An Evaluation of Contracts Between Managed Care Organizations and Community Mental Health and Substance Abuse Treatment and Prevention Agencies

This study represents a descriptive, point-in-time examination of the structure and content of provider network agreements between managed care organizations (MCOs) and community mental health and substance abuse (MH/SA) treatment and prevention agencies. This is not a study of the quality of managed care systems. Instead, this analysis is designed to assess provider contracts (one of the basic legal instruments on which the managed care system rests) and to identify the meaning of these instruments for MH/SA service providers, group purchasers, MCOs, individual consumers and their families, and public policy

2018 Annual Report of the University of Kansas Health System Poison Control Center

Background. This is the 2018 Annual Report of the Kansas Poison Control Center at The University of Kansas Health System (KSPCC). The KSPCC serves the state of Kansas 24-hours per day, 365 days a year with certified specialists in poison information and clinical and medical toxicologists.  Methods. All encounters reported to the KSPCC from 01/01/2018 through 12/31/2018 were analyzed. Data recorded for each exposure included caller location, age, weight, gender, exposure substance, nature of exposure, route of exposure, interventions, medical outcome, disposition, and location of care.  Results. There were 21,072 total encounters, including 20,031 human exposure cases. Calls were received from every county and hospital in Kansas. Most of the exposures involved females (51.5%, n = 10,320) and a child less than 19 year of age (64%, n = 12,865). Medical outcomes were 24.5% (n = 4,912) no effect, 17.7% (n = 3,542) minor effect, 9.1% (n = 1,830) moderate effect, and 2.4% (n = 476) major effect. Seven deaths were reported in 2018. The number of exposure calls from healthcare facilities and severity of medical outcomes increased in 2018 compared to 2017.  Conclusions. The 2018 KSPCC annual report demonstrated that the center receives calls from the entire state of Kansas totaling over 20,000 human exposures. While pediatric exposures remain the most common encounter, a trend continued of an increasing number of calls from healthcare facilities and for cases with serious outcomes. This report supported the continued value of the KSPCC to both public and acute health care in the state of Kansas

Living in Arverne : rebuilding the experience of landscape

Thesis (M.Arch.)--Massachusetts Institute of Technology, Dept. of Architecture, 2003.Includes bibliographical references (p. 129-131).How do we approach the inhabitation of a landscape? Starting with an understanding of the ecological system, the design acts as an enabler to the landscape, both at the scale of the urban plan and at the scale of the architecture. By paying attention to the forces of the air and water, the newly built landscape reveals these underlying systems in the experience of this newly formed place. While this design process can be generalized, it reaches its fullest expression by looking at a particular place. This thesis tackled developing Arverne, a once vibrant beach community on the eastern end of the Rockaway Peninsula, only fifteen miles from Times Square. The community of Arverne is part of one of the most significant landscapes in the United States, the barrier island system that runs the length of the eastern seaboard. Situated at the boundary between this powerful landscape and the city, any design must seek to balance both. The goal of the design is more than simply to allow the functioning of the city and nature side-by-side but to create an understanding of the landscape through the experience of this place. The ultimate value of these experiences lies in their ability to foster a new realization of a person's relationship to the landscape and consequently a better sense of their own and the community's identity.Elizabeth Rose Silver.M.Arch

Fall Prevention Knowledge, Attitude, and Practices of Community Stakeholders and Older Adults

We assessed knowledge, attitude, and provision of recommended fall prevention (FP) practices by employees of senior-serving organization and participation in FP practices by at-risk elders. The Washington State Department of Health administered structured telephone surveys to 50 employees and 101 elders in Washington State. Only 38% of employees felt “very knowledgeable” about FP, and a majority of their organizations did not regularly offer FP services. Almost half (48%) of seniors sustained a fall within the past 12 months; however, one-third perceived falling to be among their least important health concerns, and most had minimal working knowledge of proven FP practices. Seniors who perceived avoiding falls as important to their well-being were more likely to participate in practices about which they had the least knowledge (risk assessment, medication management). Increased awareness and availability of FP services might help engage older adults in FP practices and reduce the adverse effects of falls

Optimization of Process Parameters Influencing Biogas Production from Rumen and municipal waste: Analytical Approach

 Rumen waste with high carbohydrate, protein, and lipid content is considered as a suitable substrate for fermentation for methane gas. In this study, direct substrate and co-digestion of rumen waste (RW) and municipal waste (MW) were used. Samples (fresh cow rumen and food waste) were dried, grinded, and blended with water into a semi-solid to facilitate digestion. Central composite design (CCD) was applied to optimize parameters of co-digestion of RW and MW at a different temperature (29 – 33oC), initial pH values, agitation time (AGT), and carbon-nitrogen ratio (C/N). A comparative analysis was done using RSM in a predictive model of the experimental data obtained in accordance with the CCD. The combined effects of temperature, pH, AGT, and C/N as methane production by fermentation of RW and MW were investigated. Optimization using RSM showed a good fit between the experimental and the predicted data as elucidated by the coefficient of determination with R2 values of 0.9214. Quadratic RSM predicted the maximum yield to be 7764 mL CH4/g volatile solid (VS) at optimal conditions of 31°C; pH 7.05; 6s and C/N ratio 20.33. The maximum methane yield was 8550 mL CH4/g VS, at the optimal conditions for the experimental response obtained. The verification experiment successfully produced 8550 mL CH4/g VS within 30 days of incubation. This experiment indicated that the developed model was successfully and can be used for methane production from animal and municipal waste

Influence of intergenerational in utero parental energy and nutrient restriction on offspring growth in rural Gambia.

The prenatal environment can alter an individual's developmental trajectory with long-lasting effects on health. Animal models demonstrate that the impact of the early life environment extends to subsequent generations, but there is a paucity of data from human populations on intergenerational transmission of environmentally induced phenotypes. Here we investigated the association of parental exposure to energy and nutrient restriction in utero on their children's growth in rural Gambia. In a Gambian cohort with infants born between 1972 and 2011, we used multiple regression to test whether parental season of birth predicted offspring birth weight (n = 2097) or length (n = 1172), height-for-age z score (HAZ), weight-for-height z score (WHZ), and weight-for-age z score (WAZ) at 2 yr of age (n = 923). We found that maternal exposure to seasonal energy restriction in utero was associated with reduced offspring birth length (crude:-4.2 mm, P = 0.005; adjusted: -4.0 mm, P = 0.02). In contrast, paternal birth season predicted offspring HAZ at 24 mo (crude: -0.21, P = 0.005; adjusted: -0.22, P = 0.004) but had no discernible impact at birth. Our results indicate that periods of nutritional restriction in a parent's fetal life can have intergenerational consequences in human populations. Fetal growth appears to be under matriline influence, and postnatal growth appears to be under patriline intergenerational influences.-Eriksen, K. G., Radford, E. J., Silver, M. J., Fulford, A. J. C., Wegmüller, R., Prentice, A. M. Influence of intergenerational in utero parental energy and nutrient restriction on offspring growth in rural Gambia

Non-Insertive Acupuncture and Neonatal Abstinence Syndrome: A Case Series from an Inner City Safety Net Hospital

OBJECTIVE: We report on the safety of non-insertive acupuncture (NIA) in 54 newborns diagnosed with Neonatal Abstinence Syndrome (NAS) in a busy inner city hospital. METHODS: For this case series, a retrospective chart review was conducted. Data on participant demographics, number of NIA treatments, provider referrals, and outcomes of interest (sleeping, feeding, and adverse events) were collected. RESULTS: Of the 54 newborns receiving NIA, 86% were non-Hispanic White; 87% were on Medicaid, and gestational age ranged from 33.2 to 42.1 weeks. Out of 54 chart reviews, a total of 92 NIA sessions were documented ranging from 1 to 6 sessions per infant. Of the total number of treatments (n = 92), 73% were requested by a physician. Chart reviews reported restless infants calmed down during NIA, babies slept through or fell asleep immediately following NIA, and better feeding was noted following NIA. There were no adverse events noted in the medical records. CONCLUSIONS: This retrospective chart review shows potential for the use of NIA as an adjunctive treatment in newborns with NAS symptoms during hospitalization. More research is necessary to study whether the incorporation of NIA can result in positive outcomes in newborns withdrawing from narcotics

Geochemical Logging in the Cajon Pass Drill Hole and Its Application to a New, Oxide, Igneous Rock Classification Scheme

A new elemental oxide classification scheme for crystalline rocks is developed and applied to geochemical well logs from the Cajon Pass drill hole. This classification scheme takes advantage of measurements of elements taken by a geochemical logging tool string. It uses K_2O versus SiO_2/Al_2O_3 to distinguish between granites, granodiorites, tonalites, syenites, monzonites, diorites, and gabbros. Oxide measurements from cores are used to calibrate the elemental abundances determined from the well logs. From these logs, a detailed lithologic column of the core is generated. The lithologic column derived from the well log classification scheme is compared with a lithologic column constructed from core samples and well cuttings. In the upper 1295 m of the well, agreement between the two columns is good. Discrepancies occur from 1295 to 2073 m and are believed to be caused by the occurrence of rock types not distinguished by the classification scheme and/or the occurrence of secondary minerals. Despite these discrepancies, the well log-based classification scheme helps to distinguish changes in rock type and shows potential as an aid to the construction of lithologic columns in boreholes of crystalline rocks

Response to Staphylococcus aureus requires CD36-mediated phagocytosis triggered by the COOH-terminal cytoplasmic domain

Phagocyte recognition and clearance of bacteria play essential roles in the host response to infection. In an on-going forward genetic screen, we identify the Drosophila melanogaster scavenger receptor Croquemort as a receptor for Staphylococcus aureus, implicating for the first time the CD36 family as phagocytic receptors for bacteria. In transfection assays, the mammalian Croquemort paralogue CD36 confers binding and internalization of Gram-positive and, to a lesser extent, Gram-negative bacteria. By mutational analysis, we show that internalization of S. aureus and its component lipoteichoic acid requires the COOH-terminal cytoplasmic portion of CD36, specifically Y463 and C464, which activates Toll-like receptor (TLR) 2/6 signaling. Macrophages lacking CD36 demonstrate reduced internalization of S. aureus and its component lipoteichoic acid, accompanied by a marked defect in tumor necrosis factor-α and IL-12 production. As a result, Cd36−/− mice fail to efficiently clear S. aureus in vivo resulting in profound bacteraemia. Thus, response to S. aureus requires CD36-mediated phagocytosis triggered by the COOH-terminal cytoplasmic domain, which initiates TLR2/6 signaling