Correlates of Attendance in Psychiatric Services: A Critical Review

poster abstractAttendance and dropout are concerning problems in the mental health field. With dropout rates averaging around 50%, mental health agencies lose money and resources invested in missed appointments and under-attended groups, providers lose valuable time, and consumers do not receive recommended levels of services. While there is research on consumer, provider, and agency factors that affect attendance, it has not been integrated and reviewed in the context of community services for those with psychotic disorders. The authors conducted a critical review of literature examining correlates of attendance in community services provided to samples with psychotic disorders as the most prominent diagnostic category. Twenty-two studies were identified that met inclusion criteria. Over 100 unique correlates of attendance were tested; the authors categorized these into eight content areas: demographics, current functioning, history (psychiatric/functional), neurocognitive functioning, services/treatment, social functioning, self-stigma/insight, and symptoms/psychopathology. Correlates were also sorted according to how often they were examined and how many times they were found to be significantly related to consumer attendance. The category containing the most unique correlates was symptoms/psychopathology. Demographic correlates were researched the most, with three unique correlates examined in over ten studies (age, sex, and living situation). Of these demographic correlates, all but two were found significant 25% of the time or less, and none exceeded 40%. Alternatively, some correlates have been investigated few times, but with promising results and theoretical connections to attendance, such as baseline illness severity, which has been found significant in 75% of analyses. There is evidence that researchers are examining correlates for which there is little empirical evidence of a connection to attendance. This may lead to missed opportunities to maximize attendance, use of services, and resources. Implications for future research in the area are discussed

p-species integrable reaction-diffusion processes

We consider a process in which there are p-species of particles, i.e. A_1,A_2,...,A_p, on an infinite one-dimensional lattice. Each particle $A_i$ can diffuse to its right neighboring site with rate $D_i$, if this site is not already occupied. Also they have the exchange interaction A_j+A_i --> A_i+A_j with rate $r_{ij}.$ We study the range of parameters (interactions) for which the model is integrable. The wavefunctions of this multi--parameter family of integrable models are found. We also extend the 2--species model to the case in which the particles are able to diffuse to their right or left neighboring sites.Comment: 16 pages, LaTe

Natural History of Nonalcoholic Fatty Liver Disease: Implications for Clinical Practice and an Individualized Approach

Nonalcoholic fatty liver disease (NAFLD) is becoming the most prevalent liver disease worldwide, associated with epidemics of overweight and resulting metabolic syndrome (MetS). Around 20–30% of patients with NAFLD develop progressive liver fibrosis, which is the most important predictor of liver-related and overall morbidity and mortality. In contrast to classical understanding, no significant association has been demonstrated between the inflammatory component of NAFLD, i.e., nonalcoholic steatohepatitis (NASH), and the adverse clinical outcomes. Older age (>50 years) and presence of type 2 diabetes mellitus, in addition to some genetic variants, are most consistently reported indicators of increased risk of having liver fibrosis. However, critical driving force for the progression of fibrosis and risk factors for this have still not been fully elucidated. Apart from the genetic profile, gut dysbiosis, weight gain, worsening of insulin resistance, and worsening of liver steatosis represent candidate factors associated with unfavourable development of liver disease. Cardiovascular events, extrahepatic malignancies, and liver-related deaths are the leading causes of mortality in NAFLD. As patients with advanced fibrosis are under highest risk of adverse clinical outcomes, efforts should be made to recognize individuals under risk and rule out the presence of this stage of fibrosis, preferably by using simple noninvasive tools. This process should start at the primary care level by using validated biochemical tests, followed by direct serum tests for fibrosis or elastography in the remaining patients. Patients with advanced fibrosis should be referred to hepatologists for aggressive lifestyle modification and correction of the components of MetS, and cirrhotic patients should be screened for hepatocellular carcinoma and oesophageal varices

Two interacting diffusing particles on low-dimensional discrete structures

In this paper we study the motion of two particles diffusing on low-dimensional discrete structures in presence of a hard-core repulsive interaction. We show that the problem can be mapped in two decoupled problems of single particles diffusing on different graphs by a transformation we call 'diffusion graph transform'. This technique is applied to study two specific cases: the narrow comb and the ladder lattice. We focus on the determination of the long time probabilities for the contact between particles and their reciprocal crossing. We also obtain the mean square dispersion of the particles in the case of the narrow comb lattice. The case of a sticking potential and of 'vicious' particles are discussed.Comment: 9 pages, 6 postscript figures, to appear in 'Journal of Physics A',-January 200

Helping veterans achieve work: A Veterans Health Administration nationwide survey examining effective job development practices in the community.

Objective: Veterans Health Administration vocational services assist veterans with mental illness to acquire jobs; one major component of these services is job development. The purpose of this study was to characterize the nature of effective job development practices and to examine perceptions and intensity of job development services. Method: A national mixed-methods online survey of 233 Veterans Health Administration vocational providers collected data regarding frequency of employer contacts, perceptions of job development ease/difficulty, and effective job development practices when dealing with employers. Qualitative responses elucidating effective practices were analyzed using content analysis. Results: Vocational providers had a modest number of job development employer contacts across 2 weeks (M = 11.0, SD = 10.6) and fewer were face-to-face (M = 7.6, SD = 8.4). Over 70% of participants perceived job development to be difficult. Six major themes emerged regarding effective job development practices with employers: using an employer-focused approach; utilizing a targeted marketing strategy; engaging in preparation and follow-up; going about the employer interaction with genuineness, resilience, and a strong interpersonal orientation; serving as an advocate for veterans and educator of employers; utilizing specific employer-tailored strategies, such as arranging a one-on-one meeting with a decision maker and touring the business, individualizing a prescripted sales pitch, connecting on a personal level, and engaging in ongoing communication to solidify the working relationship. Conclusions and implications for practice: Respondents highlight several potentially effective job development strategies; tools and resources may be developed around these strategies to bolster job development implementation and allow opportunities for fruitful employer interactions

Subjective Experiences of the Benefits and Key Elements of a Cognitive Behavioral Intervention Focused on Community Work Outcomes in Persons With Mental Illness

New research suggests that group-based cognitive behavioral therapy (CBT) may help improve employment outcomes in persons with mental illness, yet the effects and potential key elements facilitating change in such interventions are unclear. Using a mixed methods approach, this study examined the perspectives of persons with mental illness after participating in a pilot study of the “CBT for Work Success” intervention. Findings demonstrate that participants valued the intervention and perceived that it assisted them in achieving work goals. Therapeutic effects included improved self-efficacy, work motivation, enhanced sense of self as workers, and increased beliefs that work success is attainable. CBT for Work Success elements perceived to be important in facilitating work goals included cognitive restructuring, behavioral coping strategies, problem solving work barriers, meaningful reflection on oneself as a worker, and important factors associated with the group process. The authors discuss the implications of these findings and future research directions

A Pilot Test of Group Based Cognitive Behavioral Therapy to Augment Vocational Services for Persons With Serious Mental Illness: Feasibility and Competitive Work Outcomes

Persons with serious mental illness (SMI) struggle with work functioning even with the assistance of vocational services. The current study sought to address this problem by examining a cognitive-behavioral therapy to augment vocational services. Fifty-two adults with SMI receiving vocational services participated in a pre-post feasibility trial of the Cognitive Behavior Therapy for Work Success (CBTw) intervention. CBTw is a 12-week manualized intervention that addresses cognitive and behavioral factors that impact work functioning. Competitive work outcomes were assessed in the 12 weeks preceding baseline and after the intervention. The results demonstrate strong session attendance and a low attrition rate. There were also significant improvements in work outcomes. Specifically, among participants unemployed at baseline, 50.0% attained work during follow-up. These findings provide preliminary evidence that CBTw may be a feasible intervention to augment vocational services; further controlled research should examine its benefit to work outcomes in people with SMI

Exact time-dependent correlation functions for the symmetric exclusion process with open boundary

As a simple model for single-file diffusion of hard core particles we investigate the one-dimensional symmetric exclusion process. We consider an open semi-infinite system where one end is coupled to an external reservoir of constant density $\rho^\ast$ and which initially is in an non-equilibrium state with bulk density $\rho_0$. We calculate the exact time-dependent two-point density correlation function $C_{k,l}(t)\equiv -$ and the mean and variance of the integrated average net flux of particles $N(t)-N(0)$ that have entered (or left) the system up to time $t$. We find that the boundary region of the semi-infinite relaxing system is in a state similar to the bulk state of a finite stationary system driven by a boundary gradient. The symmetric exclusion model provides a rare example where such behavior can be proved rigorously on the level of equal-time two-point correlation functions. Some implications for the relaxational dynamics of entangled polymers and for single-file diffusion in colloidal systems are discussed.Comment: 11 pages, uses REVTEX, 2 figures. Minor typos corrected and reference 17 adde

Facilitators and Barriers to Participation in a Peer Support Intervention for Veterans With Chronic Pain

OBJECTIVE: To understand facilitators and barriers to participation in a peer support intervention for self-management of chronic pain. METHODS: After completing a pilot intervention study, peer coaches and their veteran patients took part in a qualitative, semistructured interview to explore their experiences with the intervention. Data were analyzed using an immersion/crystallization approach. RESULTS: Three facilitators and 2 barriers to patient participation in a peer support intervention for veterans with chronic pain emerged. Facilitators were (1) having a shared identity as veterans, (2) being partnered with a person who also has chronic pain, and (3) support from the study staff. Barriers were (1) logistical challenges, and (2) challenges to motivation and engagement in the intervention. DISCUSSION: Awareness of facilitators and barriers to participation in a peer-supported self-management program for chronic pain, as well as strategies to capitalize on facilitators and mitigate barriers, are essential for further study and ultimate clinical implementation of such a program

An interacting spin flip model for one-dimensional proton conduction

A discrete asymmetric exclusion process (ASEP) is developed to model proton conduction along one-dimensional water wires. Each lattice site represents a water molecule that can be in only one of three states; protonated, left-pointing, and right-pointing. Only a right(left)-pointing water can accept a proton from its left(right). Results of asymptotic mean field analysis and Monte-Carlo simulations for the three-species, open boundary exclusion model are presented and compared. The mean field results for the steady-state proton current suggest a number of regimes analogous to the low and maximal current phases found in the single species ASEP [B. Derrida, Physics Reports, {\bf 301}, 65-83, (1998)]. We find that the mean field results are accurate (compared with lattice Monte-Carlo simulations) only in the certain regimes. Refinements and extensions including more elaborate forces and pore defects are also discussed.Comment: 13pp, 6 fig