Placement Criteria Research Articles

Datapoints: Medicaid Managed Care and Substance Abuse Treatment

Conversion of Medicaid substance abuse treatment to managed care has raised concerns about access. However, several states have expanded Medicaid eligibility criteria at the same time. Proponents argue that increasing Medicaid enrollment will ease access to treatment for previously uninsured individuals. It is also possible, however, that Medicaid expansion represents cost shifting from state to federal payers. If so, there would likely be no net increase in publicly funded substance abuse treatment admissions after Medicaid expansion. Another concern is “cream skimming”—giving treatment preferentially to clients whose illness is less severe. Thus the average severity of illness of those treated would decrease after conversion to managed care. Data to test these hypotheses were obtained from a Medicaid demonstration project in Oregon. Data elements from the Oregon Client Process Monitoring System were combined to generate a severity index. In a prospective study, the severity measure was found to be highly correlated with clinicians’ ratings of clients according to the placement criteria of the American Society of Addiction Medicine and with Addiction Severity Index ratings obtained via client interviews. Figure 1 plots the number of adult clients admitted for the three years before substance abuse treatment was integrated into Medicaid managed care in 1995 and the five years afterward. Medicaid admissions started to increase before the integration of substance abuse treatment because eligibility was expanded in 1994 under a federal Section 1115 waiver. After a modest initial reduction in the number of uninsured clients, the total number of publicly funded clients increased dramatically, primarily as a result of expanded Medicaid eligibility. Figure 2 plots the average severity

A comparison study of student attitudes and perceptions in homogeneous and heterogeneous classrooms

Despite arguments advocating mainstreaming and heterogeneous grouping as the best option for most, if not all students, the findings of this study suggest that homogeneous classes may serve the needs of academically talented and gifted students without detrimental effects to other students served in heterogeneous classrooms. The researcher compared a number of different measures for fifth and eighth grade students in both types of classrooms. These measures included student academic achievement as well as students’ perceptions of themselves as learners, of their school experience, and of their teachers’ behaviors and attitudes. Anticipated differences in academic achievement, consistent with initial placement criteria, were found. Statistically significant differences were identified for students’ perceptions of teachers’ behaviors and attitudes, but the anticipated differences in students’ attitudes towards themselves and their school experiences were not present.

A Key Informant Survey to Assess Service Adequacy in California's Publicly Funded Alcohol and Other Drug Treatment System

Abstract This paper presents descriptive key informant data collected from 51 county administrators of publicly funded alcohol and other drug treatment systems in California. The study examined administrators' perceptions of service adequacy, the provision of services, and evaluation of services. County AOD administrators reported that publicly funded treatment systems in California adequately serve most populations (both drug-specific and ethnic/racial). Several administrators, however, suggested that adolescents, the elderly, and the homeless were not as adequately served. Administrators also felt that most services for different drug user groups were somewhat adequate. Administrators indicated there was little use of psychological testing, placement criteria, children's counseling, and spirituality counseling in their treatment systems. They reported current treatment approaches included a mixture of more traditional methods (use of 12 step programs) with newer ones (e.g., cognitive-behavioral therapy,...

A simple algorithm for localized construction of non‐matching structural interfaces

AbstractA simple and effective algorithm for the modular construction of non‐matched interfaces is presented for the partitioned solution of large‐scale structural problems. The formulation is based on a recently developed four‐field variational principle, which introduces a connection frame between the interfaced partitions. A key result of the present study is a frame nodal placement criterion that uniquely determines the frame discretization into piecewise linear elements so that the interface patch test condition is satisfied a priori. The method is demonstrated with several 2D and 3D example problems. Copyright © 2002 John Wiley & Sons, Ltd.

SUBSTANCE USER TREATMENT PROGRAM QUALITY: SELECTED TOPICS

This panel explores the “state of the art” in conceptualization and research pertinent to program quality in substance user treatment. First, seven critical questions for program quality are identified and discussed. Second, a recent national evaluation of treatment examines the implications of long-term patient outcomes for treatment quality. Third, a large number of clinical trials of behavioral and pharmacological treatments for cocaine dependence were conducted during the 1990s; this research is synthesized and interpreted. Fourth, progress is reported in improving the quality of treatment through standardized criteria for patient placement matching.Truth seems to come with its final word; and the final word gives birth to its next.Rabindranath Tagore, Stray Birds

Analyses of the caries decline and incidence among Norwegian adolescents 1985-2000

Since most studies of caries decline are descriptive time-trend analyses, the purpose of this article was to identify factors statistically associated with the caries decline among Norwegian adolescents after 1985. The DMFT scores for the age groups 12 and 18 years reported annually by 19 counties were analysed. The average caries-free proportions of 18-year-olds increased from 2% to 15% between 1985 and 2000, while the DMFT declined by 49%; 10.2 - 0.75 to 5.2 - 0.78. The decline for the 12-year-olds was 53%. The mean DT at the dentinal level remained at about 0.8 for 12-year-olds and 1.5 for 18-year-olds throughout the observation period. There was no significant difference in DMFT increment from age 12 to 18 between the birth cohorts 1973 (3.8 - 0.46) and 1982 (3.0 - 0.52) when controlling for counties. The variables migration and children per dentist were significantly associated with the DMFT decline in multivariate analyses. The caries decline for 18-year-olds was significantly steeper before than after 1990. The decline among the 18-year-olds may be attributed to fluoride and more restrictive criteria for placement of fillings in teenagers in the 1980s and fewer filled teeth before the age of 12 years in the 1990s.

Placement and replacement of restorations in primary teeth

This practice-based study aimed to record the use of restorative materials, the type of restoration by class, and the reason for and the age of failed restorations in primary teeth by means of a survey of placement and replacement of restorations in 1996 and 2000/2001. Written alternative criteria for placement and replacement of restorations were provided for the participating clinicians. Details on 2281 restorations showed that primary caries was the main reason for inserting restorations in primary teeth. Replacements of failed restorations represented 14% of the fillings (n = 2040) in 1996 and 9% in 2000/2001 (n = 241). More than 80% of the fillings in primary teeth were of tooth-colored material, predominantly of the lightcured type. About 50% of failed amalgam and glass ionomer-type restorations were replaced due to secondary caries. The median age of amalgam restorations (3 years) was significantly higher than that of tooth-colored restorations (2 years). Any possible advantage of a cariostatic effect of glass ionomer-type materials is apparently annulled by their short longevity compared with amalgam.

Patient placement criteria and their relation to access to appropriate level of care and engagement in alcoholism treatment.

Patient placement criteria (PPC) facilitate treatment matching through detailed, standardized assessment of patients' needs. This process affords the alcoholism treatment field an opportunity to address issues that influence access to appropriate level of care by highlighting these issues during the assessment. The American Society of Addiction Medicine Patient Placement Criteria can integrate assessment of social and environmental, institutional and patient issues that affect access to appropriate care and treatment engagement. They can ultimately improve access through an iterative approach: developing a broad consensus on guidelines based on research evidence and expert clinical opinion, making criteria clear and easy to use both for assessment and for teaching purposes, addressing the needs of special populations, and testing and improving the validity of decision rules to achieve optimal access and treatment engagement. Early evidence suggests that PPC are promising but there is much about them that remains to be tested and improved.

Feasibility of matching alcohol patients to ASAM levels of care.

The study examined the feasibility of implementing treatment recommendations derived from the American Society of Addiction Medicine (ASAM) Patient Placement Criteria in an urban addiction treatment program that offered a continuum of levels of care (LOC). A cohort of 281 applicants for alcoholism treatment were evaluated and the reasons for observed differences ("mismatches") between recommended and actual LOC placements were determined. Overall, 88% of the applicants entered treatment, and 72% of these were matched to LOC vs. 28% who were mismatched. Presumptive overtreatment (59%) was more common than undertreatment (41%) among the mismatched patients. The reasons for overtreatment were availability of Medicaid coverage for inpatient rehabilitation (93%), referral sources' treatment philosophy of gradually "stepping down" from inpatient detoxification (59%), social pressures on patients (28%), and mandated treatment (8%). The reasons for presumptive undertreatment were work schedule conflicts (72%), patient reluctance (48%), insurance coverage (15%), and interference with family or personal responsibilities (9%). These results indicate multiple barriers that need to be overcome to enable full implementation of the ASAM Criteria in real world program settings, even when a continuum of care is available.

An optimization approach to optimal placement of collocated piezoelectric actuators and sensors on a thin plate

The purpose of this paper is to suggest a criterion for the optimal placement of collocated piezoelectric actuator–sensor pairs on a thin flexible plate using modal and spatial controllability measures. Consideration is given to the reduction of control spillover effect by adding an extra spatial controllability constraint in the optimization procedure. The spatial controllability is used to find the optimal placement of collocated actuator–sensor pairs for effective average vibration reduction over the entire structure, while maintaining modal controllability and observability of selected vibration modes. It is found that the methodology for optimal actuator placement can be used for a collocated system without damaging the observability performance of the collocated sensors. Experimental validation of our optimal placement is done on a simply supported thin plate with a collocated piezoelectric actuator–sensor pair.

Improving styletted oral tracheal intubation: rational use of the OTSU.

To introduce an improved method of styletted oral laryngoscopic tracheal intubation. The oral tracheal stylet unit (OTSU) is constructed using a commonly available intubating stylet combined with an ordinary endotracheal tube (ETT). The ETT/stylet is created by a series of specific steps to form an OTSU, each with a standard shape and design that allows the tracheal tube to separate freely from the stylet. After construction, every unit is tested to confirm that the frictional resistance created by the tracheal tube, as it slides along the stationary stylet, is at an absolute minimum. Successful tracheal intubation is based on the following concepts: (a) The j-shaped OTSU, when correctly directed through the airway, passes freely from the mouth to the larynx, the laryngoscopic channel; (b) The tip of the ETT must first be placed between the vocal cords with every intubation. The tracheal tube is then launched and advanced into the trachea by sliding along and off a stationary stylette; (c) Only minimal force is required to propel the ETT during intubation; (d) Resistance to placement, launch or advancement means the tip of the OTSU has come into physical contact with the patient's airway; (e) When the epiglottis obscures the larynx, the tip of the OTSU is used to explore the hypopharynx and identify the glottis. The ability to differentiate where the ETT tip is located depends primarily on interpreting the sensations of touch and pressure transmitted from the bevel of the OTSU to the hand. Successful tracheal intubation is accomplished when all criteria for placement, launch, and advancement are met. Styletted oral tracheal intubation is well known. However, we describe an improvement of the technique, based on solid physical principles and years of experience, that should prove useful both for routine intubations and unexpected difficult airways.

Modal control of smart shells by optimized discretely distributed piezoelectric transducers

Active vibration control of the shell structures with discretely distributed piezoelectric sensor and actuator patches is investigated. The quasi-modal sensor is developed to estimate the dominant mode coordinates of the shell from the outputs of the sensor patches, and a criterion for finding the optimal locations and sizes of the sensor elements is given by minimizing the observation spillover. The quasi-modal actuator is also designed to actuate the designated modes by means of modulating the voltage distribution of the piezoelectric actuator patches, and a criterion for optimal placement of the actuator patches is presented based on the energy and control spillover consideration. Furthermore, the compensators are employed to filter out the residual components with high frequencies from the estimated modal coordinates. Based on the quasi-modal sensor and quasi-modal actuator, the independent modal control is performed approximately to control the vibration of smart shells. The simulation examples show that the vibration of the shells can be controlled effectively by using the presented method.

Technology innovation in aluminum products

In 2001, the aluminum industry continues to benefit from technical innovations made in alloy development, product-manufacturing technologies, and processing equipment over the last century. This paper examines the top ten alloy, product, and process developments that have shaped the industry’s production methods and markets. The interrelationships among the alloy development, process innovations, and markets are highlighted. Omitted are details about patent literature or the inception of many technologies; the major criterion for placement on the list was impact on the total industry.

Placement of Nasoenteral Feeding Tubes Using Magnetic Guidance: Retesting a New Technique

Objective: To study a new technique of intubating the small bowel using a newly developed nasoenteral feeding tube fitted with a magnet in its tip and guided for placement with an external magnet.Methods: The study was performed in medical and surgical wards of a university-affiliated Department of Veterans Affairs hospital on 42 patients referred by their attending physicians for tube placement. The newly designed feeding tube was inserted per nares into the stomach using traditional technique. As the tube was advanced, movement of the hand-held steering magnet was designed to guide the tip of the magnetic nasoenteral tube along the lesser curvature of the stomach, through the pyloric sphincter, and into the duodenum. Portable abdominal radiography confirmed the anatomic location of the tube tip.Results: Fifty-one intubations were performed on 42 subjects. In 45 intubations (88%), tubes passed into the duodenum. Twenty-seven (53%) met criteria for optimal placement in the second portion of the duodenum or distally. Six of 11 tubes (55%) that were not optimally placed were advanced to the distal duodenum on repositioning. Median procedure time for the initial intubations was 30 minutes (interquartile range 15–40). Median procedure time for last 10 intubations improved to 13 minutes (interquartile range 5–20). No complications were related to the procedure.Conclusions: Enteral feeding tube placement using external magnetic guidance is a promising, novel technique which is deserving of further study.

Placement Matching: Challenges and Technical Progress

Although it is highly desirable, standardized placement matching for substance use disorders poses challenges due to variability in settings, services, and syndromes; multidimensionality of clinical problems; multiplicity of outcome constructs; and temporal phenomena in the course of recovery. Despite these obstacles, progress is being made in developing patient placement criteria that are comprehensive with adequate reliability, feasibility, and resolution. With these methodological advances, it has been possible to initiate controlled research with placement criteria. The first such studies provide early evidence supporting such criteria and indicate areas for refinement.

Boundaries in school: Educational settings for pupils perceived as different

<span>This paper analyses the contradictions in the Swedish school organisation between the intentions of an implemented integration of pupils with disabilities, and the actual dramatic increase of pupils enrolled in special units. The study is a multiple case study of the functions and conditions of special support in differentiated educational settings (such small teaching groups, special units, cooperation classes) based on interviews with special educators and observations in three schools with such differentiated groups in the county of Stockholm. None of the studied groups were homogeneous, but most of the children in them had in common some kind of vulnerability. The potential or actual reactions of teachers and peers in the regular settings seem to be a common criterion for placement in the differentiated setting. Psycho‐medical diagnoses were not always a prerequisite for enrolment in the special units; they were not always accurate and they were not sufficient to get special support. Problematic aspects that would have to be changed, in a school valuing individual differences, are the funding system, the grading system, the working methods, the attitudes towards parents and the personnel's competence regarding disability. Theoretical implications such as the compartmentalisation of values and goals are presented, and some further investigative tasks are suggested.</span>

Assessment of sensory function in neonatal sheep with somatosensory evoked potentials: methodology and normative data.

Fetal sheep are increasingly used as animal models for fetal surgical interventions such as repair of myelomeningocele. Since behavioral observations cannot provide objective information about preservation of sensory function, we have developed a technique for reliably recording somatosensory evoked potentials in neonatal sheep. We determined anatomic criteria for placement of recording electrodes over the somatosensory cortex using external landmarks, and recorded normative data for both ulnar and posterior tibial nerve stimulation in a series of normal neonatal sheep. The methodology and normative data are presented in this report; a companion paper demonstrates the utilization of this technique in a variety of experimental fetal interventions.

Case Studies in Support of Multiple Criteria for Developmental Reading Placement

Three incoming first-year community college students were advised into developmental reading courses because of low scores on the Nelson Denny Reading Test. While the developmental reading course was beneficial for two of the students, it was found to be an unnecessary course for the third student.

A Clinical Trial Comparing Three Antithrombotic-Drug Regimens After Coronary Artery Stenting

LEON, MARTIN B.; BAIM, DONALD S.; POPMA, JEFFREY J.; GORDON, PAUL C.; CUTLIP, DONALD E.; HO, KALON K.L.; GIAMBARTOLOMEI, ALEX; DIVER, DANIEL J.; LASORDA, DAVID M.; WILLIAMS, DAVID O.; POCOCK, STUART J.; KUNTZ, RICHARD E. FOR THE STENT ANTICOAGULATION RESTENOSIS STUDY INVESTIGATORS Author Information

Modelling and optimal placement of piezoelectric actuators in isotropic plates using genetic algorithms

Theoretical modelling of the vibration of plate components of a space structure incorporating piezoelectric actuators is presented. The equations governing the dynamics of the plate, relating the strains in the piezoelectric elements to the strain induced in the system, are derived for isotropic plates using the Rayleigh-Ritz method. The developed model was used for a simply supported plate. The results show that the model can predict natural frequencies of the plate very accurately. Two criteria for the optimal placement of piezoelectric actuators were suggested using modal controllability and the controllability Grammian. The model was then used to predict the closed-loop frequency response of the plate for active vibration control studies with optimal locations of actuators successfully obtained using genetic algorithms. Significant vibration suppression was demonstrated using optimal actuator placement algorithm developed.