Alternative Treatment Models Research Articles

Diabetes and Alternative Treatment Models

Diabetes Mellitus is a collection of various conditions that have resulted in an increase in blood glucose levels. This article outlines the current classification of diabetes mellitus and compares the majority of the characteristics of both type 1 and 2 diabetes. Fasting and oral glucose resistance tests and legitimate biochemical demonstrative criteria when utilizing hemoglobin A1c (HbA1c) are moreover summarized. Rising rates of diabetes require focused on screening to distinguish diabetes and prediabetes in at-risk bunches. In order to prevent the development of diabetes in these random clusters and delay its progression, it is necessary to engage in early physical activity after that initial activity has occurred.
 Concurring to the most recent information from The International Diabetes Federation (IDF) in 2021, the number of grown-up patients matured 20-79 a long time around the world is over 500 million and this number will increment to 800 million within the 2050s.
 Diabetes is also a costly disease that consumes about 12% of healthcare costs globally. Considering the undesirable side effects and costs of known standard treatments; Today, the tendency and preference possibilities for alternative therapies (CAM) are increasing day by day. Herbal medicines, in other words, alternative treatments are the traditional methods used in the treatment of many diseases, which are mostly preferred especially within Eastern and Middle Eastern countries.
 In this study, possible alternative treatment models and sources of active substances were presented, and the possibilities and studies for more effective treatment of diabetes were summarized and tried to be put forward.

Cost-effectiveness of monthly follow-up for the treatment of uncomplicated severe acute malnutrition: An economic evaluation of a randomized controlled trial.

Severe acute malnutrition (SAM) is a major source of mortality for children in low resource settings. Alternative treatment models that improve acceptability and reduce caregiver burden are needed to improve treatment access. We assessed costs and cost-effectiveness of monthly vs. weekly follow-up (standard-of-care) for treating uncomplicated SAM in children 6-59 months of age. To do so, we conducted a cost-effectiveness analysis of a cluster-randomized trial of treatment for newly-diagnosed uncomplicated SAM in northwestern Nigeria (clinicaltrials.gov ID NCT03140904). We collected empirical costing data from enrollment up to 3 months post-discharge. We quantified health outcomes as the fraction of children recovered at discharge (primary cost-effectiveness outcome), the fraction recovered 3 months post-discharge, and total DALYs due to acute malnutrition. We estimated cost-effectiveness from both provider and societal perspectives. Costs are reported in 2019 US dollars. Provider costs per child were $67.07 (95% confidence interval: $64.79, $69.29) under standard-of-care, and $78.74 ($77.06, $80.66) under monthly follow-up. Patient costs per child were $21.04 ($18.18, $23.51) under standard-of-care, and $14.16 ($12.79, $15.25) under monthly follow-up. Monthly follow-up performed worse than standard-of-care for each health outcome assessed and was dominated (produced worse health outcomes at higher cost) by the standard-of-care in cost-effectiveness analyses. This result was robust to statistical uncertainty and to alternative costing assumptions. These findings provide evidence against monthly follow-up for treatment of uncomplicated SAM in situations where weekly follow-up of patients is feasible. While monthly follow-up may reduce burdens on caregivers and providers, other approaches are needed to do so while maintaining the effectiveness of care.

Development of an Effective Monoclonal Antibody against Heroin and Its Metabolites Reveals Therapies Have Mistargeted 6-Monoacetylmorphine and Morphine over Heroin.

The opioid epidemic is a global public health crisis that has failed to abate with current pharmaceutical treatments. Moreover, these FDA-approved drugs possess numerous problems such as adverse side effects, short half-lives, abuse potential, and recidivism after discontinued use. An alternative treatment model for opioid use disorders is immunopharmacotherapy, where antibodies are produced to inhibit illicit substances by sequestering the drug in the periphery. Immunopharmacotherapeutics against heroin have engaged both active and passive vaccines targeting heroin’s metabolites, 6-monoacetylmorphine (6-AM) and morphine, since decades of research have stated that heroin’s psychoactive and lethal effects are mainly attributed to these compounds. However, concerted efforts to develop effective immunopharmacotherapies against heroin abuse have faced little clinical advancement, suggesting a need for reassessing drug target selection. To address this issue, four unique monoclonal antibodies were procured with distinct affinity to either heroin, 6-AM, or morphine. Examination of these antibodies through in vitro and in vivo tests revealed monoclonal antibody 11D12 as the optimal therapeutic and provided crucial insights into the key chemical species to target for blunting heroin’s psychoactive and lethal effects. These findings offer clarification into the problematic attempts of therapeutics targeting heroin’s metabolites and provide a path forward for future heroin immunopharmacotherapy development.

Integrated enhanced cognitive behavioural (I-CBTE) therapy significantly improves effectiveness of inpatient treatment of anorexia nervosa in real life settings

BackgroundInpatient treatment of anorexia nervosa can be lifesaving but is associated with high rates of relapse and poor outcomes. To address this, the Oxford service has adapted the enhanced cognitive behavioural treatment (CBTE) model, first developed for inpatients in Italy to a UK national health service (NHS) setting. In this study, we compared the outcomes from treatment as usual (TAU), integrated CBTE (I-CBTE), and alternative treatment models in routine UK clinical practice.MethodsThis is a longitudinal cohort study, using routinely collected data between 2017 and 2020 involving all adults with anorexia nervosa admitted to specialist units from a large geographical area in England covering a total population of 3.5 million. We compared TAU with (1) I-CBTE (13 weeks inpatient CBTE, restoration to a healthy weight, combined with 7 weeks day treatment followed by 20 weeks of outpatient CBTE; (2) standalone inpatient CBTE (due to insufficient resources since the pandemic; and (3) 6–8 weeks admission with partial weight restoration as crisis management. Primary outcome measures (min. 1 year after discharge from hospital) were defined as: (1) good outcome: Body Mass Index (BMI) > 19.5 and no abnormal eating or compensatory behaviours; (2) poor outcome: BMI < 19.5 and/or ongoing eating disorder behaviours; (3) readmission; or (4) deceased. Secondary outcomes were BMI on discharge, and length of stay.Results212 patients were admitted to 15 specialist units in the UK depending on bed availability. The mean age was 28.9 (18–60) years, mean admission BMI was 14.1 (10–18.3), 80% were voluntary. At minimum 1-year follow up after discharge, 70% of patients receiving I-CBTE and 29% standalone inpatient CBTE maintained good outcomes, in contrast with < 5% TAU and crisis management admission. Readmission rates of I-CBTE were 14.3% vs ~ 50% (χ2 < 0.0001) in the other groups. The main predictors of good outcome were reaching healthy BMI by discharge, I-CBTE and voluntary status. Age, psychiatric comorbidity and length of stay did not predict outcomes. BMI on discharge and length of stay were significantly better in the CBTE groups than in TAU.ConclusionsOur main finding is that in a real-life setting, I-CBTE has superior short- and minimum 1 year outcomes as compared with alternative inpatient treatment models. Dissemination of I-CBTE across the care pathway has the potential to transform outcomes of inpatient treatment for this high-risk patient population and reduce personal and societal costs.

The Hidden Potential of Herbal Remedies and Neutraceuticals in Canine and Feline Behavioural Disorders

Veterinary practitioners may encounter a wide variety of behaviorual problems such as aggresion, anxiety, compulsive behaviours, inappropriate elimination and cognitive dysfunction in daily practice. With the advance of scientific researches regarding usage of herbs and nutraceuticals in order to treat these behavioural problems, veterinarians and animal owners look for reliable sources to gain knowladge about that therapeutics. As elucidated by many published researches, neurotransmitters such as GABA, serotonin, dopamine and norepinephrine act in pathology of many psychiatric disorders and most of the modern drugs show their mechanism of action by regulating these neurochemicals. There is increasing evidence that herbal extracts and nutraceuticals act in a similiar way with the conventional therapeutics however, lots of conventional medicines have remarkable side effect unlike herbal and nutraceutical therapeutics. Despite the increasing number of studies, the mechanism of action of these therapeutics has not been fully elucidated. This review aims to introduce recent scientific knowledge on herbal and nutraceutical remedies, that may be alternative treatment models in dog and cat behavioural problems.

DNA Aptamer-Conjugated Magnetic Graphene Oxide for Pathogenic Bacteria Aggregation: Selective and Enhanced Photothermal Therapy for Effective and Rapid Killing.

Methicillin-resistant Staphylococcus aureus (MRSA), often called “superbug”, is a nosocomial and multidrug resistance bacterium that shows resistance to β-lactam antibiotics. There has been high demand to develop an alternative treatment model to antibiotics for efficiently fighting MRSA. Herein, we developed DNA aptamer-conjugated magnetic graphene oxide (Apt@MGO) as a multifunctional and biocompatible nanoplatform for selective and rapid eradication of MRSA and evaluated heat generation and cell death performance of Apt@MGO for the first time under dispersed and aggregated states. The aptamer sequence was specifically selected for MRSA and acted as a molecular targeting probe for selective MRSA recognition and antibiotic-free therapy. Magnetic graphene oxide (MGO) serves as a nanoplatform for aptamer conjugation and as a photothermal agent by converting near-infrared (NIR) light to heat. Iron oxide nanoparticles (Fe3O4 NPs) are formed on GO to prepare MGO, which shows magnetic properties for collecting MRSA cells in a certain area in the reaction tube by an external magnet. The collected MGO induces remarkably high local heating and eventual MRSA cell death under NIR laser irradiation. We demonstrate that Apt@MGO resulted in ∼78% MRSA and over >97% MRSA cell inactivation in dispersed and aggregated states, respectively, under 200 seconds (sn) exposure of NIR irradiation (808 nm, 1.1 W cm–2). An in vitro study highlights that Apt@MGO is considered a targeted, biocompatible, and light-activated photothermal agent for efficient and rapid killing of MRSA in the aggregated state under NIR light.

Radiotherapy in Combination with Chimeric Antigen Receptor T Cell Therapy Is a Safe and Promising Approach in Relapsed/Refractory Diffuse Large B Cell Lymphoma Patients with High Tumor Burden

Radiation therapy (RT) for localized-refractory or relapsed (R/R) DLBCL after chemotherapy is a standard therapy. Chimeric antigen receptor T cells (CAR-T) therapy is demonstrated as a novel immunotherapy modality with impressive efficacy in R/R B-cell malignancies including DLBCL. However, CAR-T therapy is also associated with potentially fatal toxicities, including cytokine release syndrome (CRS) and neurological toxicities. Whether radiotherapy in combination with CAR-T is a better approach to enhancing efficacy and decreasing toxicity of CAR-T therapy in R/R DLBCL patients with high tumor burden remains unknown. Human CD3+T cells were separated from peripheral blood mononuclear cells (PBMS) of patients or donors by degradable anti-CD3 magnetic microbeads followed by 24h stimulation with CD3 and CD28 monoclonal antibody (5ug/ml). Then CD3+T cells were transduced with humanized CAR construct targeting CD19, CD20 and CD22 and further expanded for 7 to 10 days in vitro. 14 patients with high tumor burden R/R DLBCL were enrolled in the study. Patients from 39 to 66 years of age had received two to four prior lines of therapy. 7 patients received intensive second-line chemotherapy (median age, 46 years) and 7 received radiotherapy (median age, 63 years) to debulking tumor after leukapheresis and during CAR-T cells preparation. Intensive combined chemotherapy or radiation (40 Gy in 20 fractions) were carried out for debulking condition after sequential FC regimen (cyclophosphamide 300mg/m2 and fludarabine 30mg/m2 X 3d) for lymphodepletion chemotherapy. Two days after FC regimen, CAR-T cells targeting CD19 and CD20 or CD22 at average dose of 1-2×107 cells for each target per kilogram (kg) were infused within 3 days. Severe CRS (grade 3/4/5) was reported in all patients of chemotherapy cohort and mild CRS (grade 1/2) was reported in all patients of radiation cohort. 4 patients (57.1%) in chemotherapy cohort showed neurological toxicity while no patient in radiation cohort showed neurological toxicity. Comparable hematological/non-hematological toxicity and non-neurological toxicity were observed in both two groups. In chemotherapy cohort, four of seven (57.1%) patients achieved an objective response after CAR-T infusion with three of seven (42.9%) achieving a CR. In radiation cohort, seven of seven (100%) achieved an objective response after CAR-T therapy with four of seven (57.1%) achieving a CR. Our results indicate that compared to intensive second-line chemotherapy, radiation is a better approach with enhanced efficacy and decreased toxicity of CAR-T therapy in R/R DLBCL patients with high tumor burden. Radiotherapy in combination with CAR-T cell infusion may be the optimal alternative treatment model of R/R DLBCL with high tumor burden.

Effect of tele-rehabilitation on glucose control, exercise capacity, physical fitness, muscle strength and psychosocial status in patients with type 2 diabetes: A double blind randomized controlled trial

AimTo determine the effect of a tele-rehabilitation (TR) program on glucose control, exercise capacity, physical fitness, muscle strength and psychosocial status in patients with type 2 diabetes mellitus (DM). MethodFifty type 2 DM participants were enrolled in the study and divided randomly into two groups; TR (n = 25, mean age: 52.82 ± 11.86) or control (n = 25, mean age: 53.04 ± 10.45) group. Participants in the TR group performed breathing and callisthenic exercises, three times a week, for 6 weeks, at home by internet based video conferences. Outcome measures including, HbA1c level, 6 min walk testing, physical fitness and muscle strength dynamometer measurement, Beck Depression Inventory were performed before and after the 6 weeks. ResultsHbA1c (p = 0.00), 6 min walking distance (p = 0.00), physical fitness subparameters; sit-up (p = 0.00), sit-and-reach (p = 0.04), back scratch (p = 0.00), lateral flexion right (p = 0.04), left (p = 0.00) and time up go tests (p = 0.00), muscles strength (p = 0.00); deltoideus-anterior, middle, quadriceps femoris and gluteus maximus, and depression levels (p = 0.00) changed significantly (p = 0.00) in TR groups. There were no significant improvements in control group (p > 0.05). ConclusionOur findings suggest that TR interventions found to be safe and effective, and may be an alternative treatment model for type 2 DM management. In addition to these health benefits, patients and rehabilitation team may save time, labor and treatment costs by using TR.

Radiotherapy Priming Chimeric Antigen Receptor T Cell Therapy Is a Safe and Promising Approach in Relapsed/Refractory Diffuse Large B Cell Lymphoma Patients with High Tumor Burden

Background: Chemoresistance is a core challenge in successful treatment of diffuse large B cell lymphoma (DLBCL). Chimeric antigen receptor T cells (CAR-T) therapy, as a novel immunotherapy modality, demonstrates impressive efficacy and durable remissions in relapsed/refractory(R/R) B-cell malignancies including DLBCL. However, CAR-T therapy is also associated with potentially fatal toxicities, including cytokine release syndrome (CRS) and neurological toxicities which limit the clinical application of CAR-T therapy in R/R DLBCL with high tumor burden. How to improve the prognosis of this population is urgently underway. Here, we conducted a trial testing efficacy and toxicities of CAR-T therapy in R/R lymphoma patients (This study is registered at www.clinicaltrials.gov as NCT03196830).Methods:Human T cells were collected from autologous/allogenous peripheral blood mononuclear cells (PBMC) . CD3+T cells were separated from PBMS of patients or donors by degradable anti-CD3 magnetic microbeads followed by 24h stimulation with CD3 and CD28 monoclonal antibody (5ug/ml). Then CD3+T cells were transduced with lentivirus particles incorporated with a humanized CAR construct targeting CD19, CD20 and CD22 and further expanded for 7 to 10 days in vitro. The transfection efficacy, ratio of CD4+ versus CD8+, antitumor activities, pathogen detection as well as cytokines releasing of CAR-T cells were evaluated before infusion to patients. In this ongoing trial, 14 patients were diagnosed as R/R DLBCL with high tumor burden. Two debulking conditioning regimens including intensive combined chemotherapy or radiation (40 gray in 20 fractions) were carried out before CAR-T therapy followed by sequential FC regimen (cyclophosphamide 300mg/m2 and fludarabine 30mg/m2 X 3d) for lymphodepletion chemotherapy. Two days after FC regimen, autologous/allogenous CAR-T cells targeting CD19 and CD20 or CD22 provided by the unicar-therapy bio-medicine technology co.(Shanghai, China) at average dose of 1-2×107 cells for each target per kilogram(kg) were infused within 3 days.Results: 14 R/R DLBCL patients with high tumor burden were enrolled in the study. Patients ranged from 39 to 66 years of age had received two to four prior lines of therapy. Out of the 14 patients, 7 patients received intensive second-line chemotherapy (median age, 46 years) and 7 received radiotherapy (median age, 63years) to debulking tumor after leukapheresis and during CAR-T cells preparation. All Adverse Events occurring within 30 days of CAR-T cells infusion were graded and reported for the 14(100%) treated patients. All patients experienced CAR-T-related CRS of any grade with severe CRS (grade 3/4/5) reported in all patients of chemotherapy cohort experienced and mild CRS (grade 1/2) reported in all patients of radiation cohort. 4 patients (57.1%) in chemotherapy cohort manifested with neurological toxicity while no patient in radiation cohort manifested with neurological toxicity. Comparable hematological toxicity as well as non-hematological and non-neurological toxicity were observed in two groups.Four of seven (57.1%) patients achieved an objective response after CAR-T infusion, with three of seven (42.9%) achieving a CR in chemotherapy cohort, while seven of seven (100%) achieved an objective response after CAR-T therapy, with four of seven (57.1%) achieving a CR in radiation cohort.Conclusions:Our clinical trial indicates that compared to intensive second-line chemotherapy, radiation is a better approach to enhancing efficacy and decreasing toxicity of CAR-T therapy in R/R DLBCL patients with high tumor burden. Radiotherapy in combination with CAR-T cell infusion may be the optimal alternative treatment model of R/R DLBCL with high tumor burden. DisclosuresNo relevant conflicts of interest to declare.

Satisfaction of trauma-affected refugees treated with antidepressants and Cognitive Behavioural Therapy

Purpose: This study seeks to evaluate the satisfaction of trauma-affected refugees after treatment with antidepressants, psycho-education and flexible Cognitive Behavioral Therapy (CBT) including trauma exposure.&#x0D; Material and methods: A treatment satisfaction questionnaire was completed by patients at the end of a randomised controlled trial (RCT) comparing treatment with CBT and antidepressants. A patient satisfaction score was developed based on the questionnaire, and predictors of satisfaction were analysed in regression models. Telephone interviews were conducted with patients dropping out of treatment before the end of the trial.&#x0D; Results: In total, 193 trauma-affected refugees with PTSD were included in the study. Patients were overall satisfied with flexible CBT including exposure treatment in cases where this was part of the treatment. There was no statistically significant association between treatment outcome and satisfaction and satisfaction and treatment efficacy were independent of each other. The results showed that bi-cultural patients who had lived in Denmark for more than a decade were satisfied with the treatment based on a western psychotherapy model.&#x0D; Discussion: Treatment with selective serotonin reuptake inhibitor and flexible CBT, including trauma exposure, is acceptable for trauma-affected refugees. More studies are needed to evaluate patient satisfaction with western psychotherapy models in refugee patients who have recently arrived and to compare satisfaction with alternative treatment models.

Hyundai lets Amec Foster Wheeler contract for new gas-to-liquid plant in Uzbekistan

Postpartum psychiatric disorders represent a significant public health problem that has not been readily addressed, particularly in the primary care setting. As maternal mood and anxiety difficulties are associated with a number of adverse outcomes for the mother, her offspring and the family system, addressing these concerns during the perinatal period is of critical importance. Although researchers and clinicians have become increasingly aware of the problem, postpartum mood and anxiety disorders (PMADs) remain widely unrecognized and poorly understood by both patients and providers. As pediatric primary care providers encounter mothers repeatedly throughout the postpartum period, the pediatric clinician has the unique opportunity to intervene with mothers suffering from mental illness. Given the potentially devastating impact of PMADs across multiple domains, the purpose of this article is to provide guidelines for pediatric clinicians to better manage maternal mental illness within the primary care pediatric setting. As such, we review the categories and prevalence of PMADs and provide strategies for responding to a positive PMADs screen or concerns raised during surveillance of the mother–infant-dyad. In addition, we offer a summary of the literature on evidence-based treatments for PMADs to allow pediatricians to guide the parents of their patients towards the most effective interventions. Finally, we provide an overview of alternative treatment models that can facilitate the screening and treatment of behavioral health concerns within the primary care setting.

Treating postpartum mood and anxiety disorders in primary care pediatrics

Postpartum psychiatric disorders represent a significant public health problem that has not been readily addressed, particularly in the primary care setting. As maternal mood and anxiety difficulties are associated with a number of adverse outcomes for the mother, her offspring and the family system, addressing these concerns during the perinatal period is of critical importance. Although researchers and clinicians have become increasingly aware of the problem, postpartum mood and anxiety disorders (PMADs) remain widely unrecognized and poorly understood by both patients and providers. As pediatric primary care providers encounter mothers repeatedly throughout the postpartum period, the pediatric clinician has the unique opportunity to intervene with mothers suffering from mental illness. Given the potentially devastating impact of PMADs across multiple domains, the purpose of this article is to provide guidelines for pediatric clinicians to better manage maternal mental illness within the primary care pediatric setting. As such, we review the categories and prevalence of PMADs and provide strategies for responding to a positive PMADs screen or concerns raised during surveillance of the mother-infant-dyad. In addition, we offer a summary of the literature on evidence-based treatments for PMADs to allow pediatricians to guide the parents of their patients towards the most effective interventions. Finally, we provide an overview of alternative treatment models that can facilitate the screening and treatment of behavioral health concerns within the primary care setting.

The Effect of Using Mobile Technology-Based Methods That Record Food or Nutrient Intake on Diabetes Control and Nutrition Outcomes: A Systematic Review.

(1) Background: Mobile technologies may be utilised for dietary intake assessment for people with diabetes. The published literature was systematically reviewed to determine the effect of using mobile electronic devices to record food or nutrient intake on diabetes control and nutrition outcomes; (2) Methods: The review protocol was registered with PROSPERO: registration number CRD42016050079, and followed PRISMA guidelines. Original research of mobile electronic devices where food or nutrient intake was recorded in people with diabetes with any treatment regimen, and where this intervention was compared with usual care or alternative treatment models, was considered. Quality was assessed using the Quality Criteria Checklist for Primary Research; (3) Results: Nine papers formed the final library with a range of interventions and control practices investigated. The food/nutrient intake recording component of the intervention and patient engagement with the technology was not well described. When assessed for quality, three studies rated positive, five were neutral and one negative. There was significantly greater improvement in HbA1c in the intervention group compared to the control group in four of the nine studies; (4) Conclusion: Based on the available evidence there are no clear recommendations for using technology to record dietary data in this population.

A Conceptual Framework for the Expansion of Behavioral Interventions for Youth Obesity: A Family-Based Mindful Eating Approach.

Currently, over 30% of US youth are overweight and 1 in 6 have metabolic syndrome, making youth obesity one of the major global health challenges of the 21st century. Few enduring treatment strategies have been identified in youth populations, and the majority of standard weight loss programs fail to adequately address the impact of psychological factors on eating behavior and the beneficial contribution of parental involvement in youth behavior change. A critical need exists to expand treatment development efforts beyond traditional education and cognitive-behavioral programs and explore alternative treatment models for youth obesity. Meditation-based mindful eating programs represent a unique and novel scientific approach to the current youth obesity epidemic given that they address key psychological variables affecting weight. The recent expansion of mindfulness programs to include family relationships shows the immense potential for broadening the customarily individual focus of this intervention to include contextual factors thought to influence youth health outcomes. This article provides an overview of how both mindful eating and family systems theory fits within a conceptual framework in order to guide development of a comprehensive family-based mindful eating program for overweight youth.

Addiction profile in probation practices in Turkey: 5-year data analysis.

IntroductionWhile drug addiction is a global problem, it is important for every region to know the general features of its own addicts in order to develop effective treatment programs. This study presents sociodemographic data of the individuals diagnosed with drug addiction.MethodsIn this study, data of the patients between the years of 2009 and 2014 were retrospectively analyzed. The patients were assessed at psychiatry polyclinics according to probation practices of drug abuse. The study involved 513 patients in whom drug positivity was detected in urine analysis at least once and whose diagnoses were confirmed with a clinical interview.ResultsAccording to this study, a majority of the addicts were detected in 2013. Males made up 98.2% of the sample population, their average age was 32.12±10.21 years, and minimum and maximum ages for the first drug use were 7 years and 45 years, respectively. Marijuana use was found in 90.8% of the patients, 90% of them were living with their families, and 59.6% of them held a regular job. Treatment response was related with age of first use of drugs, duration of use drugs, and prior treatment anamnesis of the patients.ConclusionIn this study, it was determined that the drug which was most frequently was used marijuana. The risk of drug addiction can affect any individual in society, regardless of their education, occupation, or social support levels. Alternative treatment models, especially for chronic and long-term users, should be researched.

The Blackfeet Indian culture camp: Auditioning an alternative indigenous treatment for substance use disorders.

American Indian and Alaska Native (AIAN) communities experience alarming health disparities, including high rates of substance use disorders (SUDs). Psychological services for AIANs, including SUDs treatment, are primarily funded by the federal Indian Health Service and typically administered by tribal governments. Tribal administration of SUDs treatment programs has routinely involved either inclusion of traditional cultural practices into program activities or adaptation of conventional treatment approaches to distinctive community sensibilities. In this article, we investigate a third possibility: the collaborative, community-based development of an alternative indigenous intervention that was implemented as a form of SUDs treatment in its own right and on its own terms. Specifically, in July of 2012, we undertook a trial implementation of a seasonal cultural immersion camp based on traditional Pikuni Blackfeet Indian cultural practices for 4 male clients from the reservation's federally funded SUDs treatment program. Given a variety of logistical and methodological constraints, the pilot offering of the culture camp primarily served as a demonstration of "proof of concept" for this alternative indigenous intervention. In presenting and reflecting on this effort, we consider many challenges associated with alternative indigenous treatment models, especially those associated with formal outcome evaluation. Indeed, we suggest that the motivation for developing local indigenous alternatives for AIAN SUDs treatment may work at cross-purposes to the rigorous assessment of therapeutic efficacy for such interventions. Nevertheless, we conclude that these efforts afford ample opportunities for expanding the existing knowledge base concerning the delivery of community-based psychological services for AIANs.

Spatial application of a predictive wildlife occurrence model to assess alternative forest management scenarios in northern Arizona

Wildlife species of conservation concern can present forest managers with a particular challenge when habitat needs appear to be in contrast with other management objectives, particularly fuel reduction to reduce wildfire risk. Proposed actions can be opposed by stakeholders, delaying management activities until a resolution is met. In the southwestern USA, the primary goal of forest management is to reduce the risk of severe wildfire through forest restoration treatments. The USDA Forest Service has designated the northern goshawk (Accipiter gentilis) a management indicator species in this region. However, it has been difficult to achieve a common understanding of goshawk habitat needs among forest stakeholders. We combined two separate and complementary modeling approaches – a statistically based occurrence model and alternative forest treatment models – to yield predictions about forest management effects on the goshawk in ponderosa pine-dominated forests (Pinus ponderosa) on the Kaibab Plateau, Arizona. Forest treatment models were developed based on USDA Forest Service recommendations for goshawk habitat and post-treatment data from ecological restoration experiments, both of which were also components of forest treatment guidance from the Kaibab Forest Health Focus collaborative planning effort. All treatment alternatives resulted in a 22–26% reduction in estimated goshawk occurrence, but the declines were not uniform across the study area, varied by forest type, and were not as large as the effects of recent and severe wildfire (44% reduction in occurrence). Considering the controversial history of forest management with respect to the goshawk, it is prudent to interpret results from this study in the context of tradeoffs between wildfire risk reduction and wildlife habitat quality that can be effectively evaluated through science-based collaborative assessment and planning. While developed for a specific, high-profile species in the southwestern USA, the approach is applicable to many other species whose occurrence has been monitored over multiple years.

Clinical and Economic Burden of Emergency Department Presentations for Neutropenia Following Outpatient Chemotherapy for Cancer in Victoria, Australia

To examine the clinical characteristics and financial charges associated with treating adult cancer patients receiving chemotherapy in outpatient clinics who presented to the emergency department (ED) with neutropenia. A retrospective audit was conducted across two health services involving ED episodes and subsequent hospital admissions of patients who received chemotherapy through day oncology from January 1 to December 31, 2007 and presented to the ED with neutropenia. ED data were collected from the Victorian Emergency Minimum Dataset and charges were collected from Health Information Services. Descriptive and bivariate statistics were used to describe the patient and clinical characteristics and financial outcomes, and to explore associations between these factors. In total, 200 neutropenic episodes in 159 outpatients were seen in the ED over the survey period. The mean patient age was 56.6 years (standard deviation, 13.2 years) and 47.2% were male. Overall, 70.0% of ED episodes were triaged as Australasian Triage Scale 2 (emergency). The median ED wait time was 10 minutes and the median ED length of stay was 6.8 hours. The median charge for each ED episode was $764.08 Australian dollars. The total combined ED and inpatient charge per episode was in the range of $144.27-$174,732.68, with a median charge of $5,640.87. This study provides important insights into the clinical and economic burden of neutropenia from both the ED and inpatient perspectives. Alternative treatment models, such as outpatient treatment, early discharge programs or prophylactic interventions to reduce the clinical and economic burden of neutropenia on our health system, must be explored.

The Juvenile Delinquent: Psychopathology or Self-Preservation?

Contemporary psychoanalytic ideas have been slow to migrate to child and adolescent treatment programs. Meanwhile, thousands of children in the United States whose legal offenses are rooted in emotional difficulties are detained, and often retraumatized, in correctional facilities where they do not receive mental health care. Reluctant to allow this fate to befall a 14-year-old patient who vandalized my office, it became necessary to explore an alternative treatment model for his delinquent behavior. My treatment of Angel, and the contemporary theory behind it, illustrates an alternative mode of treating delinquent behavior in adolescents. This article argues that a more rigorous consideration of, and a more psychologically enlightened response to, the emotional experiences and meaning of adolescents' behaviors increase the likelihood of resuming normal, healthy development in young people who are otherwise often retraumatized in and by more traditional treatment settings centered on behavior modification techniques.

Optimizing Blown Film Line Layouts for Improved Surface Treating Performance

Blown film processors, large and small, have limited resources in both capital and manpower to devote to optimizing their productivity. Yet avenues of improvement are open for even the most over-extended organization. And some of the most effective modifications cost little more than a small change in equipment orientation or procedures. A key aspect of optimizing a blown film layout is line footprint and determining how to minimize footprint and maximize output with each integral piece of equipment on the line. Multiple surface treatment systems are integral to every blown film line and can control product quality and line efficiencies. The objective of this work is to present best practices of blown film manufacturers ranging from multinationals to small privately owned operations relative to the most effective surface treatment system designs, their roll coverings, optimum power density settings, alternative treatment technologies, troubleshooting protocols, and model line layouts that optimize production output.