Innovation in Service Delivery: the Expansion of General Practice Services for People with Serious and Ongoing Mental Illness

Over the past 50 years there have been many innovations in New Zealand's mental health services. Using case study methodology this research examined two innovations involving general practice - the Newtown Union Health Service (NUHS) mental health programme and the Hawke's Bay (HB) shared care pilot - targeted at people with serious and ongoing mental illness (SOMI). The intent of the research was to inform service delivery arrangements and to provide new knowledge concerning the development of innovative services. Four sources of data - programme documentation, evaluation reports, utilisation data and stakeholders' experiences acquired through questionnaires and interviews - were used in developing the case studies. While the history of these innovations was traced to specific actions, these innovations emerged because of the national and clinical context. The NUHS programme was a bottom-up development the innovation occurring because NUHS needed to find a way of meeting the needs of the people with SOMI who were registered there. NUHS practitioners in consultation with the community made decisions concerning the programme's development The HB pilot was a top-down development that was purchased because new money became available. Primary and secondary service practitioners, managers, researchers and the purchaser made decisions concerning the pilot's initial development. The factors that shaped the innovations included: funding, staffing, clinical and financial risk management and time. Similarities in the innovations included the range of arrangements for mental health care for individual people (from GPs being the sole providers through to GPs providing only physical health care, with the mental health service providing the mental health care), issues of trust and poor communication between the primary and specialist services and the frequency and length of consultations. Differences included the payment arrangements, access issues, the formalisation of co-ordination arrangements and the role of the nurse. The research found that to be adopted for routine use these innovations needed to develop effective service delivery arrangements. The NUHS programme was more successful than the HB pilot at delivering accessible, acceptable, co-ordinated, comprehensive, efficient and effective services. The findings regarding targeting, funding mechanisms, practitioner roles and the time it takes for trust to develop so that innovative services can become established have implications for Primary Health Organisation development. Research is needed on other innovative services to establish whether evaluating the effectiveness of the service delivery arrangements provides a useful framework to monitor and guide the implementation of an innovation in service delivery

An Empirically Derived Three-Dimensional Laplace Resonance in the Gliese 876 Planetary System

We report constraints on the three-dimensional orbital architecture for all four planets known to orbit the nearby M dwarf Gliese 876 based solely on Doppler measurements and demanding long-term orbital stability. Our dataset incorporates publicly available radial velocities taken with the ELODIE and CORALIE spectrographs, HARPS, and Keck HIRES as well as previously unpublished HIRES velocities. We first quantitatively assess the validity of the planets thought to orbit GJ 876 by computing the Bayes factors for a variety of different coplanar models using an importance sampling algorithm. We find that a four-planet model is preferred over a three-planet model. Next, we apply a Newtonian MCMC algorithm to perform a Bayesian analysis of the planet masses and orbits using an n-body model in three-dimensional space. Based on the radial velocities alone, we find that a 99% credible interval provides upper limits on the mutual inclinations for the three resonant planets ($\Phi_{cb}<6.20^\circ$ for the "c" and "b" pair and $\Phi_{be}<28.5^\circ$ for the "b" and "e" pair). Subsequent dynamical integrations of our posterior sample find that the GJ 876 planets must be roughly coplanar ($\Phi_{cb}<2.60^\circ$ and $\Phi_{be}<7.87^\circ$), suggesting the amount of planet-planet scattering in the system has been low. We investigate the distribution of the respective resonant arguments of each planet pair and find that at least one argument for each planet pair and the Laplace argument librate. The libration amplitudes in our three-dimensional orbital model supports the idea of the outer-three planets having undergone significant past disk migration.Comment: 19 pages, 11 figures, 8 tables. Accepted to MNRAS. Posterior samples available at https://github.com/benelson/GJ87

Weight Status as a Mediator of the Association Between Preschool Extraversion and Adolescent Restrained Eating

Objectives To determine the longitudinal association between preschool extraversion and weight/dieting outcomes in adolescence. Methods Children (N = 180) were recruited as part of a longitudinal study, with child temperament assessed in preschool (age 5.25 years), weight assessed in 2nd grade and early adolescence, and eating outcomes assessed in early adolescence (mean age = 12.02 years). Results Preschoolers high in extraversion were significantly more likely to have higher body mass index z-scores (zBMI) and more restrained eating behaviors in adolescence. zBMI was found to mediate the relationship between extraversion and restrained eating, such that children with high levels of extraversion were more likely to have higher zBMI in adolescence and, owing to this higher weight status, to engage in more restrained eating. Conclusions Temperament is an important predictor of later maladaptive weight/dieting outcomes in adolescence, making it a potentially important early factor to consider in weight management interventions

Social Justice Advocacy Training: An Innovative Certificate Program for Counselor Education

The authors outline an innovative certificate program that promotes the Multicultural and Social Justice Counseling Competencies (MSJCC; Ratts, Singh, Massar-McMillan, Butler, & McCullough, 2015) and how counselor education programs can commit to a social justice approach. In addition, the authors provide a detailed summary of the certificate program that requires counselors-in-training to move beyond a multicultural understanding of diverse cultural worldviews so that they commit to becoming social change agents and take action on issues of equality and justice. Limitations and implications for counselor educators are presented

State Legislative Update

Senate Bill 1970 was introduced in the Florida Senate on March 2, 2004. It was initially referred to the Senate Judiciary Committee where it passed on April 19 with an 8-0 vote. Senate Bill 1970 was read for the first time in the Senate on April 21. The bill passed the full Senate on April 24 with a 39-0 vote. It was then sent to the full House on April 26 where it was substituted for House Bill 1765. Senate Bill 1970 was read and passed in the House on April 27 with a 114-0 vote. The bill was presented to Govenor Bush for signature on June 9 and signed into law on June 10, 2004

Charge Violation and Alice Behavior in Global and Textured Strings

Spontaneous breaking of global symmetries can produce ``Alice'' strings: line defects which make unbroken symmetries multivalued, induce apparent charge violation via Aharonov-Bohm interactions, and form point defects when twisted into loops. We demonstrate this behavior for both divergent and textured global Alice strings. Both adiabatically scatter charged particles via effective Wilson lines. For textured Alice strings, such Wilson lines occur at all radii, and are multivalued only inside the string. This produces measurable effects, including path-dependent charge violation.Comment: 32 pages, 2 epsfigs, Revte

Use of Denosumab in Children With Osteoclast Bone Dysplasias: Report of Three Cases.

Denosumab has been used successfully to treat disease-associated osteoclast overactivity, including giant cell tumor of bone. Given its mechanism of action, denosumab is a potent potential treatment of other osteoclast bone dysplasias including central giant cell granuloma (CGCG), aneurysmal bone cyst (ABC), and cherubism. Relatively little is known about the safety and efficacy of denosumab in patients with these conditions, especially in children. We report on 3 pediatric patients treated with denosumab over a 3-year period at UCLA Medical Center (Los Angeles and Santa Monica, CA, USA): a 12-year-old with recurrent ABC of the pelvis, a 14-year-old with CGCG of the mandible, and a 12-year-old with cherubism. All were started on a 1-year course of 15 doses 120 mg s.c., given monthly with two loading doses on day 8 and 15. All patients demonstrated rapid and pronounced clinical improvement while on denosumab, including a significant reduction in pain and sclerosis of lytic lesions on radiographs. Within 1 month of initiating therapy, 2 patients experienced hypocalcemia (Common Terminology Criteria for Adverse Events [CTCAE] grade 2) and hypophosphatemia, with 1 patient experiencing symptoms. One patient went on to experience symptomatic rebound hypercalcemia (CTCAE grade 4) 5 months after completing therapy, requiring bisphosphonates and calcitonin. For the second patient, we developed a schedule to wean denosumab involving the progressive lengthening of time between doses from 1 to 4 months in 1-month increments before cessation. We found that denosumab therapy results in significant clinical and radiographic improvement for pediatric patients with nonresectable ABC, CGCG, and cherubism. Problems with serum calcium may be more common in younger patients, with symptomatic and protracted rebound hypercalcemia after cessation of therapy the most significant. We present a potential solution to this problem with progressive spacing of doses. Potential serious adverse events from alterations in calcium homeostasis should be explored in prospective clinical trials. © 2019 The Authors. JBMR Plus published by Wiley Periodicals, Inc. on behalf of American Society for Bone and Mineral Research

Executive Control Goes to School: Implications of Preschool Executive Performance for Observed Elementary Classroom Learning Engagement

The transition to elementary school is accompanied by increasing demands for children to regulate their attention and behavior within the classroom setting. Executive control (EC) may be critical for meeting these demands; however, few studies have rigorously examined the association between EC and observed classroom behavior. This study examined EC in preschool (age 5 years, 3 months) as a predictor of classroom learning engagement behaviors in first grade, using a battery of performance-based EC tasks and live classroom observations in a longitudinal sample of 313 children. Multilevel modeling results indicated that stronger EC predicted more focused engagement and fewer task management and competing responses, controlling for socioeconomic status, child sex, and age at observations. Results suggest that early EC may support subsequent classroom engagement behaviors that are critical for successful transition to elementary school and long-term learning trajectories

Unraveling the Electrical and Magnetic Properties of Layered Conductive Metal-Organic Framework With Atomic Precision

This paper describes structural elucidation of a layered conductive metal-organic framework (MOF) material Cu3(C6O6)2 by microcrystal electron diffraction with sub-angstrom precision. This insight enables the first identification of an unusual π-stacking interaction in a layered MOF material characterized by an extremely short (2.73 Å) close packing of the ligand arising from pancake bonding and ordered water clusters within pores. Band structure analysis suggests semiconductive properties of the MOF, which are likely related to the localized nature of pancake bonds and the formation of a singlet dimer of the ligand. The spin of CuII within the Kagomé arrangement dominates the paramagnetism of the MOF, leading to strong geometrical magnetic frustration

Conductive Stimuli-Responsive Coordination Network Linked with Bismuth for Chemiresistive Gas Sensing

This paper describes the design, synthesis, characterization, and performance of a novel semiconductive crystalline coordination network, synthesized using 2,3,6,7,10,11-hexahydroxytriphenylene (HHTP) ligands interconnected with bismuth ions, toward chemiresistive gas sensing. Bi(HHTP) exhibits two distinct structures upon hydration and dehydration of the pores within the network, Bi(HHTP)-α and Bi(HHTP)-β, respectively, both with unprecedented network topology (2,3-c and 3,4,4,5-c nodal net stoichiometry, respectively) and unique corrugated coordination geometries of HHTP molecules held together by bismuth ions, as revealed by a crystal structure resolved via microelectron diffraction (MicroED) (1.00 Å resolution). Good electrical conductivity (5.3 × 10–3 S·cm–1) promotes the utility of this material in the chemical sensing of gases (NH3 and NO) and volatile organic compounds (VOCs: acetone, ethanol, methanol, and isopropanol). The chemiresistive sensing of NO and NH3 using Bi(HHTP) exhibits limits of detection 0.15 and 0.29 parts per million (ppm), respectively, at low driving voltages (0.1–1.0 V) and operation at room temperature. This material is also capable of exhibiting unique and distinct responses to VOCs at ppm concentrations. Spectroscopic assessment via X-ray photoelectron spectroscopy (XPS) and Fourier transform infrared spectroscopic methods (i.e., attenuated total reflectance-infrared spectroscopy (ATR-IR) and diffuse reflectance infrared Fourier transformed spectroscopy (DRIFTS)), suggests that the sensing mechanisms of Bi(HHTP) to VOCs, NO, and NH3 comprise a complex combination of steric, electronic, and protic properties of the targeted analytes