Organizational Correlates of Medication-Assisted Treatment in Substance Abuse Treatment Facilities: Examining How Institutional Forces Shape Treatment

Methadone and buprenorphine/naloxone are the two recommended pharmacotherapies for the treatment of opioid dependence, having been demonstrated to be effective in numerous clinical trials. While methadone has been an approved treatment for opioid dependence for that past 50 years, buprenorphine/naloxone is a newer substance that was only approved for use in 2002. This mixed-methods study utilizes a comprehensive conceptual framework of neoinstitutional theory and institutional logics to explore possible factors that might predict adoption of medication-assisted treatment. First, in-depth qualitative interviews with managerial level staff at substance abuse treatment centers were conducted. The interviews were semi-structured and explored perceptions of treatment philosophy, the merging of substance abuse and mental health, managed care, services, funding, licensing and accreditation and personal and professional networks. Next, logistic regression models were used to explore possible predictors of medication-assisted treatment. The National Treatment Center Study (NTCS), a nationally representative survey of private substance abuse treatment facilities conducted between 2002-2004, was used in this study, allowing for the exploration of early adoption of buprenorphine/naloxone. Findings from the qualitative interviews suggested that the two medications are viewed differently and should therefore be explored separately. Findings from the logistic analysis of the NTCS supported this distinction. The proportion of clients with a primary diagnosis of opiate dependence or abuse was the only factor positively associated with both the early adoption of buprenorphine/naloxone and methadone provision. The program\u27s proportion of managed care funding was the only other significant predictor for early adoption of buprenorphine/naloxone. Accreditation by JACHO, proportion of clients who are women and past organizational participation in research, all positively predicted methadone provision, while the proportion of counselors with a master\u27s degree or higher negatively predicted it. The results indicate that coercive and normative institutional forces, as well as the institutional logics operating on organizations and the organizational networks they are embedded in, impact service provision and adoption of innovation. To promote adoption of pharmacotherapies into treatment, attention must be paid to the unique barriers and opportunities facing the adoption of each medication

Vergleich von neuseeländischen und „einheimischen“ Holsteinkühen in erster Laktation unter Vollweide auf einem Biobetrieb

Cow types adapted to forage-based production systems are of particular interest for organic milk production, because of the limited use of additives (concentrates, pharmaceuticals etc.). The objective of this project was to study the aptitude of New Zealand Holstein cows (HNZ) to produce milk in a pasture-based production system with a shortened calving season (February to mid April) under organic conditions. 11 HNZ were compared 2007 to 11 farm-bred, “Swiss” Holstein cows (HCH), all of them during their first lactation, in a rotational pasture system on the organic farm “l’Abbaye” in Sorens (CH). With an average live weight (LW) at the beginning of 469 kg and a height at withers (WH) of 130 cm the HNZ were considerably smaller compared to HCH with 609 kg LW and 147 cm WH. During the first lactation the HNZ gained more body mass (63 kg vs. 24 kg, P < 0.03) and had a higher average body condition score (3.03 vs. 2.77, P < 0.04). The milk production per HNZ was lower by 1000 kg milk (P < 0.004) respectively 800 kg energy-corrected milk (ECM) (P < 0.02). No differences were detected between the two cow types concerning the ECM production per 100 kg metabolic weight. Milk protein and lactose contents were significantly higher for HNZ and milk fat content was not significantly different. The somatic cell counts were similar for both types. Although the adaptation period on farm for HNZ had been short, they produced the same amount of ECM per kg metabolic weight and gained more body mass compared with HCH

Excessive alcohol consumption in young men: is there an association with their earlier family situation? A baseline-analysis of the C-SURF-study (Cohort Study on Substance Use Risk Factors).

AIMS: To determine whether parental factors earlier in life (parenting, single parent family, parental substance use problem) are associated with patterns of alcohol consumption among young men in Switzerland. METHODS: This analysis of a population based sample from the Cohort Study on Substance Use Risk Factors (C-SURF) included 5,990 young men (mean age 19.51 years), all attending a mandatory recruitment process for the army. These conscripts reported on parental monitoring and rule-setting, parental behaviour and family structure. The alcohol use pattern was assessed through abstention, risky single occasion drinking (RSOD), volume drinking and dependence. Furthermore, the impact of age, family socio-economic status, educational level of the parents, language region and civil status was analysed. RESULTS: A parental substance use problem was positively associated with volume drinking and alcohol dependence in young Swiss men. Active parenting corresponded negatively with RSOD, volume drinking and alcohol dependence. Single parent family was not associated with a different alcohol consumption pattern compared to standard family. CONCLUSION: Parental influences earlier in life such as active parenting (monitoring, rule-setting and knowing the whereabouts) and perceived parental substance use problem are associated with alcohol drinking behaviour in young male adults. Therefore, health professionals should stress the importance of active parenting and parental substance use prevention in alcohol prevention strategies

Market application of a novel stent-based patency monitor to the management of ischemic vascular disease

Thesis (S.M.)--Harvard-MIT Division of Health Sciences and Technology; and, (M.B.A.)--Massachusetts Institute of Technology, Sloan School of Management, 2006.Includes bibliographical references (p. 79-82).The use of stents following angioplasty in ischemic arterial beds is limited by complications and continuing vascular deterioration. A phenomenon called stent restenosis post procedure exists which puts patients at a relatively high risk for vessel stenosis and occlusion. Stent restenosis may eventually lead to clinical symptoms such as myocardial infarction, stroke or limb loss, and if overlooked might lead to death. Within five years of stenting, a significant portion of patients require additional surgical intervention. A novel stent-based, implantable, and wireless approach for real-time monitoring of vessel patency at the site of coronary stents is proposed, will provide a measure of efficacy of stenting and of the pharmacologic regiment to mitigate the risk of vessel stenosis and narrowing due to the underlying. The purpose of this thesis is to explore and test the Hypotheses that there is a market for a direct, non-invasive monitoring of vessel patency at the site of a coronary stent; and that an implantable, wireless, stent-based device to monitor blood flow rate through a coronary stent can be designed and built.(cont.) A literature survey of late clinical studies and the opinion of numerous specialist clinicians collected in interviews and preliminary questionnaire, demonstrate sufficient clinical ambiguity regarding the safety of coronary stents, including Drug-Eluting Stents (DES) portrait an underserved clinical need to justify the introduction of a direct, non-invasive modality for post-op monitoring of vessel patency at the site of a coronary stent.by Baruch Schori.M.B.A.S.M