Consultancy Work Research Articles

Changes in memory and attention during and after occupational rehabilitation: A longitudinal study.

There is need for more knowledge about the relationship between work and cognitive functioning in sick-listed individuals. This study investigated whether the degree of work participation is relevant for recovery of cognitive functioning in sick-listed individuals. 177 occupational rehabilitation participants and 70 controls participated in a non-randomised, longitudinal study. Participants completed computerised cognitive tests targeting sustained attention and working memory at start and end of rehabilitation and 3 and 12 months after rehabilitation. The change score performance in attention and memory between start and end, start and 3 months and 12 months was compared in individuals on sick leave 100-75%, 74-40% and 39-0% (three sick leave groups) of the time in the year after rehabilitation, and a control group not being on sick leave. Fixed effect analysis of covariance adjusting for education and work ability was used. The sick leave group 100-75% had significantly lower score on work ability compared to the other groups at baseline. The main findings indicated that the sick leave group 39-0% improved significantly more in sustained attention compared to the sick leave group 100-75% between start and end of rehabilitation and from start of rehabilitation to 3 and 12 months after. The degree of work participation seems relevant to recovery of the cognitive function sustained attention in sick-listed individuals. These findings encourage work rehabilitation clinicians, work consultants and employers to develop RTW plans which take into account that graded employment influence cognitive functioning.

Ethnography beyond the tribe: from immersion to “committed localism” in the study of relational work

PurposeThe purpose of the paper is to propose a shift from the ideal of immersion to a practice of “committed localism” in the ethnographic study of relational work in the post-bureaucratic and service-based economy.Design/methodology/approachThe paper is based on ethnographic fieldwork following management consultancy projects in a hospital and a manufacturing company in Denmark. The approach was predicated on committed attention to the everyday of consultancy work activities and associated relational dynamics. This involved being present at the client sites, observing and listening in concrete situations of interaction and engaging in conversations with the multiple actors involved, both external consultants and members of client organisations.FindingsThe paper shows how “committed localism” was practiced in the ethnographic study of management consultancy as it is relationally accomplished in and through concrete situations of interaction between consultants and different actors in client organizations and the associated meaning production of the involved actors.Originality/valueThe paper develops the notion of “committed localism”, originally introduced by George Marcus, into a methodological concept to challenge the conventional ideal of immersion as the hallmark of “proper” ethnography. Such a shift is particularly pertinent for the ethnographic study of relational processes involving multiple actors occupying different positions in the temporary social spaces of contemporary workplaces.

Children with cancer at the end of life in a middle-income country: integrated pediatric palliative care improves outcomes

BackgroundIn 2020, the Global Cancer Observatory reported 280,000 cases of childhood cancer worldwide, with a higher burden of disease and mortality rates in low- and middle-income countries. In 2022, the National Institute of Health reported 1708 new cases of childhood cancer in Colombia and an overall survival rate of approximately 55%. The aim of this study is to compare outcomes in children with cancer in the hospital setting during the last 72 h of life who received concurrent Pediatric Palliative Care (PPC) versus oncology care alone.MethodsAn observational descriptive study was conducted between January 2013 and June 2022 in a center for pediatric patients with oncological diagnoses. In 2017, the PPC team was created. Patients between 28 days and 17 years of age who were hospitalized at least 72 h before death were included. A retrospective review of the medical records of patients in the last 72 h of life was performed. Two cohorts were established: oncology-alone group received exclusive management by oncology, and oncology and PPC received concurrent oncology and PPC management since the diagnosis.ResultsWe evaluated 257 medical records of deceased pediatric patients with cancer diagnoses. For the first cohort (2013–2017), 136 patients were included; for the second cohort (2018 and 2022), 121 patients were evaluated. The most frequent diagnosis was leukemia [47.1% (n = 121)]. No significant difference was found in either group between dyspnea, pain, and seizures. Dyspnea was the most frequent symptom in both groups. Agitation and anxiety were reported more frequently in children from the oncology-alone group (22.1% and 13.2%, respectively). The oncology and PPC group received more psychology and social work consultation (94.2% and 70.2% vs. 84.6 and 54.4% in the oncology alone group) and had a higher percentage of advance care planning (79.3% vs. 62.5% in the oncology alone group).ConclusionsThis retrospective study highlights that PPC at the end of life (EoL) offers a holistic approach to the physical and psychosocial symptoms experienced by children with cancer; these patients received more comfort through symptom management and less aggressive treatment at the EoL. The availability of a PPC team may contribute to improvements in the quality of end-of-life care.Trial registrationretrospectively registered.

A national survey of sedation practice and clinicians’ attitudes regarding sedation-related research in the UK paediatric intensive care units

AimsResearch involving analgo-sedation is a priority for parents and professionals in paediatric intensive care, and current guidelines are based on low-quality evidence. Future research will require an understanding of current practice and research priorities of healthcare professionals. This survey aimed to identify perceived barriers to research, describe the current UK analgo-sedation practice and assess outcome priorities for future research.MethodsA 26-question web-based survey was emailed to all Paediatric Critical Care Society members (n=1000) in April/May 2021. Responses were analysed either by ‘unit’ or at the individual respondent level. Questions related to four patient categories: ‘infant (< 3 months of age) ‘paediatric’ > 3 months of age, ‘cardiac’ and ‘non-cardiac’.ResultsTwo hundred sixteen healthcare professionals responded and responses were available from 100% of the UK paediatric intensive care units (n=29) for all questions. Most units (96%, 28/29) routinely use scoring systems for sedation adequacy but few routinely screen for delirium (24%, 7/29). The most highly prioritised outcome measure was the duration of mechanical ventilation. Respondents were most likely to agree to randomise paediatric general intensive care patients to trials comparing two different alpha agonists and least likely to randomise neonatal cardiac patients to trials comparing benzodiazepines with alpha agonists. The most common perceived barrier to research was unit familiarity with a particular regimen, followed by the perception that parents would not provide consent.ConclusionsThis study provides a snapshot of the UK analgo-sedation practice and highlights the importance of public involvement in planning future trials, as well as consultation work across the spectrum of stakeholder clinicians to maximise the acceptability of study design.

Design, Development and Commissioning of the Boldrewood Towing Tank – A Decade of Endeavour

The process of design, build and eventual commissioning of the towing tank on the Boldrewood Innovation Campus is described. The design brief required a facility that would have a capability to test models at a commercial scale but that would be effective as teaching environment for the next generation of Naval Architects as well as providing a flexible space for future fundamental research. Each of these provided their own challenges but the eventual solution of a 138 m long, 3.5 m deep, 6 m wide facility has more than met the initial aspirations. Equipped with 12 independent 0.5 m wavemaking flaps at the West end, a passive beach at the East end, a deployable side beach along the South wall for post run wave absorption and a monocoque Aluminium alloy carriage, the Boldrewood towing tank has now been successfully operating for more than a year. The carriage position and speed are controlled by a twin winch arrangement using a laser positioning system and low embodied energy composite cables. The carriage can reach a maximum speed of 10 m/s with controllable acceleration rates and can have up to four constant speed phases per run. Initial commissioning results and comparisons with benchmark data for the KCS hull confirm the accuracy and repeatability of the facility. In particular, the position and speed of the carriage are known to a high level of precision. To date research and consultancy work has spanned the performance of high speed vessels, uncrewed underwater and surface vessels, wave energy and tidal current systems, floating platforms for wind turbines, performance sport work for sailing, kayaking, rowing and swimming, open water propeller tests as well as conventional displacement vessel testing for self-propulsion and resistance. All ship science and maritime engineering students use the facility as part of their taught modules in every year of their programme as well as for individual, MSc and group projects as appropriate. It has also made a strong impact on the many thousands of visitors a year to the campus for science and engineering open days.

Поддержка грудного вскармливания в акушерских стационарах

Aim. To evaluate the implementation of the modern breastfeeding support principles into the practice of the maternity hospitals in Moscow. Design. Observational cohort study. Materials and methods. The study was conducted on the basis of two maternity hospitals in Moscow. With the help of a questionnaire specially developed by us, an anonymous survey of maternity patients was conducted at the time of discharge. A total of 614 mothers were interviewed from October 2020 to July 2021. Results. In general, the clinical practice of breastfeeding support in the maternity hospitals has demonstrated its stability and compliance with the criteria recommended by WHO for monitoring the main clinical practices. The rate of exclusive breastfeeding at the time of discharge from the hospital was 83.9%. The majority of mothers were satisfied with the breastfeeding support provided to them (90.9%). Mothers highly appreciated the work of lactation consultants introduced into the staffing of hospitals. Nevertheless, shortcomings were also identified in the implemented practice of breastfeeding support that requires improvement. Conclusion. The introduction of modern practice of breastfeeding support in maternity hospitals contributes to an increase in the level of breastfeeding among maternity hospitals, including exclusively breastfeeding from birth. To achieve the sustainability of this practice, it is necessary administration support, training of the medical staff, including lactation consultants, and monitoring of the breastfeeding practice. Keywords: breastfeeding, maternity hospitals, “Ten steps of breastfeeding support”.

Characteristics of value orientations and attitudes to communication in codependent women of different ages as predictors of the development of sustainable behavior

This article is devoted to the study of the relationship of value orientations and attitudes to communication in codependent women of different ages. In accordance with the idea of the study, we studied 225 women aged 20 to 55 years, who were divided into three groups depending on the identified level of codependency (high, medium and low). Research hypotheses: 1. It is possible that co-dependent women from different age groups have different value orientations; 2. In women, in accordance with the level of co-dependent behavior, there may be differences in the structure of the hierarchy of value orientations; 3. There may be a relationship between communicative attitudes and value orientations in codependent women. In the course of the empirical research, the following methods of psychological testing were used: the scale of codependency by B. Weinhold, J. Weinhold; the Method of “Value orientations” by M. Rokich; the Method of diagnosing the need to search for sensations by M. Zuckerman and the Method of diagnosing the communicative attitude by V. V. Boyko. The results obtained during the study can be used in the further work of consultants providing psychotherapeutic assistance to addicts and their family members.

Guidance and Counseling in Colleges and Universities in Taiwan: Challenges and Perspectives

&lt;p&gt;本文旨在探討臺灣大專校院諮商輔導工作歷經超過60年之發展，輔導工作現況、挑戰與展望。本文採文獻分析法與文件分析，以學生輔導法為依歸，依三級輔導機制、輔導組織定位與資源人力配置，以及績效評估與自我改善機制等三面向探討，並提出如下展望：(1)大專校院諮輔單位之專業形象與組織定位、角色功能宜再定義與明確化；(2)建立校園生態系統合作模式，型塑正向輔導氛圍，共同推動三級輔導工作；(3)建立資料庫或大數據平台，以利掌握現況資訊及趨勢脈動。(4)在績效展現部分，宜結合校務研究建立證據導向與持續改善機制之校本輔導工作特色與品保系統；(5)發展嚴謹、具公信力之諮商輔導認證機制。(6)同時為因應與日俱增之輔導工作需求與挑戰負荷,宜提升區域平台之功能，確保輔導工作品質與效能；(7)網路及後疫情時代宜善用科技，使諮商輔導工作與時俱進。&lt;/p&gt; &lt;p&gt;&amp;nbsp;&lt;/p&gt;&lt;p&gt;This study aimed to explore the development, implications, challenges, and prospects of counseling work at Taiwan&amp;rsquo;s colleges and universities for more than 60 years. This study employed the literature analysis and document analysis methods to explore the current situation and challenges from three aspects of counseling, namely organizational position and manpower allocation, three levels of guidance and counseling and transition mechanism, and performance evaluation and self-improvement mechanism. It anticipated the following prospects: redefine and clarify the professional image and organizational position and role and function of guidance and counseling units in colleges and universities. Additionally, according to the comprehensive professional definition and by integrating the division of work, a campus ecological system based on a cooperation model should be established, fostering a positive counseling image and collectively promoting the three levels of guidance and counseling. It is recommended that government or academic organizations establish a database or big data platform to acquire current information and trends to expand and improve guidance and counseling work. Regarding performance, it is advisable to incorporate institutional research to establish an evidence-oriented and continuous improvement mechanism for school-based counseling characteristics and quality assurance systems and develop an authentic and rigorous guidance and counseling credential-awarded mechanism. Guidance and counseling professional associations should promote effectiveness evaluation, performance presentation, and counseling work quality assurance system of each school, broadening the implications and scope of colleges and universities&amp;rsquo; counseling. Simultaneously, to cope with the ever-increasing needs and challenges of counseling, it is advisable to enhance the functions of the regional platform to ensure the quality and effectiveness of counseling work. Guidance and counseling in the post-epidemic era should be integrated with emerging technologies to develop technological consultation work that can align with current trends.&lt;/p&gt; &lt;p&gt;&amp;nbsp;&lt;/p&gt;

The Impact of Addictions Management Following Cardiac Surgery on People Who Inject Drugs and Have Infective Endocarditis

BackgroundManaging reinfection in patients who inject drugs and have undergone cardiac surgery could reduce mortality. A significant gap exists in the management of addiction in this population and it is rarely addressed during index hospitalization for surgical intervention. This study sought to determine if management of addiction changed rates of readmission for reinfection. MethodsThis study was a retrospective chart review and analysis. Patients who underwent cardiac surgery for infective endocarditis due to injection drug use underwent a full chart review to determine if they received management of their addiction (addictions medicine consultation, social work consultation, medication- and/or opioid-assisted treatment, and community follow-up) following their surgical intervention. ResultsA total of 41 patients were identified who met the inclusion criteria. For addictions management, 43.2% of patients received an addictions medicine consultation, 67.6% received a social work consultation, 40.5% received medication- and/or opioid-assisted treatment, and 56.8% received community follow-up. Overall mortality of these patients was 21.6%, and 56.8% of patients were readmitted with reinfection. Multivariate logistic regression showed that patients who received intervention were 1.6 times more likely to be readmitted with reinfection (odds ratio 1.65, 95% confidence interval 0.29-9.41, P = 0.5736). Female patients had a significantly higher odds of reinfection, when adjusted for gender (odds ratio 9.95, 95% confidence interval 1.42-69.72, P = 0.021). ConclusionsWe demonstrated a nonstandardized approach to consultation and varying approaches to management of addiction. Patients who received intervention for addiction were more likely to be readmitted for reinfection, but this difference was not significant. Future efforts can include promotion of formalized addictions consultation services for high-risk patients.

Emergency department hospice care pathway associated with decreased ED and hospital length of stay

IntroductionWhile increasing evidence shows that hospice and palliative care interventions in the ED can benefit patients and systems, little exists on the feasibility and effectiveness of identifying patients in the ED who might benefit from hospice care. Our aim was to evaluate the effect of a clinical care pathway on the identification of patients who would benefit from hospice in an academic medical center ED setting. MethodsWe instituted a clinical pathway for ED patients with potential need for or already enrolled in hospice. This pathway was digitally embedded in the electronic health record and made available to ED physicians, APPs and staff in a non-interruptive fashion. Patient and visit characteristics were evaluated for the six months before (05/04/2021–10/4/2021) and after (10/5/2021–05/04/2022) implementation. ResultsAfter pathway implementation, more patients were identified as appropriate for hospice and ED length of stay (LOS) for qualifying patients decreased by a median of 2.9 h. Social work consultation for hospice evaluation increased, and more patients were discharged from the ED with hospice. As more patients were identified with end-of-life care needs, the number of patients admitted to the hospital increased. However, more patients were admitted under observation status, and admission LOS decreased by a median of 18.4 h. ConclusionThis non-interruptive, digitally embedded clinical care pathway provided guidance for ED physicians and APPs to initiate hospice referrals. More patients received social work consultation and were identified as hospice eligible. Those patients admitted to the hospital had a decrease in both ED and hospital admission LOS.

Trials and tribulations of a life in education consultancy

This short note outlines some of the rewards and frustrations that have arisen during my 40 years as a consultant in education – mainly, but not entirely, in higher education. It is a personal picture, with no pretence to be an academic paper. It is illustrated by references based on my own experience rather than references to the work of others. The note considers consultancy projects in two parts: first, the set up stage before the work really begins, and then the analysis stage. A primary problem in the set up stage is to determine with true clarity who is actually the ‘client’ for the work and who is the ‘decision maker’ about it. This is often no easy task and the answer is rarely simple – especially for projects that are commissioned and paid for by one party, but with the claimed intention being that they are for the benefit of another. During the work, conflicts of objectives can appear that were not apparent at the start, sometimes between the parties, sometimes within them. Difficulties can also arise from being a ‘foreign’ consultant, in terms of needing to understand – and to take into account, the local culture and ways of doing things – not least, interpretations of corruption. Sometimes an attempt is made to ‘import’ a solution developed for one country into another, which in my view is a disgrace. A very rewarding ‘result’ for any consultancy work is for the ‘client’ to think that the answer developed is ‘obvious’. The note also reflects on the frequent uselessness of so-called ‘hard data’. The paper concludes by drawing on the 40 years to say a few brief words about the world of higher education and the importance of leadership both by and within universities. This is followed by four examples of issues in education more generally which, in my view, have not yet been satisfactorily resolved. It concludes with a brief note on my views as to whether it was all worth it. It was!

SAT114 Global Social Determinants Of Health Needs And Response For Those New To Insulin At Discharge

Abstract Disclosure: C.A. Bullock: None. K. Davis: None. K. Carthy: None. P. Wax: None. C. Smyrniotis: None. T. Pollack: None. C. Barnard: None. J. Holl: None. A. Wallia: Grant Recipient; Self; Novo Nordisk. Research Investigator; Self; UnitedHealth Group. Unmet social determinant of health (SDoH) needs of patients with diabetes who are discharged with newly prescribed insulin place these patients at high risk of poor outcomes. Yet, few system level initiatives exist to identify patients with these needs and address them. An SDoH screening and referral initiative, consisting of an integrated screening tool administered by nursing upon hospital admission, was launched at a Chicago academic health system that cares for a diverse patient population. The electronic health record (EHR) screener assesses six specific domains including medication affordability, transportation barriers, food insecurity, housing stability, usual source of care, and mental health needs and a follow-up question if the patient would like assistance (leading to social work consultation). Our goal was to review the identified SDOH needs of patients newly prescribed insulin at discharge, and for whom a certified diabetes care and education specialist consultation (CDCES) was placed. From 05/01/22- 09/30/22, 279 patients had a CDCES consultation at Northwestern Memorial Hospital (NMH) of which 3 expired during admission. Of the 131 patients (47%) discharged with a new prescription for insulin, 18 (14%) were non-English, of which 17 (95%) had a complete SDOH screener, and 113 were English-speaking (86%), of which 74% (N=84) had a complete SDoH screener. The 113 English speaking patients had an age range from 20-84 (mean 56, SD + 14), 37 (33%) identified as black, 58 (51%) were female, and a majority (N= 55 [49%]) had Medicaid, Medicare coverage or were uninsured. Of those who had a screener completed (N=84), 28 (33%) reported at least 1 need, while 8% (N=7) identified &amp;gt;=3 needs, and 11% (N=9) requested assistance. The most reported need was a usual source of care (N=14, 17%). Other identified SDoH needs included medication affordability (N=8), transportation need (N=8), food insecurity (N=7), and housing stability issue (N=6), but few (N=2) identified any mental health needs. Sixty-five patients in total had a Social Work consultation and of those patients who identified needs 58% had their SDoH needs addressed by a Social Worker. Of the 14 patients without a usual source of care, 5 (43%) were readmitted or seen in the emergency department within 90 days of discharge and 1 had &amp;gt; 8 visit, despite enrollment in a hospital transitional care program. Only one patient established a usual source of care. Overall, 2 patients (2%), both with no identified needs, died within 90 days. Our findings reveal that many hospitalized patients who had a CDCES consultation before discharge and were newly prescribed insulin, identified global (&amp;gt; 3 SDoH or requiring assistance) needs. The findings also suggest that CDCES, nurses, pharmacists, and/or social workers may need to facilitate and/or create new pathways to address the needs of hospitalized patients newly prescribed insulin. Presentation: Saturday, June 17, 2023

Social Justice and Multiculturalism in Consultation Training: An Analysis of Syllabi from School Psychology Programs

ABSTRACT Training in school-based consultation may encompass instruction on various consultation models, aims, and work with various partners. However, it is unclear how trainers currently structure coursework and the extent to which social justice is embedded in class. Therefore, we conducted a systematic replication of Hazel et al. (2010) analyses of consultation training syllabi. We analyzed 63 syllabi from 55 school psychology programs. We found many course instructors grounded training in problem-solving models. Trainers assigned at least one reading or assignment related to multicultural considerations or social justice, but social justice was rarely centered as a training goal. As compared to the Hazel et al. previous findings, we noted more syllabi incorporating topics on teleconsultation and self-reflection, which may be critical to advancing social justice in consultation. Limitations and implications of findings are discussed, including the need to more comprehensively incorporate social justice themes in all aspects of school consultation training.

Design, Development of a Diversified Implemention of a Supervisory Control And Data Acquisition based VLSI System (SCADA) framework Utilizing Microcontroller based Programmable Logic Controllers

In this paper, the designing &amp; implementing of a supervisory control and data acquisition system (SCADA) framework utilizing microcontroller based programmable logic controllers is presented in brief with some of the simulated results. This article shows the automation of a process by interfacing a weighing balance with Supervisory Control And Data Acquisition System (SCADA) through a Programmable Logic Controller (PLC). The research work was taken up as a part of the consultation work at a cigarette manufacturing firm. The detailed study of the entire cigarette manufacturing process revealed that after the processing of tobacco, which is the final stage in the production department, the processed tobacco is weighed in bins on a weighing balance and manually recorded by an operator. The operator has to keep a count of the bins and sum them up at the end of the day. This involves consumption of time and human labor. The aim of our research work is to automate this process so that the information regarding various blends of cigarette and their respective weights can be made available at every PC terminal at the end of the day. For storing this information, we are using the MS-Excel spreadsheet and writing in it with the help of SCADA script. The work discusses in detail the design, architecture, programming and implementation of a PLC. It also covers the various features offered by the SCADA software and also deals with the interfacing of the PLC and SCADA. The interface RS232C / RS485 is used. This work is an online research project which has now been implemented in the firm and yielding desired results. The simulated &amp; experimental results shows the power of the methodology that has been developed in this research paper.

Sustainable Urban Development in Venezuela: A Management and Economic Perspective

Sustainable development, which is defined by the United Nations through 17 goals, provides a shared blueprint for achieving peace, prosperity, and environmental well-being. Various urban projects worldwide aim to align with these sustainable goals and incorporate them into their design language. Stockholm Royal Seaport stands out as one of the largest sustainable urban developments, striving to become an international model for urban planning. Within the Stockholm Royal Seaport project, the sustainable development goals have been translated into five key strategies including vibrant city, accessibility and proximity, resource efficiency and climate responsibility, let nature do the work and participation and consultation. Here the question is whether the sustainability model works the same for developing countries. To answer, we have selected four projects in Caracas, Venezuela to compare their sustainability model with the base one from Stockholm Royal Seaport. The comparison reveals that the significance of each strategy varies in Venezuela, with some strategies being more prioritized than others. Additionally, two additional strategies, namely education and limited demolition, emerge as noteworthy and exclusive to Venezuela. By exploring these findings, we gain insights into the adaptation and customization of sustainability models in developing countries, shedding light on their unique economic and managerial perspectives.

Case Study to Improve the Growth of RIT Auto- Care

Abstract: In a rural area, vehicle washing and servicing always been done in a traditional way, either the technologies required are not easily available nor are affordable. But as a profound institute, we saw a vision to give customers the service with high-end technologies and at a low cost. Then after we department of Automobile engineering at RIT started the vehicle washing and serving center back in 1983. We kept customers always at the apex and strived to upgrade our servicing center. We refined the undergoing work and made standard operating procedures and started monitoring the activities weekly. Also, we started doing a market survey of what the customers really wanted from such a facility in order to enhance the overall performance of their vehicles at a low cost. We went nearby washing centers to look at what facilities are there? We thought that if we able to provide our customers onestop solution in vehicle servicing and validation of its performance then definitely the customers will attract and they will get what they want in single visit. As part of upgradation we successfully commissioned and running an online PUC center and new washing accessories such as vacuum cleaner, established new river water connection and installed CCTV. These facilities add value in servicing and validation of performance of the vehicle in low cost also these facilities are the part of student’s curriculum so our students are getting great exposer to such advanced technologies and they will have hands-on as well. So with this up-gradation we do consultancy work of servicing and validation of the performance of the vehicle at a low cost along with the student’s development. Keywords : Consultancy, PUC, Student’s development

Longitudinal Outcomes of the top 20 Utilizers of VA Connecticut's Psychiatric Emergency Services Between 2010 and 2020.

Frequent utilizers of emergency services represent a clinically important cohort with potentially unmet health care needs despite demanding a high volume of costly services. However, not much is known about their longitudinal course. This study identified the top 20 utilizers of VA Connecticut's psychiatric emergency services and conducted a chart review of their longitudinal outcomes during an 11-year period between 2010 and 2020, including their visit diagnoses, medical and psychiatric comorbidities, and types and frequency of other medical services and supports received. At the index visit, 19 of the 20 patients had substance use disorder and 14 patients had at least one non-substance psychiatric diagnosis. Despite all patients receiving primary care and other services, such as residential treatments, outpatient therapy, and social work consults, 11 of the 12 patients remaining alive and residing in the state continued to utilize psychiatric emergency services in 2020, revealing a pattern of persistent use.

George E. Davis: Editing the Chemical Trade Journal, 1887–1906

This article explores George Davis’s editing of the Chemical Trades Journal (CTJ) between 1887 and 1906, a period during which he was also working as a consultant chemist and consultant chemical engineer. Davis had worked from 1870 in various sectors of the chemical industry before becoming a sub-inspector in the Alkali Inspectorate between 1878 and 1884. It was during this period that the British chemical industry was facing severe economic pressure and to remain competitive was having to adapt to less wasteful and more efficient production. Drawing on this wide industrial experience, Davis developed a framework for chemical engineering with the broad aim of making chemical manufacture as economic as the latest science and technology would allow. Several important issues are raised by Davis’s editorship of the weekly CTJ alongside his extensive consultancy work and other responsibilities: Davis’s motivation given the likely impact on his consultancy work; the community the CTJ hoped to serve; competitive periodicals addressing the same market niche; the degree of focus on his chemical engineering framework; the changing content of the CTJ; and Davis’s role as editor over a period of nearly twenty years.

Between Adversarialism and Cooperation: Rhetorical Strategies of Interviewers and Interviewees in Presidential Elections

ABSTRACT This article aims to examine the rhetorical strategies employed by interviewers and interviewees to understand how adversarialism unfolds in television broadcasts. While most studies to date analyze a single interview or compare how the same interviewer confronts several interviewees, we capture how different panels of interviewers address adversarial questions in the same program format. We use mixed methods to assess nine interviews with Brazilian presidential candidates on the Roda Viva program aired during the 2018 elections. The results reveal that the structural characteristics of Roda Viva reduce the opportunities for equivocation gaps. In addition, while media professionals adopt a more assertive stance toward candidates (seeking to deauthenticate them), some interviewers from outside journalism offered the interviewees moral support. In turn, politicians avoided tricky questions and criticized the media coverage when placed in “embarrassing” situations. We also discuss how adversarial questions may help populist candidates since they use such opportunities to play the victim's role and attack the interviewers’ credibility. Besides scrutinizing the media's performance in a non-Western setting, the paper contributes to the work of journalists, candidates, and political consultants by highlighting which rhetorical elements favor or harm the efficiency of those participating in such interviews.

Integrating Behavioral Health and Primary Care: Turning a Duet Into a Trio.

Family physicians are at the front lines of mental health concerns and distress, yet often feel stymied in their attempts to fully support patients' biopsychosocial needs within the barriers of a fragmented health care system. This article describes a practice transformation designed to facilitate more empowered care experiences. We reflect on our interdisciplinary work as a family physician and a behavioral health consultant working closely together in a Primary Care Behavioral Health model within a university setting. We describe our collaborative approach to a composite character from clinical practice: a college student with symptoms of psychomotor depression who screened negative for mood and anxiety concerns. Akin to a musical ensemble, wherein the inclusion of each voice turns a solo into a symphony, we describe key details of interdisciplinary collaboration which promotes holistic care for patients and fulfilling biopsychosocial practice for us as colleagues.