Alcohol, Tobacco, and Other Drugs: Future Directions for Screening and Intervention in the Emergency Department

This article is a product of a breakout session on injury prevention from the 2009 Academic Emergency Medicine consensus conference on “Public Health in the ED: Screening, Surveillance, and Intervention.” The emergency department (ED) is an important entry portal into the medical care system. Given the epidemiology of substance use among ED patients, the delivery of effective brief interventions (BIs) for alcohol, drug, and tobacco use in the ED has the potential to have a large public health impact. To date, the results of randomized controlled trials of interventional studies in the ED setting for substance use have been mixed in regard to alcohol and understudied in the area of tobacco and other drugs. As a result, there are more questions remaining than answered. The work group developed the following research recommendations that are essential for the field of screening and BI for alcohol, tobacco, and other drugs in the ED. 1) Screening—develop and validate brief and practical screening instruments for ED patients and determine the optimal method for the administration of screening instruments. 2) Key components and delivery methods for intervention—conduct research on the effectiveness of screening, brief intervention, and referral to treatment (SBIRT) in the ED on outcomes (e.g., consumption, associated risk behaviors, and medical psychosocial consequences) including minimum dose needed, key components, optimal delivery method, interventions focused on multiple risk behaviors and tailored based on assessment, and strategies for addressing polysubstance use. 3) Effectiveness among patient subgroups—conduct research to determine which patients are most likely to benefit from a BI for substance use, including research on moderators and mediators of intervention effectiveness, and examine special populations using culturally and developmentally appropriate interventions. 4) Referral strategies—a) promote prospective effectiveness trials to test best strategies to facilitate referrals and access from the ED to preventive services, community resources, and substance abuse and mental health treatment; b) examine impact of available community services; c) examine the role of stigma of referral and follow-up; and d) examine alternatives to specialized treatment referral. 5) Translation—conduct translational and cost-effectiveness research of proven efficacious interventions, with attention to fidelity, to move ED SBIRT from research to practice.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/78664/1/j.1553-2712.2009.00552.x.pd

The Evolution of Distorted Rotating Black Holes III: Initial Data

In this paper we study a new family of black hole initial data sets corresponding to distorted ``Kerr'' black holes with moderate rotation parameters, and distorted Schwarzschild black holes with even- and odd-parity radiation. These data sets build on the earlier rotating black holes of Bowen and York and the distorted Brill wave plus black hole data sets. We describe the construction of this large family of rotating black holes. We present a systematic study of important properties of these data sets, such as the size and shape of their apparent horizons, and the maximum amount of radiation that can leave the system during evolution. These data sets should be a very useful starting point for studying the evolution of highly dynamical black holes and can easily be extended to 3D.Comment: 16 page

Symmetry without Symmetry: Numerical Simulation of Axisymmetric Systems using Cartesian Grids

We present a new technique for the numerical simulation of axisymmetric systems. This technique avoids the coordinate singularities which often arise when cylindrical or polar-spherical coordinate finite difference grids are used, particularly in simulating tensor partial differential equations like those of 3+1 numerical relativity. For a system axisymmetric about the z axis, the basic idea is to use a 3-dimensional Cartesian (x,y,z) coordinate grid which covers (say) the y=0 plane, but is only one finite-difference-molecule--width thick in the y direction. The field variables in the central y=0 grid plane can be updated using normal (x,y,z)--coordinate finite differencing, while those in the y \neq 0 grid planes can be computed from those in the central plane by using the axisymmetry assumption and interpolation. We demonstrate the effectiveness of the approach on a set of fully nonlinear test computations in 3+1 numerical general relativity, involving both black holes and collapsing gravitational waves.Comment: 17 pages, 4 figure

The Evolution of Distorted Rotating Black Holes II: Dynamics and Analysis

We have developed a numerical code to study the evolution of distorted, rotating black holes. This code is used to evolve a new family of black hole initial data sets corresponding to distorted ``Kerr'' holes with a wide range of rotation parameters, and distorted Schwarzschild black holes with odd-parity radiation. Rotating black holes with rotation parameters as high as $a/m=0.87$ are evolved and analyzed in this paper. The evolutions are generally carried out to about $t=100M$, where $M$ is the ADM mass. We have extracted both the even- and odd-parity gravitational waveforms, and find the quasinormal modes of the holes to be excited in all cases. We also track the apparent horizons of the black holes, and find them to be a useful tool for interpreting the numerical results. We are able to compute the masses of the black holes from the measurements of their apparent horizons, as well as the total energy radiated and find their sum to be in excellent agreement with the ADM mass.Comment: 26 pages, LaTeX with RevTeX 3.0 macros. 27 uuencoded gz-compressed postscript figures. Also available at http://jean-luc.ncsa.uiuc.edu/Papers/ Submitted to Physical Review

Three Dimensional Distorted Black Holes

We present three-dimensional, {\it non-axisymmetric} distorted black hole initial data which generalizes the axisymmetric, distorted, non-rotating [Bernstein93a] and rotating [Brandt94a] single black hole data developed by Bernstein, Brandt, and Seidel. These initial data should be useful for studying the dynamics of fully 3D, distorted black holes, such as those created by the spiraling coalescence of two black holes. We describe the mathematical construction of several families of such data sets, and show how to construct numerical solutions. We survey quantities associated with the numerically constructed solutions, such as ADM masses, apparent horizons, measurements of the horizon distortion, and the maximum possible radiation loss ($MRL$).Comment: 23 pages, 12 figures, accepted for publication in Classical and Quantum Gravit