Using electronic health record data for substance use Screening, Brief Intervention, and Referral to Treatment among adults with type 2 diabetes: Design of a National Drug Abuse Treatment Clinical Trials Network study.

BACKGROUND: The Affordable Care Act encourages healthcare systems to integrate behavioral and medical healthcare, as well as to employ electronic health records (EHRs) for health information exchange and quality improvement. Pragmatic research paradigms that employ EHRs in research are needed to produce clinical evidence in real-world medical settings for informing learning healthcare systems. Adults with comorbid diabetes and substance use disorders (SUDs) tend to use costly inpatient treatments; however, there is a lack of empirical data on implementing behavioral healthcare to reduce health risk in adults with high-risk diabetes. Given the complexity of high-risk patients' medical problems and the cost of conducting randomized trials, a feasibility project is warranted to guide practical study designs. METHODS: We describe the study design, which explores the feasibility of implementing substance use Screening, Brief Intervention, and Referral to Treatment (SBIRT) among adults with high-risk type 2 diabetes mellitus (T2DM) within a home-based primary care setting. Our study includes the development of an integrated EHR datamart to identify eligible patients and collect diabetes healthcare data, and the use of a geographic health information system to understand the social context in patients' communities. Analysis will examine recruitment, proportion of patients receiving brief intervention and/or referrals, substance use, SUD treatment use, diabetes outcomes, and retention. DISCUSSION: By capitalizing on an existing T2DM project that uses home-based primary care, our study results will provide timely clinical information to inform the designs and implementation of future SBIRT studies among adults with multiple medical conditions.

Gender and racial/ethnic differences in addiction severity, HIV risk, and quality of life among adults in opioid detoxification: results from the National Drug Abuse Treatment Clinical Trials Network.

PURPOSE: Detoxification often serves as an initial contact for treatment and represents an opportunity for engaging patients in aftercare to prevent relapse. However, there is limited information concerning clinical profiles of individuals seeking detoxification, and the opportunity to engage patients in detoxification for aftercare often is missed. This study examined clinical profiles of a geographically diverse sample of opioid-dependent adults in detoxification to discern the treatment needs of a growing number of women and whites with opioid addiction and to inform interventions aimed at improving use of aftercare or rehabilitation. METHODS: The sample included 343 opioid-dependent patients enrolled in two national multi-site studies of the National Drug Abuse Treatment Clinical Trials Network (CTN001-002). Patients were recruited from 12 addiction treatment programs across the nation. Gender and racial/ethnic differences in addiction severity, human immunodeficiency virus (HIV) risk, and quality of life were examined. RESULTS: Women and whites were more likely than men and African Americans to have greater psychiatric and family/social relationship problems and report poorer health-related quality of life and functioning. Whites and Hispanics exhibited higher levels of total HIV risk scores and risky injection drug use scores than African Americans, and Hispanics showed a higher level of unprotected sexual behaviors than whites. African Americans were more likely than whites to use heroin and cocaine and to have more severe alcohol and employment problems. CONCLUSIONS: Women and whites show more psychopathology than men and African Americans. These results highlight the need to monitor an increased trend of opioid addiction among women and whites and to develop effective combined psychosocial and pharmacologic treatments to meet the diverse needs of the expanding opioid-abusing population. Elevated levels of HIV risk behaviors among Hispanics and whites also warrant more research to delineate mechanisms and to reduce their risky behaviors.

Influence of social network structure on entrepreneurship participation — a study of 20 national

By investigating differences in social networks among entrepreneurs in 20 cultures, this paper contributes to the debate on whether there is universality in the process of entrepreneurial networking. Representative samples of entrepreneurs were identified in the same manner in 20 countries from 2000 to 2004 (N=€‰304,560). The sampling methodologies and the questions asked were similar across all countries. Logistic regression was used to test for significant regional interaction effects involving personally knowing an entrepreneur. Results are contrary to the existence of any mono-dimensional form of networking practice but do strongly support the existence of both variform universality (culture moderates the importance of networking) and functional universality (cultural similarities in networking practice exist).

The CDM-Net project : the development, implementation and evaluation of a broadband-based network for managing chronic disease

Background. In Australia most chronic disease management is funded by Medicare Australia through General Practitioner Management Plans (GPMPs) and Team Care Arrangements (TCAs). Identified barriers may be reduced effectively using a broadband-based network known as the Chronic Disease Management Service (CDMS).

Aims. To measure the uptake and adherence to CDMS, test CDMS, and assess the adherence of health providers and patients to GPMPs and TCAs generated through CDMS.

Methods. A single cohort before and after study.

Results. GPMPs and TCAs increased. There was no change to prescribed medicines or psychological quality of life. Attendance at allied health professionals increased, but decreased at pharmacies. Overall satisfaction with CDMS was high among GPs, allied health professionals, and patients.

Conclusion. This study demonstrates proof of concept, but replication or continuation of the study is desirable to enable the impact of CDMS on diabetes outcomes to be determined.

Exploring the global and local networks of national information system integration initiatives : a case study of national cultural collection integration from an actor-network perspective

Australian Museums Online (AMOL) was the earliest attempt to make Australia’s distributed cultural collections accessible from a single online resource. Despite early successes, significant achievements and the considerable value it offered certain groups, the project ran into operational difficulties and was eventually discontinued. By using Actor-Network Theory and analysing the global and local actor-networks, it is revealed that although the project originated from large, state museums, buy-in was restricted to individuals, rather than institutions and the most significant value was for smaller, regional institutions. Furthermore, although the global networks that governed the project could translate their visions through the local production networks, because the network’s underlying weaknesses were never addressed, over time this destablised the global networks. This case study offers advice for projects attempting to consolidate data sources from disparate sources, and highlights the importance of individual actors in championing the project.

Spanish National GPS Reference Station Network (ERGPS)

The Instituto Geográfico Nacional de España, thought its geodesy department, since 1997 has carried out the establisment of a GPS Reference Station Network (ERGPS) delivered all around Spain which allows millimetric co-ordinate results, as well as velocity fields in a Global Reference System (ITRFxx). It serves as support for other geodetic networks. Some of these stations are being integrated into the EUREF (EUropean REference Frame) Permanent Station Network. The ERGPS forms the zero order of the Spanish new geodesy

Knowledge Modelling in Multiagent Systems: The Case of the Management of a National Network

This paper presents the knowledge model of a distributed decision support system, that has been designed for the management of a national network in Ukraine. It shows how advanced Artificial Intelligence techniques (multiagent systems and knowledge modelling) have been applied to solve this real-world decision support problem: on the one hand its distributed nature, implied by different loci of decision-making at the network nodes, suggested to apply a multiagent solution; on the other, due to the complexity of problem-solving for local network administration, it was useful to apply knowledge modelling techniques, in order to structure the different knowledge types and reasoning processes involved. The paper sets out from a description of our particular management problem. Subsequently, our agent model is described, pointing out the local problem-solving and coordination knowledge models. Finally, the dynamics of the approach is illustrated by an example.

Linkage of the 1999-2008 National Health and Nutrition Examination Surveys to traffic indicators from the National Highway Planning Network /

Mode of access: Internet.