Prescriptions of Chinese medicinal herbs in Switzerland: the example of suan zao ren (Ziziphi Spinosae Semen)

Introduction According to the Swiss Health Survey 2007, 1.7% of the adult population use traditional Chinese medicine (including Chinese herbal medicine, but excluding acupuncture). In contrast to conventional drugs, that contain single chemically defined substances, prescriptions of Chinese herbs are mixtures of up to 40 ingredients (parts of plants, fungi, animal substances and minerals). Originally they were taken in the form of decoctions, but nowadays granules are more popular. Medium daily dosages of granules range between 8 to 12g. In a recent work we identified the most commonly used Chinese herbs (all ingredients are referred to as herbs for reasons of simplicity) and classical formulas (mixtures). Here we present a short overview and the example of suan zao ren (Ziziphi Spinosae Semen), which is used in the treatment of insomnia and anxiety and contains saponins that have been shown to increase sleep in animal studies. Material and Methods A random sample of 1,053 prescriptions was drawn from the database of Lian Chinaherb AG, Switzerland, and analysed according to the most frequently used individual herbs and classical formulas. Cluster analysis (Jaccard similarity coefficient, complete linkage method) was applied to identify common combinations of herbs. Results The most frequently used herbs were dang gui (Angelicae Sinensis Radix), fu ling (Poria), bai shao (Paeoniae Radix Alba), and gan cao (Glycyrrhizae Radix et Rhizoma); the most frequently used classical formulas were gui pi tang (Restore the Spleen Decoction) and xiao yao san (Rambling Powder). The average number of herbs per prescription was 12.0, and the average daily dosage of granules was 8.7g. 74.3% of the prescriptions were for female, 24.8% for male patients. Suan zao ren was present in 14.2% of all prescriptions. These prescriptions contained on average 13.7 herbs, and the daily dosage of granules was 8.9g. Suan zao ren was more frequently prescribed by practitioners of non-Asian than of Asian origin but equally often for female and male patients. Cluster analysis grouped suan zao ren with yuan zhi (Polygalae Radix), bai zi ren (Platycladi Semen), sheng di huang (Rehmanniae Radix) and dan shen (Salviae Miltiorrhizae Radix et Rhizoma). Discussion Prescriptions including suan zao ren contained on average slightly more herbs than other prescriptions. This might be due to the fact that two of the three most popular classical formulas with suan zao ren are composed of 13 and 12 herbs with the possibility of adding more ingredients when necessary. Cluster analysis resulted in the clustering of suan zao ren with other herbs of the classical formula tian wang bu xin dan (Emperor of Heaven’s Special Pill to Tonify the Heart), indicating the use of suan zao ren for the treatment of insomnia and irritability. Unfortunately, the diagnoses of the patients were unavailable and thus correlations between use of suan zao ren and diseases could not be analysed.

The effects of cardiac output and pulmonary arterial hypertension on volumetric capnography derived-variables during normoxia and hypoxia

The aim of this study was to test the effect of cardiac output (CO) and pulmonary artery hypertension (PHT) on volumetric capnography (VCap) derived-variables. Nine pigs were mechanically ventilated using fixed ventilatory settings. Two steps of PHT were induced by IV infusion of a thromboxane analogue: PHT25 [mean pulmonary arterial pressure (MPAP) of 25 mmHg] and PHT40 (MPAP of 40 mmHg). CO was increased by 50 % from baseline (COup) with an infusion of dobutamine ≥5 μg kg(-1) min(-1) and decreased by 40 % from baseline (COdown) infusing sodium nitroglycerine ≥30 μg kg(-1) min(-1) plus esmolol 500 μg kg(-1) min(-1). Another state of PHT and COdown was induced by severe hypoxemia (FiO2 0.07). Invasive hemodynamic data and VCap were recorded and compared before and after each step using a mixed random effects model. Compared to baseline, the normalized slope of phase III (SnIII) increased by 32 % in PHT25 and by 22 % in PHT40. SnIII decreased non-significantly by 4 % with COdown. A combination of PHT and COdown associated with severe hypoxemia increased SnIII by 28 % compared to baseline. The elimination of CO2 per breath decreased by 7 % in PHT40 and by 12 % in COdown but increased only slightly with COup. Dead space variables did not change significantly along the protocol. At constant ventilation and body metabolism, pulmonary artery hypertension and decreases in CO had the biggest effects on the SnIII of the volumetric capnogram and on the elimination of CO2.

Influence of experimental soil disturbances on the diversity of plants in agricultural grasslands

Aims and Methods Disturbance is supposed to play an important role for biodiversity and ecosystem stability as described by the intermediate disturbance hypothesis (IDH), which predicts highest species richness at intermediate levels of disturbances. In this study, we tested the effects of artificial soil disturbances on diversity of annual and perennial vascular plants and bryophytes in a field experiment in 86 agricultural grasslands differing in land use in two regions of Germany. On each grassland, we implemented four treatments: three treatments differing in application time of soil disturbances and one control. One year after experimental disturbance, we recorded vegetation and measured biomass productivity and bare ground. We analysed the disturbance response taking effects of region and land-use-accompanied disturbance regimes into account.Important Findings Region and land-use type strongly determined plant species richness. Experimental disturbances had small positive effects on the species richness of annuals, but none on perennials or bryophytes. Bare ground was positively related to species richness of bryophytes. However, exceeding the creation of 12% bare ground further disturbance had a detrimental effect on bryophyte species richness, which corresponds to the IDH. As biomass productivity was unaffected by disturbance our results indicate that the disturbance effect on species richness of annuals was not due to decreased overall productivity, but rather due to short-term lowered inter- and intraspecific competition at the newly created microsites.Generally, our results highlight the importance of soil disturbances for species richness of annual plants and bryophytes in agricultural grasslands. However, most grasslands were disturbed naturally or by land-use practices and our additional experimental soil disturbances only had a small short-term effect. Overall, total plant diversity in grasslands seemed to be more limited by the availability of propagules rather than by suitable microsites for germination. Thus, nature conservation efforts to increase grassland diversity should focus on overcoming propagule limitation, for instance by additional sowing of seeds, while the creation of additional open patches by disturbance might only be appropriate where natural disturbances are scarce.

Temporal Changes in Randomness of Bird Communities across Central Europe

Many studies have examined whether communities are structured by random or deterministic processes, and both are likely to play a role, but relatively few studies have attempted to quantify the degree of randomness in species composition. We quantified, for the first time, the degree of randomness in forest bird communities based on an analysis of spatial autocorrelation in three regions of Germany. The compositional dissimilarity between pairs of forest patches was regressed against the distance between them. We then calculated the y-intercept of the curve, i.e. the ‘nugget’, which represents the compositional dissimilarity at zero spatial distance. We therefore assume, following similar work on plant communities, that this represents the degree of randomness in species composition. We then analysed how the degree of randomness in community composition varied over time and with forest management intensity, which we expected to reduce the importance of random processes by increasing the strength of environmental drivers. We found that a high portion of the bird community composition could be explained by chance (overall mean of 0.63), implying that most of the variation in local bird community composition is driven by stochastic processes. Forest management intensity did not consistently affect the mean degree of randomness in community composition, perhaps because the bird communities were relatively insensitive to management intensity. We found a high temporal variation in the degree of randomness, which may indicate temporal variation in assembly processes and in the importance of key environmental drivers. We conclude that the degree of randomness in community composition should be considered in bird community studies, and the high values we find may indicate that bird community composition is relatively hard to predict at the regional scale.

Velocity of early BCR-ABL transcript elimination as an optimized predictor of outcome in chronic myeloid leukemia (CML) patients in chronic phase on treatment with imatinib

UNLABELLED Early assessment of response at 3 months of tyrosine kinase inhibitor treatment has become an important tool to predict favorable outcome. We sought to investigate the impact of relative changes of BCR-ABL transcript levels within the initial 3 months of therapy. In order to achieve accurate data for high BCR-ABL levels at diagnosis, beta glucuronidase (GUS) was used as a reference gene. Within the German CML-Study IV, samples of 408 imatinib-treated patients were available in a single laboratory for both times, diagnosis and 3 months on treatment. In total, 301 of these were treatment-naïve at sample collection. RESULTS (i) with regard to absolute transcript levels at diagnosis, no predictive cutoff could be identified; (ii) at 3 months, an individual reduction of BCR-ABL transcripts to the 0.35-fold of baseline level (0.46-log reduction, that is, roughly half-log) separated best (high risk: 16% of patients, 5-year overall survival (OS) 83% vs 98%, hazard ratio (HR) 6.3, P=0.001); (iii) at 3 months, a 6% BCR-ABL(IS) cutoff derived from BCR-ABL/GUS yielded a good and sensitive discrimination (high risk: 22% of patients, 5-year OS 85% vs 98%, HR 6.1, P=0.002). Patients at risk of disease progression can be identified precisely by the lack of a half-log reduction of BCR-ABL transcripts at 3 months.

Self-esteem development across the life span: A longitudinal study with a large sample from Germany

The authors examined the development of self-esteem across the life span. Data came from a German longitudinal study with 3 assessments across 4 years of a sample of 2,509 individuals ages 14 to 89 years. The self-esteem measure used showed strong measurement invariance across assessments and birth cohorts. Latent growth curve analyses indicated that self-esteem follows a quadratic trajectory across the life span, increasing during adolescence, young adulthood, and middle adulthood, reaching a peak at age 60 years, and then declining in old age. No cohort effects on average levels of self-esteem or on the shape of the trajectory were found. Moreover, the trajectory did not differ across gender, level of education, or for individuals who had lived continuously in West versus East Germany (i.e., the 2 parts of Germany that had been separate states from 1949 to 1990). However, the results suggested that employment status, household income, and satisfaction in the domains of work, relationships, and health contribute to a more positive life span trajectory of self-esteem. The findings have significant implications, because they call attention to developmental stages in which individuals may be vulnerable because of low self-esteem (such as adolescence and old age) and to factors that predict successful versus problematic developmental trajectories.

Guidance of treatment decisions in risk-adapted primary radiotherapy for prostate cancer using multiparametric magnetic resonance imaging: a single center experience.

BACKGROUND Magnetic resonance imaging (MRI) of the prostate is considered to be the most precise noninvasive staging modality for localized prostate cancer. Multiparametric MRI (mpMRI) dynamic sequences have recently been shown to further increase the accuracy of staging relative to morphological imaging alone. Correct radiological staging, particularly the detection of extraprostatic disease extension, is of paramount importance for target volume definition and dose prescription in highly-conformal curative radiotherapy (RT); in addition, it may affect the risk-adapted duration of additional antihormonal therapy. The purpose of our study was to analyze the impact of mpMRI-based tumor staging in patients undergoing primary RT for prostate cancer. METHODS A total of 122 patients admitted for primary RT for prostate cancer were retrospectively analyzed regarding initial clinical and computed tomography-based staging in comparison with mpMRI staging. Both tumor stage shifts and overall risk group shifts, including prostate-specific antigen (PSA) level and the Gleason score, were assessed. Potential risk factors for upstaging were tested in a multivariate analysis. Finally, the impact of mpMRI-based staging shift on prostate RT and antihormonal therapy was evaluated. RESULTS Overall, tumor stage shift occurred in 55.7% of patients after mpMRI. Upstaging was most prominent in patients showing high-risk serum PSA levels (73%), but was also substantial in patients presenting with low-risk PSA levels (50%) and low-risk Gleason scores (45.2%). Risk group changes occurred in 28.7% of the patients with consequent treatment adaptations regarding target volume delineation and duration of androgen deprivation therapy. High PSA levels were found to be a significant risk factor for tumor upstaging and newly diagnosed seminal vesicle infiltration assessed using mpMRI. CONCLUSIONS Our findings suggest that mpMRI of the prostate leads to substantial tumor upstaging, and can considerably affect treatment decisions in all patient groups undergoing risk-adapted curative RT for prostate cancer.

Biotic and abiotic controls of nitrogen and phosphorus cycling in Central European forests

The functioning and services of Central European forests are threatened by global change and a loss of biodiversity. Nutrient cycling as a key forest function is affected by biotic drivers (e.g., dominant tree species, understory plants, soil organisms) that interact with abiotic conditions (e.g., climate, soil properties). In contrast to grassland ecosystems, evidence for the relationship of nutrient cycles and biodiversity in forests is scarce because the structural complexity of forests limits experimental control of driving factors. Alternatively, observational studies along gradients in abiotic conditions and biotic properties may elucidate the role of biodiversity for forest nutrient cycles. This thesis aims to improve the understanding of the functional importance of biodiversity for nutrient cycles in forests by analyzing water-bound fluxes of nitrogen (N) and phosphorus (P) along gradients in biodiversity in three regions of Germany. The tested hypotheses included: (1) temperate forest canopies retain atmospheric N and retention increases with increasing plant diversity, (2) N release from organic layers increases with resource availability and population size of decomposers but N leaching decreases along a gradient in plant diversity, (3) P leaching from forest canopies increases with improved P supply from recalcitrant P fractions by a more diverse ectomycorrhizal fungal community. In the canopies of 27 forest stands from three regions, 16 % to 51 % of atmospheric N inputs were retained. Regional differences in N retention likely resulted from different in N availability in the soil. Canopy N retention was greater in coniferous than in beech forests, but this was not the case on loessderived soils. Nitrogen retention increased with increasing tree and shrub diversity which suggested complementary aboveground N uptake. The strength of the diversity effect on canopy N uptake differed among regions and between coniferous and deciduous forests. The N processing in the canopy directly coupled back to N leaching from organic layers in beech forests because throughfall-derived N flushed almost completely through the mull-type organic layers at the 12 studied beech sites. The N release from organic layers increased with stand basal area but was rather low (< 10 % of annual aboveground litterfall) because of a potentially high microbial N immobilization and intensive incorporation of litter into the mineral soil by bioturbation. Soil fauna biomass stimulated N mineralization through trophic interactions with primary producers and soil microorganisms. Both gross and net leaching from organic layers decreased with increasing plant diversity. Especially the diversity but not the cover of herbs increased N uptake. In contrast to N, P was leached from the canopy. Throughfall-derived P was also flushed quickly through the mull-type organic layers and leached P was predominantly immobilized in non directly plant-available P fractions in the mineral soil. Concentrations of plant-available phosphate in mineral soil solution were low and P leaching from the canopy increased with increasing concentrations of the moderately labile P fraction in soil and increasing ectomycorrhiza diversity while leaf C:P ratios decreased. This suggested that tree P supply benefited from complementary mining of diverse mycorrhizal communities for recalcitrant P. Canopy P leaching increased in years with pronounced spring drought which could lead to a deterioration of P supply by an increasing frequency of drought events. This thesis showed that N and P cycling in Central European forests is controlled by a complex interplay of abiotic site conditions with biological processes mediated by various groups of organisms, and that diverse plant communities contribute to tightening the N cycle in Central European forests and that diverse mycorrhizal communities improve the limited P availability. Maintaining forest biodiversity seems essential to ensure forest services in the light of environmental change.

DNA probes for the detection of Fasciola hepatica in snails

Fasciola hepatica, also called the large liver fluke, is a trematode which can infect most mammals. Monitoring the infection rate of snails, which function as intermediate hosts and harbour larval stages of F. hepatica, is an important component of epidemiological studies on fascioliasis. For this purpose, DNA probes were generated which can be used for the detection of F. hepatica larvae in snails. Four highly repetitive DNA fragments were cloned in a plasmid vector and tested by Southern blot hybridization to the DNA of various trematodes for specificity and sensitivity. The probes Fhr-I, Fhr-II and Fhr-III hybridized only to F. hepatica DNA. Fhr-IV contained ribosomal RNA gene sequences and cross-hybridize with the DNA from various other trematode species. Squash blot analysis showed that the different probes were able to detect the parasite larvae in trematode-infected snails even as isolated single larvae. No signals were obtained in squash blots of uninfected snails. Probes Fhr-I, Fhr-II and Fhr-III are thus useful specific tools for studying the epidemiology of fascioliasis. The probe Fhr-IV, because of its broader spectrum, can be used to detect the larvae of a wide range of trematode species of waterbirds, which are the causative agents of swimmer's itch.

Na 1 Nachlass Max Horkheimer, 657 - "The Philosophy of Western Society", "Bericht über die Aktivitäten des Instituts für Sozialforschung für Robert M. MacIver", "Über die Tätigkeit des Instituts für Sozialforschung", "Stipendiaten des Instituts für Sozialforschung: Forschungsberichte", "Research Projects of the International Institut of Social Research" (p. IX 56-IX 59.2)

Über das Forschungsprogramm: The Philosophy of Western Society. Teilstück des allgemeinen Forschungsprogramms, veröffentlicht unter dem Untertitel: "The Philosophy of Social Science", in: "International Institute of Social Research. A Report of Its History, Aims and Activites, 1933-1938", New York (1938?), S. 19, Typoskript mit eigenhändiger Korrektur, 2 Blatt; Bericht über die Aktivitäten des Instituts für Sozialforschung für Robert M. MacIver, 1938-39: 1. Bericht vom 7.12.1939; a) Typoskript, englisch, 9 Blatt; b) Typoskript, als Brief von Pollock an Robert M. MacIver, Typoskript 10 Blatt; c) Entwurf Typoskript, englisch, 15 Blatt; d) Entwurf Typoskript, deutsch, 17 Blatt; MacIver, Robert M.: 1 Brief mit Unterschrift an Friedrich Pollock, New York, 27.04.1938, 1 Blatt; "Some data on the Institut`s Staff and Activities", 11.03.1938, zwei Typoskripte, je 2 Blatt; Über die Tätigkeiten des Instituts für Sozialforschung. Verschiedene Berichte. 1939; Aufstellung der Forschungsgebiete verschiedener Mitarbeiter des Instituts. Ohne Datum, Typoskript, 9 Blatt; Aufstellung der Forschungsgebiete verschiedener Mitarbeiter des Institutes, aus einem Bericht. Typoskript, 7 Blatt; Bericht an den Präsidenten des Columbia University. Typoskript, 2 Blatt; "Contribution of Dr. Franz Neumann to the Round Table Discussion, Chicago, Social Science Reaserach Building" Dezember 1939; a) Typoskript mit Handschriftlichen Korrekturen, 3 Blatt; b) Typoskript, 3 Blatt; "Statment on the objectives of the International Institut of Social Research". Typoskript, 2 Blatt; Stipendiaten des Instituts für Sozialforschung: Forschungsberichte, Ende 1939; Adorno, Theodor W.: a) Typoskript, englisch, mit eigenhändigen Korrekturen, 4 Blatt; b) Typoskript, deutsch, 3 Blatt; Beck, Maximilian: "Geschichte des Begriffs der Vernunft von Platon bis Husserl (Outline)". Typoskript, englisch und deutsch, mit handschriftlichen Korrekturen, 7 Blatt; Flechtheim, Ossip K.: Typoskript mit handschriftlichen Ergänzungen, 1 Blatt; Fried, Hans Ernest: Typoskript, 1 Blatt, 16.11.1939; Grossmann, Henryk: "Capitalism in the 13th Century"; a) Typoskript, englisch, mit handschriftlichen Korrekturen, 6 Blatt; b) Typoskript, englisch, 6 Blatt; c) Typoskript, deutsch, 4 Blatt; Grossmann, Henryk: "The Classical Theory and Marxism"; a) Typoskript, englisch, mit handschriftlichen Korrekturen, 2 Blatt; b) Typoskript, deutsch, mit handschriftlichen Korrekturen, 2 Blatt; Kirchheimer, Otto: Manuskript, 1 Blatt; Lauterbach, Albert: a) Typoskript, englisch, mit handschriftlichen Korrekturen, 2 Blatt; b) Typoskript, deutsch, mit handschriftlichen Korrekturen, 1 Blatt; Marcuse, Herbert: Typoskript mit handschriftlichen Korrekturen, 2 Blatt; Neumann, Franz L.: Typoskript, 2 Blatt; Wittfogel, Karl August: Typsokript, 2 Blatt; Zilsel, Edgar: Typoskript, 4 Blatt; Research Projects of the International Institute of Social Research. nicht vor 1939; Beschreibung der Forschungsprojekte: Pollock, Friedrich: "Economic and Social Cosequences of a Prepardness Economy". Neumann, Franz L.: "The Rule of Law". Fromm, Erich: "The German Worker in the Weiman Republic". Kirchheimer,Otto: "Criminal Law and Social Structure". Marcuse, Herbert: " A Text and Source Book for the History of Philosophy". Fromm, Erich: "Character Structure of Modern Man". Neumann, Franz L.: "The Theory and Practice of European Labor Law". Wittfogel, Karl August; Wittfogel-Lang, Olga: "The Chinese Family"; Dasselbe wie in "Beschreibung der Forschungsprojekte", ausgenommen Pollock, Friedrich: "Economic and Social Cosquences of a Prepardness Economy" und Fromm, Erich: "The German Worker in the Weimar Republic", zusätzlich Kirchner, Otto; Weil, Felix: "Changes in Social Stratification, National Income, and Living Standards of Germany since 1933"; 1 Ordner, Typoskript mit eigenhändigen Korrekturen, 49 Blatt;

Na 1 Nachlass Max Horkheimer, 685 - "Post War Antisemitism in Germany" (p. IX 147.1-6)

Gurland, A.R.L.: "Fight against Antisemitism within the Framwork of Germany's Education for Democracy. Draft Program", 1947. Als Typoskript vervielfältigt, 62 Blatt; Horkheimer, Max: "Momorandum on Post-War Antisemitism in Germany", 31.05.1945. Typoskript, 1 Blatt; Massing, Paul W.; Gurlach, A.R.L.: 2 Briefe mit Unterschrift an Max Horkheimer, ohne Ort, 1944; 1 Brief von Max Horkheimer, ohne Ort, 05.10.1944, 11 Blatt; Massig, Paul W.; Gurlach A.R.L.: "Some Remarks on Leo Löwenthals Memorandum" [September 1944]. Typoskript, 14 Blatt; [Löwenthal, Leo?]: "Post-War Antisemitism in Germany", a) Typoskript, 21 Blatt; b) Typoskript, 29 Blatt; Peck, Georg: "On the Problem of Antisemitism in Post-War Germany", 28.07.1943. Typoskript, 12 Blatt;

New insights into the role of the duodenal vitamin D receptor in calcium homeostasis

It is generally believed that 1,25(OH)2D3, bound to its receptor (VDR) contributes to calcium homeostasis by regulating active calcium absorption in the proximal small intestine. However, studying patients with hereditary vitamin D-resistant rickets (HVDRR) provided investigators with a better understanding of VDR's role in calcium homeostasis. HVDRR patients have inactivating mutations in the VDR, and as a consequence they develop hypocalcemia, hyperparathyroidism and severe rickets. However, these phenotypes can be corrected if the patients are given IV infusions of calcium or dietary calcium. This raises the question of what is the physiological significance of VDR-regulated active calcium absorption if calcium homeostasis can be restored independently of the VDR. ^ In order to distinguish the contribution of VDR in the proximal small intestine to overall calcium homeostasis, I generated transgenic mice expressing the human VDR (hVDR) exclusively in the proximal small intestine of mVDR-/- mice by using an hVDR-expressing transgene driven by the duodenal-specific adenosine deaminase enhancer (hVDR+/mVDR-/-). hVDR+/mVDR-/- mice expressed transcriptionally active hVDR only in the proximal small intestine and responded to 1,25(OH)2D3 by up-regulating expression of TRPV6 and calbindin D9K, genes involved in calcium absorption. Furthermore, ligated duodenal loop assays determined that calcium absorption in hVDR+/mVDR-/- mice was as responsive to 1,25(OH)2D3 as in WT mice. Despite having a functional hVDR in the proximal small intestine, hVDR+/mVDR-/- mice were hypocalcemic, had hyperparathyroidism, and were rachitic when fed a normal rodent diet at weaning, as were the mVDR-/- mice. However, when fed a high calcium, phosphorus, and lactose diet (rescue diet), the hVDR+/mVDR-/- mice responded more effectively than the mVDR-/- mice by down-regulation of parathyroid hormone production and by a greater increase in bone mineralization. Furthermore, when three-month-old rachitic mice were fed a rescue diet for 3 weeks, serum calcium and bone mineral content were normalized in hVDR+/mVDR-/- mice, but not in mVDR-/- mice. ^ In conclusion, hVDR expression enabled young mice to better use the rescue diet than mVDR-/- mice. Expression of transgenic hVDR also protected the ability of older mice to respond to the rescue diet despite the absence of the VDR elsewhere in the intestinal tract. I propose that because hVDR+/mVDR-/- mice responded better than mVDR-/- mice to the rescue diet, it is likely that VDR expression in the proximal small intestine is necessary in nutritional (insufficient dietary calcium) and physiological (age) conditions when passive calcium absorption is inadequate. ^

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. ^