A MANAGEMENT INFORMATION SYSTEM AND EVALUATION SCHEME FOR THE UNIVERSITY OF TEXAS EMPLOYEE ASSISTANCE PROGRAMS

Early Employee Assistance Programs (EAPs) had their origin in humanitarian motives, and there was little concern for their cost/benefit ratios; however, as some programs began accumulating data and analyzing it over time, even with single variables such as absenteeism, it became apparent that the humanitarian reasons for a program could be reinforced by cost savings particularly when the existence of the program was subject to justification.^ Today there is general agreement that cost/benefit analyses of EAPs are desirable, but the specific models for such analyses, particularly those making use of sophisticated but simple computer based data management systems, are few.^ The purpose of this research and development project was to develop a method, a design, and a prototype for gathering managing and presenting information about EAPS. This scheme provides information retrieval and analyses relevant to such aspects of EAP operations as: (1) EAP personnel activities, (2) Supervisory training effectiveness, (3) Client population demographics, (4) Assessment and Referral Effectiveness, (5) Treatment network efficacy, (6) Economic worth of the EAP.^ This scheme has been implemented and made operational at The University of Texas Employee Assistance Programs for more than three years.^ Application of the scheme in the various programs has defined certain variables which remained necessary in all programs. Depending on the degree of aggressiveness for data acquisition maintained by program personnel, other program specific variables are also defined. ^

Na 1 Nachlass Max Horkheimer, 44 - Korrespondenzen u.a. mit Marthe Roth (p. I 21, 313-463)

2 Briefe und 1 Lebenslauf von Max Horkheimer an Arthur Rosenberg, 1939, 1941; 2 Briefe zwischen Kurt Rosenfeld und Karl Brandt, 22.04.1937, 27.04.1937; 5 Briefe von Kurt Rosenfeld an Max Horkheimer, 1937-19378; 4 Brief und Beilage an Kurt Rosenfeld, 1937-1943; 11 Briefe zwischen Hans W. Rosenhaupt und Max Horkheimer, 1935, 1941, 1942, 1947; 4 Briefe zwischen Samuel I. Roseman und Max Horkheimer, 1939, 03.01.1940; 2 Briefe zwischen J. Rosenstock und Max Horkheimer, 15.07.1946; 2 Briefe zwischen Joseph Adolphe Rosenthal und Max Horkheimer, 09.04.1941, 08.05.1941, sowie Briefwechsel mit Sophie Ries; 2 Briefe zwischen Sophie Ries und Max Horkheimer, 08.05.1941, 11.05.1941; 1 Brief von Max Horkheimer an Lore Woedthke, 08.05.1941; 2 Briefe zwischen Morris Rosenthal und Max Horkheimer, 01.10.1935, 04.10.1935; 1 Brief von Max Horkheimer an das Rosenwald Capital Outlay Fund New York, 30.01.1940; 1 Brief B. Lifschitz an Marthe Roth, 21.04.1937; 1 Brief von Chamorel et Simond an Marthe Roth, 11.06.1937; 1 Brief von F.K. Sung an Marthe Roth, 24.06.1937; 12 Briefe zwischen Marthe Roth und Max Horkheimer, Juli 1937-1938, sowie Briefwechsel mit Louis Vogt; 4 Briefe zwischen Louis Vogt und Max Horkheimer, 10.08.1937, 1937; 1 Brief von Max Horkheimer an Dr. Rothen, 31.01.1935; 1 Umzugsmitteilung von Hans Rothmann; 2 Briefe zwischen Richard C. Rothschild und Max Horkheimer, 11.05.1940, 13.05.1940; 4 Briefe zwischen Ludwig Rothschild, Hilde Rothschild und Max Horkheimer, 1936-15.09.1939; 2 Briefe zwischen S. Rothschildt und Max Horkheimer, 23.11.1940, 29.11.1940; 4 Brief zwischen J. S. Roucek und Max Horkheimer, 1941; 1 Brief von Joseph Rovan an Max Horkheimer, 11.05.1948; 2 Brief zwischen Wilmina Rowland und Max Horkheimer, 13.03.1949, 11.04.1949; 2 Briefe zwischen dem Royal Automobile Club und Max Horkheimer, 26.08.1937, 22.09.1937; 2 Briefe zwischen Royal Motors Inc. und Max Horkheimer, 05.02.1940, 06.03.1940; 1 Beitrag von Nina Rubinstein zur Soziologie des Fremden; 1 Brief von Theodor W. Adorno an Rudd, 09.09.1940; 1 Brief von Jay Rumney an Goldstein, 18.06.1936; 20 Briefe und Beilage zwischen Jay Rumney und Max Horkheimer, 1934- 1937, 1949 sowie Briefwechsel mit D. Mitrany; 3 Briefe zwischen D. Mitrany und Max Horkheimer, 01.12.1937, 1937; 3 Briefe von Theodor W. Adorno an Dagobert D. Runes, 1941; 1 Brief und 1 Beilage von N. Waterman an Georg Rusche, 03.05.1939; 12 Briefe und Beilage zwischen Georg Rusche und Max Horkheimer, 1939-1942 sowie Briefwechsel mit N. Waterman; 1 Brief von N. Waterman an Georg Rusche, 03.04.1939; 2 Briefe zwischen N. Waterman und Max Horkheimer, 21.04.1939, 05.05.1939; 1 Brief von Ruth an Max Horkheimer;

Na 1 Nachlass Max Horkheimer, 103 - Korrespondenzen u.a. mit Maria Pattermann und Franz Neumann (p. III 11, 1-335)

1 Drucksache der Rechtsanwaltskanzlei Pacht, Tannenbaum & Ross, 1951; 2 Briefe zwischen der Pädagogischen Hauptstelle der Gewerkschaft Erziehung u. Wissenschaft und Max Horkheimer, 1954; 1 Brief vom Pädagogischen Verlag B. Schulz an Max Horkheimer, 1950; 3 Briefe zwischen dem Professor Erwin Walter Palm und Max Horkheimer, 1957-1958; 2 Briefe zwischen Helena Brans und Max Horkheimer, 1953; 2 Briefe vom Park-Hotel Frankfurt an Max Horkheimer,1957-1958; 1 Brief von Enno Patalas an Max Horkheimer, 1 Brief von Theodor W. Adorno an Enno Patalas, 1956; 2 Briefe zwischen Dieter Pätzold und Max Horkheimer, 1952; 8 Briefe zwischen Maria Pattermann und Max Horkheimer, 1952-1958; 2 Briefe zwischen F. Perrot und Max Horkheimer, 1953; 2 Briefe zwischen der Buchhandlung Werner Peter und Max Horkheimer, 1954; 3 Briefe zwischen Alfred Peters und Max Horkheimer, 1952-1953; 1 Zeugnis von dem Studenten Joachim Peter, 1953; 1 Brief von Max Horkheimer an F.H. Peterson, 1950; Briefwechsel zwischen dem Studenten Klaus Peuker und Max Horkheimer, 1951; 1 Brief des Chefredakteuren Karl Pfannkuch an Max Horkheimer, 1955; 1 Brief von Dr. Karl Pfauter an Max Horkheimer, 1952; Briefwechsel zwischen der Studentin Renate Pflaume und Max Horkheimer, 1952; Briefwechsel zwischen Joseph B. Phillips und Max Horkheimer, 1955; 1 Brief von Professor Josef Pieper an Max Horkheimer , 1951; 1 Brief von Ehrenfried Pihan an Max Horkheimer, 1953; 1 Brief von F. G. Pincus an Theodor W. Adorno, 1954; Briefwechsel zwischen dem Professor Koppel S. Pinson und Max Horkheimer, 1956; 2 Briefe zwischen dem Professor Kurt Pinthus und Max Horkheimer, 1953; 1 Brief an Dr. Knut Pipping von Max Horkheimer, 1950; 2 Briefe zwischen Erwin Piscator und Max Horkheimer, 1954; Briefwechsel zwischen der Max-Planck-Gesellschaft zur Förderung der Wissenschaften und Max Horkheimer, 1953-1955; Briefwechsel zwischen dem Professor Richard Plant und Max Horkheimer, 1953 und 2 Briefe zwischen Professor Richard Plant und Margarete Feretty-Füredi, 1953; Briefwechsel zwischen dem Professor Johann Plenge und Max Horkheimer, 1951-1952; Briefwechsel zwischen Barbara Pleyer und Max Horkheimer, 1954; 1 Brief von Erich Paul Pechmann an Max Horkheimer, 1952; Briefwechsel zwischen Dr. Gerhard Poetzsch und an Max Horkheimer, 1958; Briefwechsel zwischen dem Committee on Science & Freedom und Max Horkheimer, 1955-1956; 1 Brief an den Professor Rudolf Pohl von Max Horkheimer, 1953; 1 Brief von der Zeitschrift "Die politsche Meinung" an Max Horkheimer, 1956; 1 Brief von Max F. Pollack an Max Horkheimer, 1954; 1 Brief von dem Professor Wilhelm Polligkeit an Max Horkheimer, 1951; 1 Brief von dem Poli-Verlag an Max Horkheimer, 1950; Briefwechsel zwischen Alexej Poremsky und Max Horkheimer, 1955; 1 Brief von Rita Post an Max Horkheimer, 1952; 1 Brief von Max Potzin an Max Horkheimer, 1951; Briefwechsel zwischen dem Oberstudienrat Max Preitz und Max Horkheimer, 1955; 1 Brief von dem Professor Wolfgang Preiser an Max Horkheimer, 1952; 1 Gutachten und Beilagen von Dr. Karl A. Preuschen an Max Horkheimer, 1955; Briefwechsel und Beilagen zwischen dem Direktor des The Commonwealth Fund E. K. Wickman und Max Horkheimer, 1955; Briefwechsel zwischen Klaus H. Pringsheim und Max Horkheimer, 1952-1958; 1 Brief von Curt Freiherr von Preuschen an Max Horkheimer, 1953; Briefwechsel zwischen Rüdiger Proske und Max Horkheimer, 1951; Briefwechsel und Beilagen zwischen Dr. Harry Pross und Max Horkheimer, 1954; 1 Brief von dem Professor Franz Neumann an Max Horkheimer, 1954; 1 Brief an G. H. Graber von Max Horkheimer, 1953; Briefwechsel zwischen dem Quaker Service und Max Horkheimer, 1950; Briefwechsel zwischn Günther Quandt und Max Horkheimer, 1953 und 2 Todesanzeigen, 1955; 1 Brief an den Querido-Verlag von Max Horkheimer, 1951; Briefwechsel zwischen Emil Querinjean und Max Horkheimer, 1955; Briefwechsel zwischen John Raatjes und Max Horkheimer, 1956; Briefwechsel zwischen der Zeitschrift the humanist radical und Max Horkheimer, 1957; Briefwechsel zwischen Sitangghu Chatterji und Max Horkheimer, 1957; 1 Brief von der Radio Corporation of America an Max Horkheimer, 1953; 1 Brief und Beilagen vom Radiodiffusion et Télévision Francaises an Max Horkheimer, 1955; Briefwechsel zwischen dem Österreichischer Rundfunk Radio Wien und Max Horkheimer, 1956; 1 Brief von dem Professor Boris Rajewsky an Max Horkheimer, 1953; 1 Brief an Else Rang von Max Horkheimer, 1950; Briefwechsel zwischen Heinz Raspini und Max Horkheimer, 1956; 1 Drucksache zwischen Hanna Becker vom Rath und Max Horkheimer, 1953; 1 Telegramm von dem Professor Roland Rather an Max Horkheimer und 2 Briefe von Max Horkheimer an Roland Rather, 1957; Briefwechsel zwischen dem Professor L. J. Rather und Max Horkheimer, 1955; Briefwechsel zwischen Phillip Roth und Max Horkheimer, 1958; Briefwechsel zwischen Sibnarayan Ray und Max Horkheimer, 1956-1957; Briefwechsel mit Beilagen zwischen dem Rationalisierungs-Kuratorium der Deutschen Wirtschaft und Max Horkheimer, 1954; 1 Aktennotiz von dem Jornalisten Rasten der dänischen Zeitung Politiken, 1953; Briefwechsel zwischen Wolfgang M. Rauch und Max Horkheimer, 1956; 1 Anzeige der Ingeborg Rauter, 1953; 1 Brief von dem Hotel Reber au lac an Max Horkheimer, 1955; Briefwechsel zwischen Alice Reboly und Max Horkheimer, 1955; 3 Briefe an die Regensburger Zeitungen von Max Horkheimer, 1956; 1 Brief an den Professor Klaus Reich von Max Horkheimer, 1950; Briefwechsel zwischen dem Reinhardt, Ernst, Verlag und Max Horkheimer, 1953; 1 Brief von dem Apotheker Hermann Reitberger an Max Horkheimer, 1955; Briefwechsel zwischen Dr. Paul Reiwald und Max Horkheimer, 1950; 1 Brief von dem Journalist Godo Remszhardt an Max Horkheimer, 1954; Briefwechsel zwischen Dr. Irmgard Rexroth-Kern und Max Horkheimer, 1952; Briefwechsel zwischen Hans Rheinbay und Max Horkheimer, 1955; 1 Brief von der Universität Bonn an Max Horkheimer, 1953; 1 Brief an den Rheinischer Merkur von Max Horkheimer, 1951; 1 Brief an die Rheinische Post von Max Horkheimer, 1954; 1 Brief an Hans Richter von Max Horkheimer, 1954; Briefwechsel zwischen Dr. Hermann Riefstahl und Max Horkheimer, 1957; Briefwechsel zwischen dem Professor Svend Riemer und Max Horkheimer, 1957; Briefwechsel zwischen dem Ring-Verlag und Max Horkheimer, 1957; Briefwechsel zwischen Werner Rings und Max Horkheimer, 1954; Briefwechsel zwischen Martha Ritter-Raabe und Max Horkheimer, 1955; Briefwechsel zwischen Otto-Heinz Rocholl und Max Horkheimer, 1954; 1 Brief von Hilde Rodemann an Max Horkheimer, 1952; 1 Brief von Edouard Roditi an Max Horkheimer, 1951 und 1 Brief von Theodor W. Adorno an Edouard Roditi, 1951; Briefwechsel zwischen der Zeitschrift Studenten-Kurier und Max Horkheimer, 1955; 1 Brief von Karl Roeloffs an Max Horkheimer, 1953; Briefwechsel zwischen der Kunsthistorikerin Hanna Rhode und Max Horkheimer, 1950-1951; 1 Brief an Dr. Anna Ronge von Max Horkheimer, 1954; 2 Brief an Kathe Romney von Max Horkheimer, 1952-1955; Briefwechsel zwischen Dr. Paul Rompel und Max Horkheimer, 1952; 1 Brief an den Zahnartz Dr. Ingo Ropper von Max Horkheimer, 1953; Briefwechsel zwischen Ilse Wallis Ross und Max Horkheimer, 1955-1956; 1 Brief von dem Professor Hans W. Rosenhaupt an Max Horkheimer, 1952; 1 Brief von Rosenthal an Max Horkheimer, 1958; Briefwechsel zwischen dem Generalstaatsanwalt und Staatssekretär Erich Rosenthal-Pelldram und Max Horkheimer, 1952-1956; Briefwechsel zwischen Lessing J. Rosenwald und Max Horkheimer, 1950; Briefwechsel zwischen dem Lieutenant Dr. Alan O. Ross und Max Horkheimer, 1955; 4 Briefe und Beilagen von Günther Roth an Max Horkheimer, 1953-1957; Briefwechsel zwischen dem Professor Wolfram Eberhardt und Max Horkheimer, 1955; 1 Brief an den Professor M. A. Stewart von Theodor W. Adorno, 1955; Briefwechsel zwischen dem Professor Rheinhard Bendix und Max Horkheimer, 1955; Briefwechsel zwischen der Studentin Valentine Rothe und Max Horkheimer, 1957; 1 Brief von dem Student Rudolf Rothrock an Max Horkheimer, 1953; 1 Brief von Guy Roustang an Max Horkheimer, ohne Jahr; 1 Brief von Heinz Maria Ledig-Rowohlt an Max Horkheimer, 1950; Briefwechsel zwischen Ellen Roy und Max Horkheimer, 1956; Briefwechsel zwischen dem Professor Paul Royen und Max Horkheimer, 1954; Briefwechsel zwischen dem Staatsminister August Rucker und Max Horkheimer, 1955-1957 1 Brief an den Staatsminister August Rucker von Leopold von Wiese, 1955; 1 Bericht von Walter Rüegg, 1953 und 2 Briefe von Max Horkheimer an den Professor Walter Rüegg, 1955; 3 Briefe an den Professor Alexander Rüstow von Max Horkheimer, 1953-1958; Briefwechsel zwischen Käthe von Ruckteschell und Max Horkheimer, 1951-1954; Briefwechsel zwischen dem Student Gerhard Rudolph und Max Horkheimer, 1954; 1 Brief von der Ruf und Echo, Arbeitsgemeischaft an Max Horkheimer, 1952; 3 Briefe an den Professor Jay Rumney von Max Horkheimer, 1952-1954; Briefwechsel zwischen Clarence R. Rungee und Max Horkheimer, 1951-1952;

Bayesian doubly optimal group sequential designs for randomized clinical trials

When conducting a randomized comparative clinical trial, ethical, scientific or economic considerations often motivate the use of interim decision rules after successive groups of patients have been treated. These decisions may pertain to the comparative efficacy or safety of the treatments under study, cost considerations, the desire to accelerate the drug evaluation process, or the likelihood of therapeutic benefit for future patients. At the time of each interim decision, an important question is whether patient enrollment should continue or be terminated; either due to a high probability that one treatment is superior to the other, or a low probability that the experimental treatment will ultimately prove to be superior. The use of frequentist group sequential decision rules has become routine in the conduct of phase III clinical trials. In this dissertation, we will present a new Bayesian decision-theoretic approach to the problem of designing a randomized group sequential clinical trial, focusing on two-arm trials with time-to-failure outcomes. Forward simulation is used to obtain optimal decision boundaries for each of a set of possible models. At each interim analysis, we use Bayesian model selection to adaptively choose the model having the largest posterior probability of being correct, and we then make the interim decision based on the boundaries that are optimal under the chosen model. We provide a simulation study to compare this method, which we call Bayesian Doubly Optimal Group Sequential (BDOGS), to corresponding frequentist designs using either O'Brien-Fleming (OF) or Pocock boundaries, as obtained from EaSt 2000. Our simulation results show that, over a wide variety of different cases, BDOGS either performs at least as well as both OF and Pocock, or on average provides a much smaller trial. ^

The influence of contact pressure, moisture, and compression time on the performance of cotton anti-contamination clothing

The objectives of this research were (1) to study the effect of contact pressure, compression time, and liquid (moisture content of the fabric) on the transfer by sliding contact of non-fixed surface contamination to protective clothing constructed from uncoated, woven fabrics, (2) to study the effect of contact pressure, compression time, and liquid content on the subsequent penetration through the fabric, and (3) to determine if varying the type of contaminant changes the effect of contact pressure, compression time, and liquid content on the transfer by sliding contact and penetration of non-fixed surface contamination. ^ It was found that the combined influence of the liquid (moisture content of the fabric), load (contact pressure), compression time, and their interactions significantly influenced the penetration of all three test agents, sucrose- 14C, triolein-3H, and starch-14C through 100% cotton fabric. The combined influence of the statistically significant main effects and their interactions increased the penetration of triolein- 3H by 32,548%, sucrose-14C by 7,006%, and starch- 14C by 1,900%. ^

A systematic review of community-based colorectal cancer screening randomized controlled trials with multi-ethnic groups

Background. The CDC estimates that 40% of adults 50 years of age or older do not receive time-appropriate colorectal cancer screening. Sixty percent of colorectal cancer deaths could be prevented by regular screening of adults 50 years of age and older. Yet, in 2000 only 42.5% of adults age 50 or older in the U.S. had received recommended screening. Disparities by health care, nativity status, socioeconomic status, and race/ethnicity are evident. Disparities in minority, underserved populations prevent us from attaining Goal 2 of Healthy People 2010 to “eliminate health disparities.” This review focuses on community-based screening research among underserved populations that includes multiple ethnic groups for appropriate disparities analysis. There is a gap in the colorectal cancer screening literature describing the effectiveness of community-based randomized controlled trials. ^ Objective. To critically review the literature describing community-based colorectal cancer screening strategies that are randomized controlled trials, and that include multiple racial/ethnic groups. ^ Methods. The review includes a preliminary disparities analysis to assess whether interventions were appropriately targeted in communities to those groups experiencing the greatest health disparities. Review articles are from an original search using Ovid Medline and a cross-matching search in Pubmed, both from January 2001 to June 2009. The Ovid Medline literature review is divided into eight exclusionary stages, seven electronic, and the last stage consisting of final manual review. ^ Results. The final studies (n=15) are categorized into four categories: Patient mailings (n=3), Telephone outreach (n=3), Electronic/multimedia (n=4), and Counseling/community education (n=5). Of 15 studies, 11 (73%) demonstrated that screening rates increased for the intervention group compared to controls, including all studies (100%) from the Patient mailings and Telephone outreach groups, 4 of 5 (80%) Counseling/community education studies, and 1 of 4 (25%) Electronic/multimedia interventions. ^ Conclusions. Patient choice and tailoring education and/or messages to individuals have proven to be two important factors in improving colorectal cancer screening adherence rates. Technological strategies have not been overly successful with underserved populations in community-based trials. Based on limited findings to date, future community-based colorectal cancer screening trials should include diverse populations who are experiencing incidence, survival, mortality and screening disparities. ^

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. ^

Evidence that lymphokine -activated killer (LAK) cell function is regulated by both serine and tyrosine kinase pathways

Signal transduction pathways operative in lymphokine activated killer (LAK) cells during execution of cytolytic function have never been characterized. Based on ubiquitous involvement of protein phosphorylation in activation of cytolytic mechanisms used by CTL and NK cells, it was hypothesized that changes in protein phosphorylation should occur when LAK encounter tumor targets. It was further hypothesized that protein kinases would regulate LAK-mediated cytotoxicity. Exposure to either SK-Mel-1 (melanoma) or Raji (lymphoma) targets consistently led to increased phosphorylation of two 65-kD LAK proteins pp65a and -b, with isoelectric points (pI) of 5.1 and 5.2 respectively. Increased p65 phosphorylation was initiated between 1 and 5 min after tumor coincubation, occurred on Ser residues, required physical contact between LAK and tumors, correlated with target recognition, and also occurred after crosslinking Fc$\gamma$RIIIA in the absence of tumors. Both pp65a and -b were tentatively identified as phosphorylated forms of the actin-bundling protein L-plastin, based on pI, molecular weight, and cross-reactivity with specific antiserum. The known biochemical properties of L-plastin suggest it may be involved in regulating adhesion of LAK to tumor targets. The protein tyrosine kinase-specific inhibitor Herb A did not block p65 phosphorylation, but blocked LAK killing of multiple tumor targets at a post-binding stage. Greater than 50% inhibition of cytotoxicity was observed after a 2.5-h pretreatment with 0.125 $\mu$g/ml Herb A. Inhibition occurred over a period in pretreatment which LAK were not dependent upon IL-2 for maintenance of killing activity, supporting the conclusion that the drug interfered with mobilization of cytotoxic function. Granule exocytosis measured by BLT-esterase release from LAK occurred after coincubation with tumors, and was inhibited by Herb A LAK cytotoxicity was dependent upon extracellular calcium, suggesting that granule exocytosis rather than Fas ligand was the principal pathway leading to target cell death. The data indicate that protein tyrosine kinases play a pivotal role in LAK cytolytic function by regulating granule exocytosis, and that tumor targets can activate an adhesion dependent Ser kinase pathway in LAK resulting in phosphorylation of L-plastin. ^

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. ^