Efficacy of Integrated Mental Health Care with Dual Diagnosis Patients and Their Utilization of Psychiatric Emergency Services

Historically, patients with dual diagnosis have been subjected to ineffective treatment and negative attitudes from healthcare providers. Further, these patients are plagued with myriad afflictions that exist beyond substance abuse and mental illness. The treatments and collateral damage associated with the diagnosis impose excessive healthcare costs and can be of significant detriment to society. Largely, patients suffering from dual diagnosis do not receive adequate treatment. As such, psychiatric emergency services are frequently utilized as an alternate treatment, wherein the main focus of care is on the substance abuse alone. This study argues that solely treating the substance abuse is not sufficient for positive outcomes because the substance use, in most cases, is merely a self-discovered treatment for an underlying mental illness. This study proposes an integrative model that involves both substance abuse counseling and mental health counseling in order to treat this suffering population more effectively. Using archival data from the years 2014–2017, this study examined the effectiveness of integrative care among dual diagnosis patients at a methadone clinic in San Francisco, California. The study measured whether patients with dual diagnosis, who were assigned to both Substance Abuse Counseling (SAC) and Mental Health Counseling (MHC), differ in the mean number of Psychiatric Emergency Services (PES) visits from patients with dual diagnosis receiving SAC alone. Additionally, this study measured whether females and males differ in the mean number of PES visits and whether age positively or negatively correlates with the number of PES visits. Independent samples t-tests were used to measure mean differences of PES visits between treatment groups (MHC+SAC vs. SAC only) and mean difference of PES visits between gender. Pearson correlation was used to measure correlation between age and PES visits. Results revealed that patients receiving integrative care (MHC+SAC) had fewer PES visits than those receiving SAC only, suggesting that integrative care is a more effective treatment model than SAC only when treating patients with dual diagnosis. Additionally, although females accessed PES less than males, there were no statistically significant differences found. Lastly, there was no correlation found between age and number of PES visits

Sailing Blue Oceans in Search of Blue Ribbons: A Case Study of the Application of Reconstructionist Strategy in Collegiate Business Schools

Business schools are facing an increasingly competitive marketplace driven by the globalization of management education and the many new entrants providing educational and research services within this space. School rankings have become a substitute for independent assessments of quality by constituencies, often driving schools toward isomorphism in bids to climb higher in the rankings. Business school leaders need to fully understand their strategic options as they lead their schools during this challenging time. The purpose of this case study was to explore the pursuit, implementation, and potential performance effects of a type of reconstructionist strategy, Blue Ocean Strategy, within the context of two collegiate business schools. For schools that meet certain criteria, employing a reconstructionist strategy in the pursuit of uncontested markets appears to be a viable approach to the crowded, global market for management education. Using three strategic moves, two at one US business school and one at a European business school, this study used a case study methodology to explore the use of reconstructionist strategy. A total of 15 semi-structured interviews were conducted with school administration, faculty, and staff along with a review of documentation relevant to these three moves. In concert with findings from previous studies in corporate environments, this study found that schools that were poorly positioned for direct competition with higher ranked and better-funded schools could effectively employ reconstructionist strategies when the school had an organizational orientation toward innovation. Further findings included general support for the six principles of Blue Ocean Strategy in this context although some divergence was found due to differences in academic organizational structures. In effect, these schools were found to foster innovation by individual faculty entrepreneurs although no clear pathway emerged for innovative activities to be incorporated into the overall school strategy or marketing plans. Nevertheless, the three strategic moves studied did bring overall benefit to their schools. Business school leaders and researchers are urged to continue research in this area to further understand how reconstructionist moves may be better integrated into a school’s overall strategy as well as how to use them in a school’s market positioning

U.S. southeastern shrimp and reef fish resources and their management

Catch rates of target and non-target species from commercial shrimp and reef fish fisheries operating in the U.S. southeastern region and associated fishing practices are provided in relation to an environmentally sound and economically driven approach to resource conservation. Beginning in 1992, fishery observers were placed aboard commercial vessels in the southeastern shrimp fishery. From 1993 through 1995 the program expanded to include reef fish vessels in the Gulf of Mexico (Gulf), and during 2004 and 2005 skimmer trawl vessels in coastal Louisiana. Data from 27,868 tows were collected aboard shrimp vessels. Total catch rates in kilograms per hour were 30.8 in the Gulf, and 27.7 in the southeastern Atlantic. In the Gulf, finfish comprised 65% of the total weight, with penaeid shrimp at 16%, nonpenaeid shrimp crustaceans at 13%, non-crustacean invertebrates at 4%, and debris at 1%. In the southeastern Atlantic, finfish accounted for 47%, with penaeid shrimp at 24%, invertebrates at 18%, crustaceans at 8%, and debris at 3%. In the Gulf, finfish catch rates by weight were significantly higher in Alabama/Mississippi and Louisiana as compared with Texas and Florida. Shrimp catchper- unit-effort (CPUE) was significantly higher off Texas. For all states areas, higher shrimp catch rates occurred in nearshore waters. Red snapper (Lutjanus campechanus) CPUE was significantly higher off Texas in offshore waters during September through December. Assessment of the directed commercial reef fish fishery revealed relatively low release mortality. Based on surface release observations of under-sized target and unwanted species, the majority of fish were released alive with release mortality ranging from approximately 2% to 5% for all gear types. Five hundred forty-eight sea turtle captures were documented aboard commercial shrimp vessels from 1992 through 2005. Ratio estimation reflected higher catch rates in nets not equipped with turtle excluder devices (TEDs). Two alternative methods, logistic regression and conceptual modeling, revealed reduced take levels in TEDequipped nets. Data from 307 tows were collected aboard skimmer trawl vessels. Penaeid shrimp accounted for 66% of the total catch, followed by finfish at 19%, crustaceans at 7%, discarded penaeid shrimp at 6%, and debris at 3%

Spring Awakening: A Lighting Design

The purpose of this thesis is to provide research, supporting paperwork and production photographs that document the lighting design for the University ofMaryland - College Park, School of Theatre, Dance, and Performance Studies' production of Spring Awakening; Music by Duncan Sheik, Book and Lyrics by Steven Sater. This thesis contains the following: research images collected to develop and visually communicate ideas about color, texture, intensity, form, composition and mood to the production team; preliminary and final organization of desired equipment to execute the lighting design; a full set of drafting plates and supplementary paperwork used to communicate the organization and placement of lighting equipment to the master electrician; and magic sheets and cue lists used as organizational tools for the lighting designer during the tech process. Archival production photographs are included as documentation of the completed design

Fact sheet: Using a terrestrial ecosystem survey to estimate the historical density of ponderosa pine trees in northern Arizona

The Terrestrial Ecosystem Survey (TES) delineates ecosystems according to their climate, geology, soils, and potential natural vegetation (U.S. Forest Service 1986). Land managers and planners can use this information to help interpret site suitability for natural regeneration, reforestation, and revegetation potential as well as site suitability for road building, range and timber, range structures (watering sources), and other land uses. However, the TES can be used for other purposes as Ganey and Benoit (2002) demonstrated in their report about identifying potential habitat for Mexican spotted owl on national forest lands. Similarly, Bell and colleagues (2009) used the TES and its specific survey units (TESU) to analyze the characteristics of the Woolsey plots in northern Arizona - plots the Forest Service established in the early 1900s to examine tree regeneration. In our study, we identified historic ponderosa pine densities on various TES mapping units and then correlated our findings with what the TESU predicted we should find

Documenting and harnessing the biological potential of molecules in Distributed Drug Discovery (D3) virtual catalogs

Virtual molecular catalogs have limited utility if member compounds are (i) difficult to synthesize or (ii) unlikely to have biological activity. The Distributed Drug Discovery (D3) program addresses the synthesis challenge by providing scientists with a free virtual D3 catalog of 73,024 easy-to-synthesize N-acyl unnatural α-amino acids, their methyl esters, and primary amides. The remaining challenge is to document and exploit the bioactivity potential of these compounds. In the current work, a search process is described that retrospectively identifies all virtual D3 compounds classified as bioactive hits in PubChem-cataloged experimental assays. The results provide insight into the broad range of drug-target classes amenable to inhibition and/or agonism by D3-accessible molecules. To encourage computer-aided drug discovery centered on these compounds, a publicly available virtual database of D3 molecules prepared for use with popular computer docking programs is also presented

Mojave Applied Ecology Notes Summer 2011

Thoughts on fire possibilities on Mount Charleston, estimating historical densities of Ponderosa pine in northern AZ, over-understory changes in the Spring Mountains, seeding effectiveness in Red Rock Canyon, workshop announcements

Hypoxia during maintenance hemodialysis; the critical role of pH

Background The impact and management of subclinical hypoxia during hemodialysis is a significant medical challenge. As key determinants of O2 availability and delivery, proposed mechanisms contributing to hypoxia include ischemia, alkalemia and pulmonary leukocyte sequestration. However, no study has comprehensively investigated and compared these interrelated mechanisms throughout a typical hemodialysis treatment week. This study aimed to comprehensively assess the physiological mechanisms that contribute to hypoxia during hemodialysis. Methods In 76 patients, we measured arterial blood gases and pH at four time-points during hemodialysis (start, 15 min, 60 min, end) over the course of a standard treatment week. For the mid-week hemodialysis session, we additionally measured central hemodynamics (non-invasive cardiac output monitoring) and white blood cell count. Results Linear regression modelling identified changes in pH, but not central hemodynamics or white blood cell count, to be predictive of changes in PaO2 throughout hemodialysis (e.g. at 60 min, β standardized coefficient pH = 0.45, model R2 = 0.25, P < .001). Alkalemia, hypokalemia, decreased calcium and increased hemoglobin–O2 affinity (leftward shift in the oxyhemoglobin dissociation curve) were evident at the end of hemodialysis. pH and hemoglobin–O2 affinity at the start of hemodialysis increased incrementally over the course of a standard treatment week. Conclusion These data highlight the important role of pH in regulating O2 availability and delivery during hemodialysis. Findings support routine pH monitoring and personalized dialysate bicarbonate prescription to mitigate the significant risk of alkalemia and subclinical hypoxia