Defining Success: The Politics of Evaluation in Alcohol and Drug Abuse Treatment Programs

Alcohol and drug abuse treatment programs must respond to several important stakeholders or beneficiaries of services who have an investment in how success is defined. Utilizing data from recent statewide studies of treatment outcomes of alcohol and drug abuse services, this paper concludes that a strict adherence to an abstinence-only model of success, rigidly adopted by many in the treatment industry is counterproductive. Multiple measures of success are essential to fully understand and assess a changing model of intervention in the chemical dependency field

Fate of dissipative hierarchy of timescales in the presence of unitary dynamics

The generic behavior of purely dissipative open quantum many-body systems with local dissipation processes can be investigated using random matrix theory, revealing a hierarchy of decay timescales of observables organized by their complexity as shown in [Wang et al., $\href{https://link.aps.org/doi/10.1103/PhysRevLett.124.100604}{Phys. Rev. Lett. \textbf{124}, 100604 (2020)}]$. This hierarchy is reflected in distinct eigenvalue clusters of the Lindbladian. Here, we analyze how this spectrum evolves when unitary dynamics is present, both for the case of strongly and weakly dissipative dynamics. In the strongly dissipative case, the unitary dynamics can be treated perturbatively and it turns out that the locality of the Hamiltonian determines how susceptible the spectrum is to such a perturbation. For the physically most relevant case of (dissipative) two-body interactions, we find that the correction in the first order of the perturbation vanishes, leading to the relative robustness of the spectral features. For weak dissipation, the spectrum flows into clusters with well-separated eigenmodes, which we identify to be the local symmetries of the Hamiltonian

In situ associations between marine photosynthetic picoeukaryotes and potential parasites - a role for fungi?

Photosynthetic picoeukaryotes (PPEs) are important components of the marine picophytoplankton community playing a critical role in CO2 fixation but also as bacterivores, particularly in the oligotrophic gyres. Despite an increased interest in these organisms and an improved understanding of the genetic diversity of this group, we still know little of the environmental factors controlling the abundance of these organisms. Here, we investigated the quantitative importance of eukaryotic parasites in the free-living fraction as well as in associations with PPEs along a transect in the South Atlantic. Using tyramide signal amplification-fluorescence in situ hybridization (TSA-FISH), we provide quantitative evidence of the occurrence of free-living fungi in open ocean marine systems, while the Perkinsozoa and Syndiniales parasites were not abundant in these waters. Using flow cytometric cell sorting of different PPE populations followed by a dual-labelled TSA-FISH approach, we also demonstrate fungal associations, potentially parasitic, occurring with both pico-Prymnesiophyceae and pico-Chrysophyceae. These data highlight the necessity for further work investigating the specific role of marine fungi as parasites of phytoplankton to improve understanding of carbon flow in marine ecosystems

Glassy states in fermionic systems with strong disorder and interactions

We study the competition between interactions and disorder in two dimensions. Whereas a noninteracting system is always Anderson localized by disorder in two dimensions, a pure system can develop a Mott gap for sufficiently strong interactions. Within a simple model, with short-ranged repulsive interactions, we show that, even in the limit of strong interaction, the Mott gap is completely washed out by disorder for an infinite system for dimensions $D\le 2$. The probability of a nonzero gap falls onto a universal curve, leading to a glassy state for which we provide a scaling function for the frequency dependent susceptibility.Comment: 8 pages, 5 figures, expanded to contain some analytical results for one dimensio

Laparoscopic anterior 180-degree versus nissen fundoplication for gastroesophageal reflux disease: systematic review and meta-analysis of randomized clinical trials.

This item is under embargo for a period of 12 months from the date of publication, in accordance with the publisher's policy.Objective: To compare short and longer-term outcome after laparoscopic anterior 180˚ fundoplication (180˚ LAF) versus laparoscopic Nissen fundoplication (LNF). Summary of background data: LNF is currently the most frequently performed surgical therapy for GORD. Alternatively, 180˚ LAF has been alleged to reduce troublesome dysphagia and gas-related symptoms, with similar reflux control. Methods: MEDLINE, EMBASE, Cochrane Library and ISI web of Knowledge CPCI-S were searched for randomized clinical trials (RCTs) comparing primary 180˚ LAF versus LNF. The methodological quality was evaluated to assess bias risk. Primary outcomes were esophageal acid exposure, esophagitis, heartburn score, dilatation for dysphagia, modified Dakkak dysphagia score [0-45] and reoperation rate. Meta-analysis was conducted at one and five years. Results: Five distinct RCTs comparing 180˚ LAF (n=227) versus LNF (n=231) were identified. At one year, the Dakkak dysphagia score (2.8 vs 4.8; weighted mean difference (WMD) -2.25; 95% CI [-2.66, -1.83]; P<0.001), gas bloating (11% vs 18%; relative risk (RR) 0.59; 95% CI [0.36,0.97]; P=0.04), flatulence (14% vs 25%; RR 0.57; 95% CI [0.35,0.91]; P=0.02), inability to belch (19% vs 31%; RR0.63 ;95% CI [0.40,0.99]; P=0.05) and inability to relieve bloating (34% vs 44%; RR 0.74; 95% CI [0.55,0.99]; P=0.04) were lower after 180˚ LAF. Esophageal acid exposure (standardized mean difference (SMD) 0.19; 95% CI [-0.07,0.46]; P=0.15), esophagitis (19% vs 13%; RR 1.42; 95% CI [0.69, 2.91]; P=0.34), heartburn score (SMD 1.27; 95% CI [-0.36,2.90]; P=0.13), dilatation rate (1.4% vs 2.8%; RR 0.60; 95% CI [0.19,1.91]; P=0.39), reoperation rate (5.7% vs 2.8%; RR 2.08; 95% CI [0.80,5.41]; P=0.13), perioperative outcome, regurgitation, PPI use, LES pressure and patient satisfaction were similar after 180˚ LAF and LNF. At 5 years, the Dakkak dysphagia score, flatulence, inability to belch and inability to relieve bloating remained lower after 180˚ LAF. The five-year heartburn score, dilatation rate, reoperation rate, PPI use and patient satisfaction were similar. Conclusions: At one and five years, dysphagia and gas-related symptoms are lower after 180˚ LAF compared with LNF, and esophageal acid exposure and esophagitis are similar, with no differences in heartburn scores, patient satisfaction, dilatations and reoperation rate. These results lend level 1a support for the use of 180˚ LAF for the surgical treatment of GERD