Process Improvement to Return Stabilized Behavioral Health Patients to Primary Care

Purpose: The purpose of this project is to increase the number of open patient appointments by implementing a validated process in which stabilized behavioral health patients are repatriated to primary care. Currently, there is an increased demand for behavioral health services and decreased supply of behavioral health clinicians at the Nashville Veterans Affairs Medical Center (VAMC). Aims: This project aims to teach behavioral health providers how to identify appropriate patients and complete successful discharges while helping primary care providers integrate the repatriation process into their workflow. Without the proposed intervention, veterans initiating behavioral health services in the catchment area will continue to experience delays. Methods: The Knowledge to Action Framework is being used to adapt the process to the local context. All behavioral health and primary care clinicians at the Nashville VAMC are included in project knowledge dissemination. Data is collected by tracking the behavioral health discharge note within the site. The number of discharge notes per month will be analyzed by comparing the number of discharge notes from previous years to those after project implementation. Results: Results are ongoing, however preliminary results from January and February of 2022 look promising with a total of 35 discharge notes, compared to the six discharge notes from the same months in 2019, 11 in 2020, and 15 in 2021. Conclusion: Preliminary results are encouraging, as the number of successful discharges has significantly increased. This allows for more veterans with mental health needs to be served at the Nashville VAMC

Self-defense, subversion and the status quo : four Tennessee newspapers assess the Columbia race riot of 1946

The period immediately following World War II in the United States saw an uptick in racially charged violence, as increasingly empowered black veterans came into conflict back home with white Americans content with the continuation of the Jim Crow system. Columbia, Tenn., about 40 miles south of Nashville, became the site of one such incident in 1946, when an altercation between a black mother and son and a white clerk erupted into a full-scale invasion of the town's African-American business district by Tennessee state troopers. Numerous black Columbians were beaten and arrested. By looking at how four different newspapers in Tennessee covered the Columbia riot story, this study hoped to discover the ways in which race and civil rights were presented to local readers at the time. What assumptions did reporters make about culpability in the riot? How did discussion of the riot mirror discussion of other political matters in 1946 America? How did white and black newspapers differ in their coverage? These were some of the questions asked. The study found vast differences in how the papers covered the riot story, the most profound of which revolved around two issues: attention paid to the historical context surrounding perceived threats of racial violence and empathy shown to black citizens

Determining the performance of breakwaters during high energy events: a case study of the Holly Beach breakwater system

Breakwaters have been constructed in many areas along Louisiana’s coastline to protect the shoreline from wave energy and erosion. During normal conditions, these breakwaters can typically be analyzed using traditional empirical methods for emergent breakwaters. However, Louisiana’s coastline is under constant threat from tropical storms and hurricanes, during which breakwaters can frequently become overtopped or submerged systems. Recent studies show that the type of shoreline response to a breakwater system may vary depending on the crest height of the breakwater in relation to the mean water level. Though emergent breakwaters typically induce sediment accretion along the shoreline, studies using laboratory and numerical models indicate that overtopped or submerged breakwaters may increase erosion of the shoreline. This variation of the hydrodynamic patterns and shoreline response is of particular interest for breakwaters along shorelines that can be impacted by hurricanes and other events that trigger large variances in water level, as the breakwaters may periodically shift between emergent and submerged states. The Holly Beach Breakwater System has been constructed to protect a vital piece coastline in southwestern Louisiana. These breakwaters are typically emergent, but can frequently be inundated by surge events and become submerged, and therefore may not always perform as intended. This study uses topographic survey data, aerial photography, and wave and surge information associated with Hurricanes Rita and Ike to identify the sediment transport patterns generated by emergent breakwaters impacted by storm surge and waves. The results of this study show that during a storm event the sediment transport patterns within the breakwater system are very different from those of an emergent system and vary with the geometry of the breakwater system. During Hurricanes Rita (2005) and Ike (2008), breakwaters near the shoreline exhibited extreme erosion and very little accretion, while breakwaters farther from the shoreline showed more accretion which, in some cases, offset the erosion of the beach. Erosion to accretion ratios for segments of breakwaters near the shore were 20 to 50 times higher breakwaters farther from shore. The cause of these erosion patterns is investigated based on the hydrodynamic conditions of Hurricanes Rita and Ike