The impact of traditional psychiatric services and case management services on the functioning of people with schizophrenia: A cross-national study in Nova Scotia and Texas

The purpose of this study was to determine the impact of traditional psychiatric services with case management services on the functioning of people with schizophrenia. Traditional services were defined as routine clinic services consisting of medication follow-along, psychotherapy, and support services. Case management consisted of activities involved in linking, planning, and monitoring services for the outpatient client who has schizophrenia. The target population was adult schizophrenics who had been receiving outpatient clinic services for a minimum of six months. Structured interviews were conducted using standardized scales (e.g., Quality of Life, Self-Efficacy, and Brief Symptom Inventory) with 78 outpatient client volunteers from two sites: Nova Scotia (Canada) and Texas (USA). The researcher tested for differences in psychiatric symptomatology, recidivism, and quality of life for persons with schizophrenia receiving traditional psychiatric services in Nova Scotia and traditional plus case management services in Texas. Data were collected from the structured interviews and medical records review forms. Types of services were blocked into low and high levels of Intensity (frequency x minutes) and compared to determine the relative contribution of each. Finally, the role of clients' self-efficacy was tested as an intervening variable. Although the findings did not support the hypotheses in the direction anticipated, there were some interesting and useful results. From the Nova Scotia site, clients who received low levels of services were hospitalized less compared to the Texas site. The more psychotic a patient was the higher their involvement in medication follow-along and the more monitoring they received. The more psychotherapy received, the lower the reported satisfaction with social relationships. Of particular interest is the role that self-efficacy played in improved client outcomes. Although self-efficacy scores were related to improved functioning, the mechanism for this still needs to be clarified through subsequent research. ^

THE EFFECTS OF COST-SHARING ON USE OF SERVICES AND CONSUMER CHARACTERISTICS IN A STATE'S CRIPPLED CHILDREN'S DIVISION

The present study analyzed some of the effects of imposing a cost-sharing requirement on users of a state's health service program. The study population consisted of people who were in diagnosed medical need and included, but was not limited to, people in financial need.^ The purpose of the study was to determine if the cost-sharing requirement had any detrimental effects on the service population. Changes in the characteristics of service consumers and in utilization patterns were analyzed using time-series techniques and pre-post policy comparisons.^ The study hypotheses stated that the distribution of service provided, diagnoses serviced, and consumer income levels would change following the cost-sharing policy.^ Analysis of data revealed that neither the characteristics of service users (income, race, sex, etc.) nor services provided by the program changed significantly following the policy. The results were explainable in part by the fact that all of the program participants were in diagnosed medical need. Therefore, their use of "discretionary" or "less necessary" services was limited.^ The study's findings supported the work of Joseph Newhouse, Charles Phelps, and others who have contended that necessary service use would not be detrimentally affected by reasonable cost-sharing provisions. These contentions raise the prospect of incorporating cost-sharing into programs such as Medicaid, which, at this writing, do not demand any consumer payment for services.^ The study concluded with a discussion of the cost-containment problem in health services. The efficacy of cost-sharing was considered relative to other financing and reimbursement strategies such as HMO's, self-funding, and reimbursement for less costly services and places of service. ^

Post-Permanency: An Assessment for Families’ Needs for Services and Supports

This article reports the results of a qualitative study that sought the perspectives of birth parents and adoptive parents following reunification or adoption of children from foster care. Using a participatory action design that actively involved young adults formerly in foster care and parents in the design and implementation of the study, the study focused on the consumers’ perspectives on several issues related to permanency. The article reports findings from interviews with a subset of 27 birth and adoptive families in New York City who were asked about their post-permanency experiences and from interviews with 38 child welfare professionals who were asked to respond to the parents’ perspectives. The article offers directions for child welfare practice and program development.

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. ^

Grain entrainment and transport rates of magnetic minerals of coastal sediment samples from the Bay of Plenty, New Zealand

Heavy (magnetic & non-magnetic) minerals are found concentrated by natural processes in many fluvial, estuarine, coastal and shelf environments with a potential to form economic placer deposits. Understanding the processes of heavy mineral transport and enrichment is prerequisite to interpret sediment magnetic properties in terms of hydro- and sediment dynamics. In this study, we combine rock magnetic and sedimentological laboratory measurements with numerical 3D discrete element models to investigate differential grain entrainment and transport rates of magnetic minerals in a range of coastal environments (riverbed, mouth, estuary, beach and near-shore). We analyzed grain-size distributions of representative bulk samples and their magnetic mineral fractions to relate grain-size modes to respective transport modes (traction, saltation, suspension). Rock magnetic measurements showed that distribution shapes, population sizes and grain-size offsets of bulk and magnetic mineral fractions hold information on the transport conditions and enrichment process in each depositional environment. A downstream decrease in magnetite grain size and an increase in magnetite concentration was observed from riverine source to marine sink environments. Lower flow velocities permit differential settling of light and heavy mineral grains creating heavy mineral enriched zones in estuary settings, while lighter minerals are washed out further into the sea. Numerical model results showed that higher heavy mineral concentrations in the bed increased the erosion rate and enhancing heavy mineral enrichment. In beach environments where sediments contained light and heavy mineral grains of equivalent grain sizes, the bed was found to be more stable with negligible amount of erosion compared to other bed compositions. Heavy mineral transport rates calculated for four different bed compositions showed that increasing heavy mineral content in the bed decreased the transport rate. There is always a lag in transport between light and heavy minerals which increases with higher heavy mineral concentration in all tested bed compositions. The results of laboratory experiments were validated by numerical models and showed good agreement. We demonstrate that the presented approach bears the potential to investigate heavy mineral enrichment processes in a wide range of sedimentary settings.

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.

An introduction to flow and transport in fractal models of porous media: Part I

This special issue gathers together a number of recent papers on fractal geometry and its applications to the modeling of flow and transport in porous media. The aim is to provide a systematic approach for analyzing the statics and dynamics of fluids in fractal porous media by means of theory, modeling and experimentation. The topics covered include lacunarity analyses of multifractal and natural grayscale patterns, random packing's of self-similar pore/particle size distributions, Darcian and non-Darcian hydraulic flows, diffusion within fractals, models for the permeability and thermal conductivity of fractal porous media and hydrophobicity and surface erosion properties of fractal structures.

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.

Assessing the accessibility impact of transport policy by a land-use and transport interaction model - The case of Madrid

Accessibility is an essential concept widely used to evaluate the impact of transport and land-use strategies in urban planning and policy making. Accessibility is typically evaluated by using separately a transport model or a land-use model. This paper embeds two accessibility indicators (i.e., potential and adaptive accessibility) in a land use and transport interaction (LUTI) model in order to assess transport policies implementation. The first aim is to define the adaptive accessibility, considering the competition factor at territorial level (e.g. workplaces and workers). The second aim is to identify the optimal implementation scenario of policy measures using potential and adaptive accessibility indicators. The analysis of the results in terms of social welfare and accessibility changes closes the paper. Two transport policy measures are applied in Madrid region: a cordon toll and increase bus frequency. They have been simulated through the MARS model (Metropolitan Activity Relocation Simulator, i.e. LUTI model). An optimisation procedure is performed by MARS for maximizing the value of the objective function in order to find the optimal policy implementation (first best). Both policy measures are evaluated in terms of accessibility. Results show that the introduction of the accessibility indicators (potential and adaptive) influence the optimal value of the toll price and bus frequency level, generating different results in terms of social welfare. Mapping the difference between potential and adaptive accessibility indicator shows that the main changes occur in areas where there is a strong competition among different land-use opportunities.

NEAT - A New, Evolutive API and Transport-Layer Architecture for the Internet

ACKNOWLEDGMENTS This work has received funding from the European Union’s Horizon 2020 research and innovation programme under grant agreement No. 644334 (NEAT). The views expressed are solely those of the authors.

Charge transfer and transport in DNA

We explore charge migration in DNA, advancing two distinct mechanisms of charge separation in a donor (d)–bridge ({Bj})–acceptor (a) system, where {Bj} = B1,B2, … , BN are the N-specific adjacent bases of B-DNA: (i) two-center unistep superexchange induced charge transfer, d*{Bj}a → d∓{Bj}a±, and (ii) multistep charge transport involves charge injection from d* (or d+) to {Bj}, charge hopping within {Bj}, and charge trapping by a. For off-resonance coupling, mechanism i prevails with the charge separation rate and yield exhibiting an exponential dependence ∝ exp(−βR) on the d-a distance (R). Resonance coupling results in mechanism ii with the charge separation lifetime τ ∝ Nη and yield Y ≃ (1 + δ̄ Nη)−1 exhibiting a weak (algebraic) N and distance dependence. The power parameter η is determined by charge hopping random walk. Energetic control of the charge migration mechanism is exerted by the energetics of the ion pair state d∓B1±B2 … BNa relative to the electronically excited donor doorway state d*B1B2 … BNa. The realization of charge separation via superexchange or hopping is determined by the base sequence within the bridge. Our energetic–dynamic relations, in conjunction with the energetic data for d*/d− and for B/B+, determine the realization of the two distinct mechanisms in different hole donor systems, establishing the conditions for “chemistry at a distance” after charge transport in DNA. The energetic control of the charge migration mechanisms attained by the sequence specificity of the bridge is universal for large molecular-scale systems, for proteins, and for DNA.

Alternative splicing of the rat sodium/bile acid transporter changes its cellular localization and transport properties

Bile secretion involves the structural and functional interplay of hepatocytes and cholangiocytes, the cells lining the intrahepatic bile ducts. Hepatocytes actively secrete bile acids into the canalicular space and cholangiocytes then transport bile acids in a vectorial manner across their apical and basolateral plasma membranes. The initial step in the transepithelial transport of bile acids across rat cholangiocytes is apical uptake by a Na+-dependent bile acid transporter (ASBT). To date, the molecular basis of the obligate efflux mechanism for extrusion of bile acids across the cholangiocyte basolateral membrane remains unknown. We have identified an exon-2 skipped, alternatively spliced form of ASBT, designated t-ASBT, expressed in rat cholangiocytes, ileum, and kidney. Alternative splicing causes a frameshift that produces a 154-aa protein. Antipeptide antibodies detected the ≈19 kDa t-ASBT polypeptide in rat cholangiocytes, ileum, and kidney. The t-ASBT was specifically localized to the basolateral domain of cholangiocytes. Transport studies in Xenopus oocytes revealed that t-ASBT can function as a bile acid efflux protein. Thus, alternative splicing changes the cellular targeting of ASBT, alters its functional properties, and provides a mechanism for rat cholangiocytes and other bile acid-transporting epithelia to extrude bile acids. Our work represents an example in which a single gene appears to encode via alternative splicing both uptake and obligate efflux carriers in a bile acid-transporting epithelial cell.

Manipulation of in Vivo Sorbitol Production Alters Boron Uptake and Transport in Tobacco1

Recent evidence that some species can retranslocate boron as complexes with sugar alcohols in the phloem suggests a possible mechanism for enhancing boron efficiency. We investigated the relationship between sugar alcohol (sorbitol) content, boron uptake and distribution, and translocation of foliar-applied, isotopically enriched 10B in three lines of tobacco (Nicotiana tabacum) plants differing in sorbitol production. In tobacco line S11, transformed with sorbitol-6-phosphate dehydrogenase, the production of sorbitol was accompanied by an increase in the concentration of boron in plant tissues and an increased uptake of boron compared with either tobacco line A4, transformed with antisense orientation of sorbitol-6-phosphate dehydrogenase, or wild-type tobacco (line SR1, zero-sorbitol producer). Foliar application of 10B to mature leaves was translocated to the meristematic tissues only in line S11. These results demonstrate that the concentration of the boron-complexing sugar alcohol in the plant tissue has a significant effect on boron uptake and distribution in plants, whereas the translocation of the foliar-applied 10B from the mature leaves to the meristematic tissues verifies that boron is mobile in sorbitol-producing plants (S11) as we reported previously. This suggests that selection or transgenic generation of cultivars with an increased sugar alcohol content can result in increased boron uptake, with no apparent negative effects on short-term growth.