Cost -effectiveness of services and treatments for ambulatory dually diagnosed CMHC clients: Implications for managed care

This paper reports a cost-effectiveness analysis of standard therapeutic interventions received by ambulatory dually diagnosed clients of a Community Mental Health Center (CMHC). For the purposes of this study dually diagnosed was defined as a DSM-III-R or IV diagnosis of a major mental disorder and a concomitant substance abuse disorder. The prevalence of dually diagnosed people among the mentally ill and their unique and problematic nature continues to challenge and encumber CMHCs and poses grave public health risks. An absence of research on these clients in community-based settings and the cost-effectiveness of their standard CMHC care has hindered the development of effective community-based intervention strategies. This exploratory and descriptive effort is a first step toward providing information on which to base programmatic management decisions.^ Data for this study were derived from electronic client records of a CMHC located in a large Southwestern, Sun-belt metropolitan area. A total of 220 records were collected on clients consecutively admitted during a two-and-one-half year period. Information was gathered profiling the clients' background characteristics, receipt of standard services and treatments, costs of the care they received, and length of CMHC enrollment and subsequent psychiatric hospitalizations. The services and treatments were compared with regard to their costs and predicted contributions toward maintaining clients in the community and out of public psychiatric hospitals.^ This study investigated: (1) the study groups' background, mental illness, and substance abuse characteristics; (2) types, extent, and patterns of their receipt of standard services and treatments; (3) associations between the receipt of services and treatments, community tenure, and risk of psychiatric hospitalization; and, (4) comparisons of average costs for services and treatments in terms of their contributions toward maintaining the clients in the community.^ The results suggest that substance abuse and other lifestyle factors were related to the dually diagnosed clients' admissions to the CMHC. The dually diagnosed clients' receipt of care was associated strongly with their insurability and global functioning. Medication Services were the most expensive yet effective service or treatment. Supported Education was the third most expensive and second most effective. Psychosocial Services, the second most expensive, were only effective in terms of maintaining clients in the community. Group Counseling, the fourth most expensive, had no effect on community maintenance and increased the risk of hospitalization when accompanied by Medication Services. Individual Counseling, the least expensive, had no effect on community maintenance. But it reduced the risk of hospitalization when accompanied by Medication Services. Networking/Referral, the fifth most expensive service or treatment, was ineffective.^ The study compared the results with findings in the literature. Implications are discussed regarding further research, study limitations, practical applications and benefits, and improvements to theoretical understandings, in particular, concepts underscoring Managed Care. ^

A Model-Based Monitoring Architecture for Heterogeneous Enterprise Services and Information Systems

Runtime management of distributed information systems is a complex and costly activity. One of the main challenges that must be addressed is obtaining a complete and updated view of all the managed runtime resources. This article presents a monitoring architecture for heterogeneous and distributed information systems. It is composed of two elements: an information model and an agent infrastructure. The model negates the complexity and variability of these systems and enables the abstraction over non-relevant details. The infrastructure uses this information model to monitor and manage the modeled environment, performing and detecting changes in execution time. The agents infrastructure is further detailed and its components and the relationships between them are explained. Moreover, the proposal is validated through a set of agents that instrument the JEE Glassfish application server, paying special attention to support distributed configuration scenarios.

Ada real-time services and virtualization

Virtualization techniques have received increased attention in the field of embedded real-time systems. Such techniques provide a set of virtual machines that run on a single hardware platform, thus allowing several application programs to be executed as though they were running on separate machines, with isolated memory spaces and a fraction of the real processor time available to each of them.This papers deals with some problems that arise when implementing real-time systems written in Ada on a virtual machine. The effects of virtualization on the performance of the Ada real-time services are analysed, and requirements for the virtualization layer are derived. Virtual-machine time services are also defined in order to properly support Ada real-time applications. The implementation of the ORK+ kernel on the XtratuM supervisor is used as an example.

A proposal for a Business Framework targeted at emerging business services and applications

Un Service Business Framework consiste en una serie de componentes interrelacionados que permiten la gestión de servicios de negocio a través de su ciclo de vida, desde su creación, descubrimiento y comparación, hasta su monetización (incluyendo un posible reparto de beneficios). De esta manera, el denominado FIWARE Business Framework trata de permitir a los usuarios de la plataforma FIWARE mejorar sus productos con funcionalidades de búsqueda, describrimiento, comparación, monetización y reparto de beneficios. Para lograr este objetivo, el Business Framework de FIWARE proporciona la especificación abierta y las APIs de una serie de components (denominados \Generic Enablers" en terminología FIWARE), junto con una implementación de referencia de las mismas pueden ser facilmente integradas en los sitemas existentes para conseguir aplicaciones con valor a~nadido. Al comienzo de este trabajo de fin de master, el Business Framework de FIWARE no era lo suficientemente maduro como para cubrir los requisitos de sus usuarios, ya que ofrecía modelos demasiado generales y dejaba algunas funcionalidades clave para ser implementadas por los usuarios. Para solucionar estos problemas, el principal objectivo desarrollado en el contexto de este trabajo de fin de master ha consistido en mejorar y evolucionar el Business Framework de FIWARE para dar respuesta a las demandas de sus usuarios. Para alcanzar el pricipal objetivo propuesto, el Business Framework de FIWARE ha sido evaluado usando la información proporcionada por los usuarios de la plataforma, principalmente PyMEs y start-ups que usan este framework en sus soluciones, con el objetivo de obtener una lista de requisitos y de dise~nar a partir de éstos un roadmap de evolución a 6 meses. Después, los diferentes problemas identificados se han tratado uno por uno dando en cada caso una solución capaz de cubrir los requisitos de los usuarios. Finalmente, se han evaluado los resultados obtenidos en el proyecto integrando el Business Framework desarrollado con un sistema existente para la gestión de datos de consusmo energético, construyendo lo que se ha denominado Mercado de Datos de Consumo Energético. Esto además ha permitido demostrar la utilidad del framework propuesto para evolucionar una plataforma de datos abiertos bien conocida como es CKAN a un verdadero mercado de datos.---ABSTRACT---Service Business Frameworks consist on a number of interrelated components that support the management of business services across their whole lifecycle, from their creation, publication, discovery and comparison, to their monetization (possibly including revenue settlement and sharing). In this regard, the FIWARE Business Framework aims at allowing FIWARE users to enhance their solutions with search, discovery, comparison, monetization and revenue settlement and sharing features. To achieve this objective, the FIWARE Business Framework provides the open specification and APIs of a comprehensive set of components (called Generic Enablers in FIWARE terminology), along with a reference implementation of these APIs,, that can be easily integrated with existing systems in order to create value added applications. At the beginning of the current Master's Thesis, the FIWARE Business Framework was not mature enough to cover the requirements of the its users, since it provided too general models and leaved some key functionality to be implemented by those users. To deal with these issues, the main objective carried out in the context of this Master's Thesis have been enhancing and evolving the FIWARE Business Framework to accomplish with the demands of its users. For achieving the main objective of this Master's Thesis, the FWARE Business Framework has been evaluated using the feedback provided by FIWARE users, mainly SMEs and start-ups, actually using the framework in their solutions, in order to determine a list of requirements and to design a roadmap for the evolution and improvement of the existing framework in the next 6 months. Then, the diferent issues detected have been tackle one by one enhancing them, and trying to give a solution able to cover users requirements. Finally, the results of the project have been evaluated by integrating the evolved FIWARE Business Framework with an existing system in charge of the management of energy consumption data, building what has been called the Energy Consumption Data Market. This has also allowed demonstrating the usefulness of the proposed business framework to evolve CKAN, a renowned open data platform, into an actual, fully- edged data market.

New agnathous fishes from the Pennsylvanian of Illinois / David Bardack -- and Eugene S. Richardson, Jr. --

v.33:no.26(1977)

Pennsylvanian invertebrates of the Mazon Creek Area, Illinois: the morphology and affinities of Tullimonstrum / Ralph Gordon Johnson -- and Eugene S. Richardson, Jr. --

v.12:no.8(1969)

New fossil polychaete from Essex, Illinois / Ida Thompson -- and Ralph G. Johnson --.

v.33:no.25(1977)

An essay on the universal plentiude of being and on the nature and immortality of the human soul and its agency : manuscript, [1784]

Autograph manuscript, signed, with autograph manuscript revisions.

Financial services and the Transatlantic Trade and Investment Partnership. CEPS Policy Brief No. 302, 20 November 2013

Given the size of the financial markets on both sides of the Atlantic and the symmetry in the follow-up of the G-20 standards, Karel Lannoo argues in this Policy Brief that the Transatlantic Trade and Investment Partnership (TTIP) provides a good opportunity to put in place a more institutionalised framework. He finds that both blocs have reacted in similar ways to the financial crisis in strengthening their regulatory and supervisory frameworks and incorporating the G-20 recommendations into federal law. He also notes that consumer protection has been reinforced, certainly in the US, with the creation of the Consumer Financial Protection Bureau. And on the EU side, the Single Supervisory Mechanism (SSM) will radically change banking supervision. In his view, inclusion of financial services could also be an opportunity to strengthen prudential rules and consumer protection provisions on both sides. Rather than leading to a reduction of consumer protection, as had been feared in the post-crisis environment, it could lead to an examination, exchange and recognition of best practices in regulation and enforcement. Finally, he concludes that inclusion of financial services would make it part of the permanent regulatory dialogue that will be established as a result of a successful TTIP.