, 3 figures. Submitte

Using Touchscreen Electronic Medical Record Systems to Support and Monitor National Scale-Up of Antiretroviral Therapy in Malawi

Gerry Douglas and colleagues describe the rationale and their experience with scaling up electronic health records in six antiretroviral treatment sites in Malawi

Progress in noncommutative function theory

In this expository paper we describe the study of certain non-self-adjoint operator algebras, the Hardy algebras, and their representation theory. We view these algebras as algebras of (operator valued) functions on their spaces of representations. We will show that these spaces of representations can be parameterized as unit balls of certain $W^{*}$-correspondences and the functions can be viewed as Schur class operator functions on these balls. We will provide evidence to show that the elements in these (non commutative) Hardy algebras behave very much like bounded analytic functions and the study of these algebras should be viewed as noncommutative function theory

Succeeding against the odds: can schools ‘compensate for society’?

Education researchers, policy-makers and practitioners in the UK have debated the question of what, and how much, schools can do to mitigate the effects of parental background on educational outcomes over the last half a century. A range of programmes, strategies and interventions have been implemented, and continue to be implemented in an effort to ‘break the link’ between socio-economic disadvantage and low educational outcomes, but educational inequalities have persisted. This paper draws on theoretical and empirical research to offer a new analysis of compensatory education in England across three main phases since the 1960s

Qualitative Examination of Voting Empowerment and Participation Among People Living With Traumatic Brain Injury

Objective To examine political participation after traumatic brain injury (TBI). Design Qualitative, participatory research via interviews and observations. Each participant was interviewed to discuss their experience of voting in 2007 or 2008. Data were coded using Grounded Theory to develop themes, metacodes, and theories. Setting Community. Participants A total of 57 individuals with history of TBI and 28 family members (N=85). Main Outcome Measures Not applicable. Results Four themes emerged from the data: (1) people with TBI have barriers to voting; (2) the voting process can be improved for people with TBI; (3) voting is the responsibility of members of society; and (4) voting is one way we have a voice in society. Conclusions The data support the importance of voting as an American right regardless of the presence of disability. While persons with TBI report voting represents their freedom and voice, there may be barriers that can threaten or limit their voice