VA residential substance use disorder treatment program providers’ perceptions of facilitators and barriers to performance on pre-admission processes

Abstract Background In the U.S. Department of Veterans Affairs (VA), residential treatment programs are an important part of the continuum of care for patients with a substance use disorder (SUD). However, a limited number of program-specific measures to identify quality gaps in SUD residential programs exist. This study aimed to: (1) Develop metrics for two pre-admission processes: Wait Time and Engagement While Waiting, and (2) Interview program management and staff about program structures and processes that may contribute to performance on these metrics. The first aim sought to supplement the VA’s existing facility-level performance metrics with SUD program-level metrics in order to identify high-value targets for quality improvement. The second aim recognized that not all key processes are reflected in the administrative data, and even when they are, new insight may be gained from viewing these data in the context of day-to-day clinical practice. Methods VA administrative data from fiscal year 2012 were used to calculate pre-admission metrics for 97 programs (63 SUD Residential Rehabilitation Treatment Programs (SUD RRTPs); 34 Mental Health Residential Rehabilitation Treatment Programs (MH RRTPs) with a SUD track). Interviews were then conducted with management and front-line staff to learn what factors may have contributed to high or low performance, relative to the national average for their program type. We hypothesized that speaking directly to residential program staff may reveal innovative practices, areas for improvement, and factors that may explain system-wide variability in performance. Results Average wait time for admission was 16 days (SUD RRTPs: 17 days; MH RRTPs with a SUD track: 11 days), with 60% of Veterans waiting longer than 7 days. For these Veterans, engagement while waiting occurred in an average of 54% of the waiting weeks (range 3–100% across programs). Fifty-nine interviews representing 44 programs revealed factors perceived to potentially impact performance in these domains. Efficient screening processes, effective patient flow, and available beds were perceived to facilitate shorter wait times, while lack of beds, poor staffing levels, and lengths of stay of existing patients were thought to lengthen wait times. Accessible outpatient services, strong patient outreach, and strong encouragement of pre-admission outpatient treatment emerged as facilitators of engagement while waiting; poor staffing levels, socioeconomic barriers, and low patient motivation were viewed as barriers. Conclusions Metrics for pre-admission processes can be helpful for monitoring residential SUD treatment programs. Interviewing program management and staff about drivers of performance metrics can play a complementary role by identifying innovative and other strong practices, as well as high-value targets for quality improvement. Key facilitators of high-performing facilities may offer programs with lower performance useful strategies to improve specific pre-admission processes

Magnetoresistance of YBa2Cu3O7 in the "cold spots" model

We calculate the in-plane magnetoresistance $\Delta\rho_{xx}/\rho_{xx}$ of YBa$_2$Cu$_3$O$_7$ in a magnetic field applied perpendicular to the $CuO_2$ planes for the ``cold spots'' model. In this model, the electron relaxation time $\tau_2\propto1/T^2$ at small regions on the Fermi surface near the Brillouin zone diagonals is much longer than the relaxation time $\tau_1\propto1/T$ at the rest of the Fermi surface ($T$ is temperature). In qualitative agreement with the experiment, we find that Kohler's rule is strongly violated, but the ratio $\Delta\rho_{xx}/\rho_{xx}\tan^2\theta_H$, where $\tan\theta_H$ is the Hall angle, is approximately temperature-independent. We find the ratio is about 5.5, which is of the same order of magnitude as in the experiment.Comment: RevTeX, 4 pages, 6 figures. V.2: 2 references adde

Effects of ventilation strategy on distribution of lung inflammatory cell activity

Introduction: Leukocyte infiltration is central to the development of acute lung injury, but it is not known how mechanical ventilation strategy alters the distribution or activation of inflammatory cells. We explored how protective (vs. injurious) ventilation alters the magnitude and distribution of lung leukocyte activation following systemic endotoxin administration. Methods: Anesthetized sheep received intravenous endotoxin (10 ng/kg/min) followed by 2 h of either injurious or protective mechanical ventilation (n = 6 per group). We used positron emission tomography to obtain images of regional perfusion and shunting with infused 13N[nitrogen]-saline and images of neutrophilic inflammation with 18F-fluorodeoxyglucose (18F-FDG). The Sokoloff model was used to quantify 18F-FDG uptake (Ki), as well as its components: the phosphorylation rate (k3, a surrogate of hexokinase activity) and the distribution volume of 18F-FDG (Fe) as a fraction of lung volume (Ki = Fe × k3). Regional gas fractions (fgas) were assessed by examining transmission scans. Results: Before endotoxin administration, protective (vs. injurious) ventilation was associated with a higher ratio of partial pressure of oxygen in arterial blood to fraction of inspired oxygen (PaO2/FiO2) (351 ± 117 vs. 255 ± 74 mmHg; P < 0.01) and higher whole-lung fgas (0.71 ± 0.12 vs. 0.48 ± 0.08; P = 0.004), as well as, in dependent regions, lower shunt fractions. Following 2 h of endotoxemia, PaO2/FiO2 ratios decreased in both groups, but more so with injurious ventilation, which also increased the shunt fraction in dependent lung. Protective ventilation resulted in less nonaerated lung (20-fold; P < 0.01) and more normally aerated lung (14-fold; P < 0.01). Ki was lower during protective (vs. injurious) ventilation, especially in dependent lung regions (0.0075 ± 0.0043/min vs. 0.0157 ± 0.0072/min; P < 0.01). 18F-FDG phosphorylation rate (k3) was twofold higher with injurious ventilation and accounted for most of the between-group difference in Ki. Dependent regions of the protective ventilation group exhibited lower k3 values per neutrophil than those in the injurious ventilation group (P = 0.01). In contrast, Fe was not affected by ventilation strategy (P = 0.52). Lung neutrophil counts were not different between groups, even when regional inflation was accounted for. Conclusions: During systemic endotoxemia, protective ventilation may reduce the magnitude and heterogeneity of pulmonary inflammatory cell metabolic activity in early lung injury and may improve gas exchange through its effects predominantly in dependent lung regions. Such effects are likely related to a reduction in the metabolic activity, but not in the number, of lung-infiltrating neutrophils

Magnetoresistance in High-Tc Superconductors: The Role of Vertex Corrections

In high-Tc cuprates, the orbital magnetoresistance in plane (MR, $\Delta\rho/\rho$) is anomalously enhanced at lower tempemeratures compared with conventional Fermi liquids, and thus Kohler's rule is strongly violated. Moreover, it should be noted that an intimate relation between the MR and the Hall coefficient ($R_H$), $\Delta\rho/\rho \propto (R_H/\rho)^2$, holds well experimentally, and is called the "modified Kohler's rule". In this letter, we study this long-standing problem in terms of the nearly antiferromagnetic (AF) Fermi liquid. We analyze the exact expression for the MR by including the vertex corrections (VC's) to keep the conservation laws, and find the approximate "scaling relation" $\Delta\rho/\rho \propto \xi_{AF}^4 /\rho^2$ ($\xi_{AF}$ being the AF correlation length.) in the presence of AF fluctuations. The factor $\xi_{AF}^4$, which comes from the VC's for the current, gives the additional temperature dependence. By taking account of the relation $R_H \propto \xi_{AF}^2$ [Kontani et al., PRB 59 (1999) 14723.], we can naturally explain the modified Kohler's rule. In conclusion, based on the Fermi liquid theory, the famous {\it seemingly} non-Fermi liquid behaviors of the Hall coefficient and the MR in high-Tc cuprates are naturally understood on an equal footing.Comment: 5 pages, 5 figures, to appear in J. Phys. Soc. Jpn. 70 (2001) No.

Predictive blood biomarkers and brain changes associated with age-related cognitive decline

Growing evidence supports the use of plasma levels of tau phosphorylated at threonine 181, amyloid-β, neurofilament light and glial fibrillary acidic protein as promising biomarkers for Alzheimer's disease. While these blood biomarkers are promising for distinguishing people with Alzheimer's disease from healthy controls, their predictive validity for age-related cognitive decline without dementia remains unclear. Further, while tau phosphorylated at threonine 181 is a promising biomarker, the distribution of this phospho-epitope of tau in the brain is unknown. Here, we tested whether plasma levels of tau phosphorylated at threonine 181, amyloid-β, neurofilament light and fibrillary acidic protein predict cognitive decline between ages 72 and 82 in 195 participants in the Lothian birth cohorts 1936 study of cognitive ageing. We further examined post-mortem brain samples from temporal cortex to determine the distribution of tau phosphorylated at threonine 181 in the brain. Several forms of tau phosphorylated at threonine 181 have been shown to contribute to synapse degeneration in Alzheimer's disease, which correlates closely with cognitive decline in this form of dementia, but to date, there have not been investigations of whether tau phosphorylated at threonine 181 is found in synapses in Alzheimer's disease or healthy ageing brain. It was also previously unclear whether tau phosphorylated at threonine 181 accumulated in dystrophic neurites around plaques, which could contribute to tau leakage to the periphery due to impaired membrane integrity in dystrophies. Brain homogenate and biochemically enriched synaptic fractions were examined with western blot to examine tau phosphorylated at threonine 181 levels between groups (n = 10-12 per group), and synaptic and astrocytic localization of tau phosphorylated at threonine 181 were examined using array tomography (n = 6-15 per group), and localization of tau phosphorylated at threonine 181 in plaque-associated dystrophic neurites with associated gliosis were examined with standard immunofluorescence (n = 8-9 per group). Elevated baseline plasma tau phosphorylated at threonine 181, neurofilament light and fibrillary acidic protein predicted steeper general cognitive decline during ageing. Further, increasing tau phosphorylated at threonine 181 over time predicted general cognitive decline in females only. Change in plasma tau phosphorylated at threonine 181 remained a significant predictor of g factor decline when taking into account Alzheimer's disease polygenic risk score, indicating that the increase of blood tau phosphorylated at threonine 181 in this cohort was not only due to incipient Alzheimer's disease. Tau phosphorylated at threonine 181 was observed in synapses and astrocytes in both healthy ageing and Alzheimer's disease brain. We observed that a significantly higher proportion of synapses contain tau phosphorylated at threonine 181 in Alzheimer's disease relative to aged controls. Aged controls with pre-morbid lifetime cognitive resilience had significantly more tau phosphorylated at threonine 181 in fibrillary acidic protein-positive astrocytes than those with pre-morbid lifetime cognitive decline. Further, tau phosphorylated at threonine 181 was found in dystrophic neurites around plaques and in some neurofibrillary tangles. The presence of tau phosphorylated at threonine 181 in plaque-associated dystrophies may be a source of leakage of tau out of neurons that eventually enters the blood. Together, these data indicate that plasma tau phosphorylated at threonine 181, neurofilament light and fibrillary acidic protein may be useful biomarkers of age-related cognitive decline, and that efficient clearance of tau phosphorylated at threonine 181 by astrocytes may promote cognitive resilience

Measuring anisotropic scattering in the cuprates

A simple model of anisotropic scattering in a quasi two-dimensional metal is studied. Its simplicity allows an analytic calculation of transport properties using the Boltzmann equation and relaxation time approximation. We argue that the c-axis magnetoresistance provides the key test of this model of transport. We compare this model with experiments on overdoped Tl-2201 and find reasonable agreement using only weak scattering anisotropy. We argue that optimally doped Tl-2201 should show strong angular-dependent magnetoresistance within this model and would provide a robust way of determining the in-plane scattering anisotropy in the cuprates.Comment: 12 pages, 8 figures, typset in REVTeX 4. Version 2; added references and corrected typo

Wastewater Surveillance for SARS-CoV-2 on College Campuses: Initial Efforts, Lessons Learned, and Research Needs

Wastewater surveillance for the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is an emerging approach to help identify the risk of a coronavirus disease (COVID-19) outbreak. This tool can contribute to public health surveillance at both community (wastewater treatment system) and institutional (e.g., colleges, prisons, and nursing homes) scales. This paper explores the successes, challenges, and lessons learned from initial wastewater surveillance efforts at colleges and university systems to inform future research, development and implementation. We present the experiences of 25 college and university systems in the United States that monitored campus wastewater for SARS-CoV-2 during the fall 2020 academic period. We describe the broad range of approaches, findings, resources, and impacts from these initial efforts. These institutions range in size, social and political geographies, and include both public and private institutions. Our analysis suggests that wastewater monitoring at colleges requires consideration of local information needs, sewage infrastructure, resources for sampling and analysis, college and community dynamics, approaches to interpretation and communication of results, and follow-up actions. Most colleges reported that a learning process of experimentation, evaluation, and adaptation was key to progress. This process requires ongoing collaboration among diverse stakeholders including decision-makers, researchers, faculty, facilities staff, students, and community members

Twelve experiments in restorative justice: the Jerry Lee program of randomized trials of restorative justice conferences

Objectives: We conducted and measured outcomes from the Jerry Lee Program of 12 randomized trials over two decades in Australia and the United Kingdom (UK), testing an identical method of restorative justice taught by the same trainers to hundreds of police officers and others who delivered it to 2231 offenders and 1179 victims in 1995–2004. The article provides a review of the scientific progress and policy effects of the program, as described in 75 publications and papers arising from it, including previously unpublished results of our ongoing analyses. Methods: After random assignment in four Australian tests diverting criminal or juvenile cases from prosecution to restorative justice conferences (RJCs), and eight UK tests of supplementing criminal or juvenile proceedings with RJCs, we followed intention-to-treat group differences between offenders for up to 18 years, and for victims up to 10 years. Results: We distil and modify prior research reports into 18 updated evidence-based conclusions about the effects of RJCs on both victims and offenders. Initial reductions in repeat offending among offenders assigned to RJCs (compared to controls) were found in 10 of our 12 tests. Nine of the ten successes were for crimes with personal victims who participated in the RJCs, with clear benefits in both short- and long-term measures, including less prevalence of post-traumatic stress symptoms. Moderator effects across and within experiments showed that RJCs work best for the most frequent and serious offenders for repeat offending outcomes, with other clear moderator effects for poly-drug use and offense seriousness. Conclusions: RJ conferences organized and led (most often) by specially-trained police produced substantial short-term, and some long-term, benefits for both crime victims and their offenders, across a range of offense types and stages of the criminal justice processes on two continents, but with important moderator effects. These conclusions are made possible by testing a new kind of justice on a programmatic basis that would allow prospective meta-analysis, rather than doing one experiment at a time. This finding provides evidence that funding agencies could get far more evidence for the same cost from programs of identical, but multiple, RCTs of the identical innovative methods, rather than funding one RCT at a time

Gold nanoparticles to improve HIV drug delivery

Antiretroviral therapy (ART) has improved lifespan and quality of life of patients infected with the HIV-1. However, ART has several potential limitations, including the development of drug resistance and suboptimal penetration to selected anatomic compartments. Improving the delivery of antiretroviral molecules could overcome several of the limitations of current ART

Quantifying and addressing the prevalence and bias of study designs in the environmental and social sciences

Building trust in science and evidence-based decision-making depends heavily on the credibility of studies and their findings. Researchers employ many different study designs that vary in their risk of bias to evaluate the true effect of interventions or impacts. Here, we empirically quantify, on a large scale, the prevalence of different study designs and the magnitude of bias in their estimates. Randomised designs and controlled observational designs with pre-intervention sampling were used by just 23% of intervention studies in biodiversity conservation, and 36% of intervention studies in social science. We demonstrate, through pairwise within-study comparisons across 49 environmental datasets, that these types of designs usually give less biased estimates than simpler observational designs. We propose a model-based approach to combine study estimates that may suffer from different levels of study design bias, discuss the implications for evidence synthesis, and how to facilitate the use of more credible study designs.Fil: Christie, Alec P.. University of Cambridge; Reino UnidoFil: Abecasis, David. Universidad de Algarve. Centro de Ciencias del Mar; PortugalFil: Adjeroud, Mehdi. Université de Perpignan; Francia. Institut de Recherche Pour Le Developpement; FranciaFil: Alonso, Juan Carlos. Consejo Superior de Investigaciones Científicas. Museo Nacional de Ciencias Naturales; EspañaFil: Amano, Tatsuya. University of Queensland; AustraliaFil: Anton, Alvaro. Universidad del País Vasco. Facultad de Educación de Bilbao; EspañaFil: Baldigo, Barry P.. United States Geological Survey; Estados UnidosFil: Barrientos, Rafael. Universidad Complutense de Madrid; EspañaFil: Bicknell, Jake E.. University of Kent; Reino UnidoFil: Buhl, Deborah A.. United States Geological Survey; Estados UnidosFil: Cebrian, Just. Mississippi State University; Estados UnidosFil: Ceia, Ricardo S.. Universidad de Coimbra; PortugalFil: Cibils Martina, Luciana. Universidad Nacional de Río Cuarto. Facultad de Ciencias Exactas, Fisicoquímicas y Naturales. Departamento de Ciencias Naturales; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Córdoba; ArgentinaFil: Clarke, Sarah. Marine Institute; IrlandaFil: Claudet, Joachim. Universite de Paris; Francia. Centre National de la Recherche Scientifique; FranciaFil: Craig, Michael D.. University of Western Australia; Australia. Murdoch University; AustraliaFil: Davoult, Dominique. Sorbonne University; FranciaFil: De Backer, Annelies. Flanders Research Institute for Agriculture, Fisheries and Food; BélgicaFil: Donovan, Mary K.. University of California; Estados Unidos. University of Hawaii at Manoa; Estados UnidosFil: Eddy, Tyler D.. University of South Carolina; Estados Unidos. Memorial University of Newfoundland; Canadá. Victoria University of Wellington; Nueva ZelandaFil: França, Filipe M.. Lancaster University; Reino UnidoFil: Gardner, Jonathan P. A.. Victoria University of Wellington; Nueva ZelandaFil: Harris, Bradley P.. Alaska Pacific University; Estados UnidosFil: Huusko, Ari. Natural Resources Institute Finland; FinlandiaFil: Jones, Ian L.. Memorial University of Newfoundland; CanadáFil: Kelaher, Brendan P.. Southern Cross University; AustraliaFil: Kotiaho, Janne S.. Universidad de Jyvaskyla; FinlandiaFil: López Baucells, Adrià. Universidad de Lisboa; Portugal. Smithsonian Tropical Research Institute; Panamá. Universidad Nacional de Colombia. Instituto de Investigaciones Amazonicas; Colombia. Museo de Ciencias Naturales de Granollers; EspañaFil: Major, Heather L.. University of New Brunswick; CanadáFil: Mäki Petäys, Aki. Voimalohi Oy; Finlandia. University of Oulu; Finlandi