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Developing consistent, valid, and efficient implementation outcome measures is necessary to advance implementation science. However, development of such measures has been limited to date, especially for validating the extent to which such measures are associated with important improvements in client outcomes. This study seeks to address this gap by developing one or more evidence-based measures of implementation (EBMIs; i.e., implementation outcome measure that is predictive of improvements in key client outcomes) for the Adolescent Community Reinforcement Approach (A-CRA), an evidence-based practice (EBP) for adolescent substance use.Data for the current study were collected as part of a large-scale federally funded EBP dissemination and implementation initiative. The multilevel dataset included 65 substance use treatment organizations, 308 clinicians, and 5873 adolescent clients. Adjusted multilevel regression analyses were used to examine the extent to which client-level outcome measures assessed at 6-month follow-up (i.e., substance use, emotional problems) could be predicted by four implementation outcomes: two measures of fidelity (i.e., session exposure, procedure exposure) and two measures of penetration (i.e., absolute client penetration, absolute staff penetration).Adjusting for client substance use at intake, as well as several client characteristics (e.g., age, race, criminal justice involvement), client substance use at follow-up was significantly lower for treatment organizations that had higher procedure exposure (B=-1.227, standard error [SE]=0.583, 95% confidence interval=-2.370, 0.252; p.05). None of the other three implementation outcome measures were found to predict improvements in client outcomes.The current study provides support for procedure exposure as an organizational-level EBMI for A-CRA. Thus, future efforts focused on implementing A-CRA could be improved by measuring and monitoring the extent to which A-CRA procedures are being delivered to clients. Additionally, given the dearth of studies that have examined the relationship between organizational-level measures of implementation and client outcomes, this article provides a prototype for future research to identify EBMIs for other behavioral treatments.

Previous studies on neck muscle strength and motion have assumed or imposed varying constraints on the heads and bodies of the subjects. In this study, we asked 20 subjects to vigorously shake their heads 5−10 times in a completely unconstrained manner. The kinematics and kinetics of the head and neck were measured from video analysis and instrumentation mounted inside the mouth. Subjects shook their heads at self-selected tempos ranging from 1.9−4.7 Hz over a 20−91° range of motion. The motion of each subject’s head could be approximated by a fixed center of rotation that was typically located in the midcervical spine, but varied widely among subjects. Significant differences between men and women were observed. Peak head accelerations were low (4.3 ± 1.1 g and 250 ± 103 rad/s2 for men, 3.0 ± 0.9 g and 182 ± 58 rad/s2 for women) and estimated peak generated neck moments at C7/T1 were comparable to values reported in isometric neck strength studies (47 ± 14 N·m in extension and 22 ± 9 N·m in flexion for men, 25 ± 8 N·m in extension and 9 ± 7 N·m in flexion for women).

The Kansai International Airport was constructed in Osaka Bay in 18- to 20-m-deep seawater to avoid noise pollution and land acquisition disputes. Construction of the 511-ha Island I began in 1987 and Runway I began operation in 1994. Construction of the 545-ha Island II began in 1999, and Runway II began operation in 2007. Using more than 2.2 million vertical sand drains fully penetrating into the 17.3- to 24.1-m-thick Holocene clay layer and 430 million cubic meters of fill material, the project is viewed as an engineering marvel. On the basis of a detailed review of the geology of Osaka Bay, construction of the Airport Islands, and the permeability and compressibility of the Holocene and Pleistocene subseabed deposits that reached a depth of 400 m below the seafloor at the Kansai Airport site, settlement analyses were conducted assuming the uniqueness of end-of-primary void ratio–effective vertical stress relationship and the C α / C c law of compressibility. Airport Island I has already settl...

The present quasi-experiment examined the direct and indirect effects of recovery support telephone calls following adolescent substance use disorder treatment. Six-month outcome data from 202 adolescents who had received recovery support calls from primarily pre-professional (i.e., college-level social service students) volunteers was compared to 6-month outcome data from a matched comparison sample of adolescents (n = 404). Results suggested adolescents in the recovery support sample had significantly greater reductions in their recovery environment risk relative to the comparison sample (β = -.17). Path analysis also suggested that the reduction in recovery environment risk produced by recovery support calls had indirect impacts (via recovery environment risk) on reductions in social risk (β = .22), substance use (β = .23), and substance-related problems (β = .16). Finally, moderation analyses suggested the effects of recovery support calls did not differ by gender, but were significantly greater for adolescents with lower levels of treatment readiness. In addition to providing rare empirical support for the effectiveness of recovery support services, an important contribution of this study is that it provides evidence that recovery support services do not necessarily have to be “peer-based,” at least in terms of the recovery support service provider having the experiential credentials of being “in recovery.” If replicated, this latter finding may have particularly important implications for helping increase the recovery support workforce.

The Global Appraisal of Individual Needs (GAIN)1 is a 1–2 hour standardized biopsychosocial that integrates clinical and research assessment for people presenting to substance abuse treatment. The GAIN – Short Screener (GSS) is 3–5 minute screener to quickly identify those who would have a disorder based on the full 60–120 minute GAIN and triage the problem and kind of intervention they are likely to need along four dimensions (internalizing disorders, externalizing disorders, substance disorders, and crime/violence). Data were collected from 6,177 adolescents and 1,805 adults as part of 77 studies in three dozen locations around the United States that used the GAIN. For both adolescents and adults the 20-item total disorder screener (TDScr) and its four 5-item sub-screeners (internalizing disorders, externalizing disorders, substance disorders, and crime/violence) has good internal consistency (alpha of .96 on total screener), is highly correlated (r = .84 to .94) with the 123-item longer scales in the full GAIN. The GSS also does well in terms of its receiver operator characteristics (90% or more under the curve in all analyses) and has clinical decision-making cut points with excellent sensitivity (90% or more) for identifying people with a disorder and excellent specificity (92% or more) for correctly ruling out people who did not have a disorder. The GSS has good potential as an efficient screener for identifying people with co-occurring disorders across multiple systems and routing them to the right services and more detailed assessments.

Background. According to the scientific literature, a hearing impairment which is acquired late reduces mental efficiency. Objective. To determine by empirical examination whether hearing aids increase mental efficiency. Persons and methods. An open controlled application study was carried out on the capacity of working memory in 15 first users of hearing aids. Results. The working memory's capacity in the 15 users (age: 72±12 years; six females; crystallized IQ: 100±13; test-retest period: 74±35 days) increased 13±19% (IQ-increment 3.4±6.3 points), while the capacity of the 15 controls (age: 71±11 years; seven females; crystallized IQ: 103±12; test-retest period: 58±21 days) remained unchanged: 0±12% (IQ-change: -0.3±5.1 points). The difference between the samples is significant (p=0.012 one-tailed). The visually and auditively administered subtests yielded equal changes. According to self-reports, the daily wearing time was 6.7±3.5 h. Daily wearing times of the hearing aids (self-re ports) of between 4-8 h showed the multiple IQ-gain compared to lesser or longer times. The audiometric gain in hearing without noise on the right (rho=0.58; significant), left (0.48; not significant), and on both sides (0.68; significant) correlated with IQ-gain. Conclusions. Under a more favourable usage a still more striking benefit is to be expected in mental efficiency.

Because alcohol or other drug use following adolescent substance abuse treatment is common, understanding mediators of posttreatment outcome could help improve treatment interventions. The authors conducted path analyses based on data from 552 adolescents (aged 12-18; 82% male) with cannabis abuse or dependence who participated in outpatient treatment. The analysis used the Family Conflict and Cohesion subscales, from the Family Environment Scale, and several scales and indices from the Global Appraisal of Individual Needs. Family conflict, family cohesion, and social support indirectly predicted substance use and substance-related problems as mediated by recovery environment and social risk. This model replicated across 4 follow-up waves (3, 6, 9, and 12 months postintake). These results support the idea of targeting environmental factors during continuing care as a way to improve treatment outcomes for adolescents with cannabis disorders.

Aims To examine the comparability, reliability and predictive validity of two instruments used to assess alcohol use and dependence: the Global Appraisal of Individual Needs (GAIN) and the Form 90 Timeline Followback (TLFB) method. Design, setting and participants Adolescents (n = 101) admitted to a residential treatment program in the United States were interviewed at intake with the GAIN, and again within a week with a variation of TLFB, called Form 90. Alcohol and cannabis measures were compared and used to predict the number of past-month substance abuse and dependence symptoms. Measurement Self-report measures of days of alcohol and cannabis use in the 90 days prior to intake, peak number of drinks/joints used, peak blood alcohol content (BAC) and alcohol and cannabis abuse and dependence symptom counts. Findings Results revealed that the measures had: (a) excellent comparability (r = 0.7–0.8) across the two instruments; (b) deteriorating reliability after reported peak BAC levels exceeded 0.50 and peak joints exceeding 19; and (c) similar and strong relationships between use measures and the number of abuse/dependence symptoms across measures and instruments. Conclusions In a sample of 101 adolescents who were admitted to residential treatment for alcohol or drug dependence, the corresponding measures from the two instruments produced comparable results. If the cross-validation of these two measures generalizes to adolescents treated in out-patient settings and other adolescent treatment populations, the GAIN and Form 90 may provide useful core alcohol measures for meta-analyses.

Glutaric acidaemia type I (GA I) is caused by the deficiency of glutaryl-CoA dehydrogenase, resulting in accumulation of glutaric acid (GA) and 3- hydroxyglutaric acid (3-OH-GA) in blood and cerebrospinal fluid (CSF). Neuropathological changes with onset in childhood consist of severe neuronal loss in the caudate and putamen. An animal model is necessary to test possible intervention strategies, and prior reports suggested that GA or 3-OH-GA could be used to create specific neuron loss in adult rats. Adult, 3-week-old and 2-week-old rats received intrastriatal injections of GA and 3-OH-GA at a range of doses. High concentrations caused necrotic lesions in striatum. Low concentrations caused white-matter axonal damage and small areas of neuron loss. Injection of lipopolysaccharide prior to administration of 3-OH-GA was not associated with enhanced neuronal loss. Our findings contradict prior claims and we conclude that the simple model of a single GA or 3-OH-GA injection into rat brain does not replicate the neuropathological findings in humans.

Soil properties and soil water conditions were assessed for different land use (forest, arable land, grassland) on a silty Calcaric Regosol in the Yangjuangou Catchment of the Chinese Loess Plateau. The loess here is unimodal, poorly sorted with abundant coarse silt, has very low dry bulk density (1.11 – 1.38 g cm − 3) and little organic carbon content (1.6 – 3.7 g kg − 1). The soils are hydrophilic, have high porosity (0.5 – 0.55 cm3 cm − 3), unsaturated hydraulic conductivity, and plant available water content (0.34 – 0.4 cm3 cm − 3). Soil properties are quite uniform in space. Land use had no significant effects on soil properties and soil water conditions.

The tibia index (TI) is commonly used to predict leg injury based on measurements taken by an anthropomorphic test device (ATD). The TI consists of an interaction formula that combines axial loading and bending plus a supplemental compressive force criterion. Current ATD lower limbs lack geometric biofidelity with regard to tibial curvature and fibular load-sharing. Due to differences in tibial curvature, the midshaft moments induced by axial loading are different in humans and ATDs. Midshaft tibial loading in the human is also reduced by load-sharing through the fibula, which is not replicated in current ATDs. In this study, tibial curvature and fibular load-sharing are quantified through CT imaging and biomechanical testing, and equations are presented to correct ATD measurements to reflect the loading that would be experienced by a human tibia.

The treatment response of 139 pregnant and postpartum women in gender-specific residential substance abuse treatment was investigated. These women were assessed with the Addiction Severity Index (ASI) at intake and six months after their discharge. A factor analysis performed with these women's ASI composite scores revealed two distinct factors: a substance use severity factor primarily from the alcohol and drug composite scores, and a general life distress factor primarily from the medical, legal, family/social and psychiatric composite scores. A cluster analysis of the pre- and post-ASI factor scores revealed four main subgroups of women (ranging in size from 14 to 41%) that had different patterns of change in response to treatment. Patterns of change could accurately be predicted for 71% of the women based on intake ASI severity composite scores, history of prior treatment, and service bundle received.

Comparisons of well-developed practice-based interventions with research-based interventions are rare. This quasi-experimental study compares the outcomes of 274 adolescents (75% male; 63% weekly+ users; 54% dependent; 27% prior treatment; 73% with co-occurring problems) who received Chestnut Health System's best-practice Outpatient Treatment (CHS) or Cannabis Youth Treatment (CYT) research-based interventions. Ninety-five percent of participants completed follow-up interviews at three, six, nine, and 12 months after their intake GAIN interview. Initially, the CYT cohort scores indicated greater severity on several substance-related measures, while the CHS cohort scored higher on prior mental health treatment, victimization, and illegal activities measures. Adolescents in the CHS cohort were more likely to have longer lengths of stay and receive over three times as many hours of treatment. Mixed effects models revealed that CHS participants were significantly more likely to report a decrease in recovery environment risk, an increase in self-help attendance after treatment, and greater decreases in emotional problems, while CYT participants were significantly more likely to report decreases in their substance use. The results suggest that neither the best-practice nor the research-based interventions were clearly superior and call for a more rigorous randomized field experiment to better understand the differences in effectiveness between interventions.

A transformation system for triploid bermudagrass ( Cynodon dactylon x C. transvaalensis cv. TifEagle) was established with a biolistic bombardment delivery system. Embryogenic callus was induced from stolons and maintained on Murashige and Skoog's medium supplemented with 30 microM dicamba, 20 microM benzylaminopurine, and 100 mg/l myo-inositol. Using the hygromycin phosphotransferase ( hpt) gene as the selectable marker gene, we obtained 75 transgenic lines from 18 petri dishes bombarded. Integration of the hpt gene into genomic DNA and transcription of hpt was confirmed by Southern and Northern blot analyses, respectively. Through suspension culture screening, we obtained homogeneously transformed plants showing stable transcription of the hpt gene.

Differences in self-reported victimization and outcomes for residential (n=114) vs. outpatient (n=73) substance abuse treatment samples were examined. Repeated measures MANOVAs for victimization level by level of care were performed on days of alcohol and marijuana use and substance-related problems. Residential treatment participants reported higher prevalence of victimization and higher levels of general victimization but did not differ on acute (high) victimization at intake. Analyses revealed a significant interaction between follow-up outcomes and level of care for adolescents with acute intake victimization. Adolescents placed in residential treatment were more likely to reduce their days of alcohol and marijuana use and past month substance-related problems at follow-up. Adolescents with low intake levels of victimization did not differ by level of care. Findings suggest that clinicians must carefully weigh placement recommendations for adolescents with maltreatment histories and that researchers should study ways to increase outpatient treatment effectiveness for these adolescents.

This article uses data from the Global Appraisal of Individual Needs (GAIN) on 214 adolescents entering substance abuse treatment. The goals of the article are to validate the General Victimization Index (GVI), examine its relationship to gender and co-occurring problems, and determine its relationship to outcomes. The GVI includes 15 items on lifetime traumatic events, traumagenic factors, and current worries of victimization. The items fall along a severity dimension (α =.88), and evidence was generated to support the construct validity of cutoff scores for interpretation. Girls were significantly more likely than boys to have experienced a variety of victimization incidents. When used as grouping variables, gender and severity of victimization significantly interacted with measures of intake status and were significant predictors of 3-month postdischarge treatment outcomes.

Streamlined admission procedures for adolescents entering outpatient substance abuse treatment were evaluated. A time cohort of 128 adolescents receiving existing admission procedures over a 12 month period were compared to a subsequent cohort of 149 who received same day assessments, same day treatment placement staffings, use of pre-set admission appointments, and admission tracking procedures. Measures included: (a) the length of time taken to complete assessments, (b) the length of time between the assessment and admission appointments, and (c) the percentage of clients admitted to treatment. Results revealed that each of the new admission procedures were implemented in at least 50% of the cases, adolescents who received them completed their assessments sooner, and time-to-event analysis demonstrated that this group was admitted to treatment sooner. However, the percentage of adolescents who entered treatment was not significantly different between cohorts.

Defects in various nanomaterials are often desirable to enable enhanced functional group attachments and attain properties that are not available with their intact counterparts. A new paradigm in the defective low-dimensional carbon nanomaterials is to create holes on the graphitic surfaces via partial etching. For example, holey graphene, graphene sheets with through-thickness holes, was synthesized using several different partial etching approaches and found useful for various applications such as field-effect transistors, sensors, energy storage devices, and separation membranes. In these applications, the presence of holes led to unique advantages, such as bandgap widening, chemical functionalization of hole edges, improved through-the-thickness ion transport with lowered tortuosity, and improved accessible surface area. Here, we present a facile method to prepare holey carbon nanotubes via controlled air oxidation. Although no additional catalyst was added, the residual iron nanoparticles from nanotube growth encapsulated in the nanotube cavity significantly contributed to the hole generation through the nanotube walls. The holey carbon nanotube products exhibited enhanced surface area, pore volume, and oxygen-containing functional groups, which led to their much enhanced electrochemical capacitive properties. Synthesis and characterization details of this novel class of holey carbon nanomaterials are presented, and their potential applications are discussed.

Reaction of 10 nm gold nanoparticles (AuNPs) with a thiol-functionalized bipyridine copper(II) complex, Cu[(N-(6-mercaptohexyl)-2,2′-bipyridinyl-5-carboxamide)]Cl2 (3), and (1-mercaptohex-6-yl)tri(ethylene glycol) (5) in different ratios resulted in mixed monolayer modified NPs with varying surface coverage of capping agent. The copper complex modified NPs were used for surface plasmon resonance (SPR) promoted homogeneous catalysis applied to the hydrolysis of the nerve agent methyl parathion (MeP) at pH 8.0. Low power green laser (532 nm) irradiation of solutions of modified AuNPs with MeP resulted in significant increase in the rate of phosphate ester hydrolysis which could not be attributed to a thermal process. Ratios of initial rates (laser/dark) at high substrate concentrations of MeP as a function of copper catalyst coverage were determined. A possible mechanism for catalytic enhancement involving dissociation of catalytically inactive hydroxy-bridged Cu(II) dimer is discussed.

© 2014 International Association for Correctional and Forensic Psychology. This study examines predictors of recidivism over 3 years for 624 women released from a county jail using a comprehensive range of standardized measures derived from gender-responsive and gender-neutral criminogenic recidivism models. Although more than a dozen factors were related to recidivism in the univariate analysis, the multivariate analysis shows that recidivism can be reliably predicted (area under the curve = 0.90) with just four factors: age, no custody of children, substance use frequency, and number of substance problems. Exploratory analysis of women who recidivated in post-release months 1 to 3, 4 to 12, and 13 to 36 revealed that the effects of several variables (age, super optimism, and number of weeks in the jail treatment program) were dependent on the time elapsed since release from jail, whereas others (substance use and custody) had persistent effects over time. These findings support the development of re-entry services tailored for female offenders who address both gender-responsive and gender-neutral criminogenic risk factors.

Several market forces including the federal government (Government Performance and Results Act of 1993), managed behavioral health care, and accreditation organizations such as JCAHO, NCQA, and CARF are placing increasing emphasis on substance abuse treatment programs to use performance indicators to monitor quality of outcomes. Discharge status is a frequently cited performance indicator with high intuitive appeal to serve as a low-cost proxy indicator of therapeutic outcome. Researchers are just beginning to address the relationship of discharge status to therapeutic outcomes for adolescents treated for substance abuse. The purpose of the present study was to assess the relationship between discharge status and therapeutic outcomes after discharge from a residential treatment program for adolescents. Eighty-six clients were categorized based on the discharge status assigned to them by the treatment program and interviewed using the Global Appraisal of Individual Needs (GAIN) questionnaire at in...

A significant factor in the successful recovery process of adolescent substance abusers is family involvement in the client's treatment experience. This study investigated whether or not participant needs were being met at a Family Night program for residential and outpatient clients. Participant responses (N = 322 questionnaires) indicated that increased satisfaction with the program was associated with increased participation and with perceptions that the presented material related to their respective family problems. Implications for increasing the efficacy of Family Night programs are discussed.

Diabetes mellitus has been shown to alter the properties of bone and impair fracture healing in both humans and animals. The objective of this study was to document changes in the structural and material properties of intact bone and bone with healed fractures in diabetic rats compared with nondiabetic controls after 3 and 4 weeks of healing. Rods were inserted in the right femurs of control rats and rats with streptozotocin-induced diabetes, and the femurs were fractured in a standardized procedure and then allowed to heal for 3 and 4 weeks. After death, all femurs were mechanically tested to failure in torsion. The degree of healing was quantified for each animal by normalizing mechanical parameters for the femur with a healed fracture with those for the intact contralateral femur. At both time points of healing, diabetic rats exhibited inferior healing compared with that of control animals in terms of failure torque, failure stress, structural stiffness, and material stiffness of the femur with the healed fracture relative to the intact contralateral femur (p < 0.05). Our results demonstrate that the recovery of structural and material strength in femurs with healed fractures in diabetic rats is delayed by at least 1 week compared with that in controls.

Interactions between infiltrating T cells and keratinocytes via the secretion of the TH1 cytokines interleukin (IL) 2 and interferon gamma (INF-gamma), the keratinocyte growth factor transforming growth factor alpha (TGF-alpha) and the cytokines IL-6 and IL-8 are thought to be the predominant mechanisms inducing skin lesions in psoriatic patients. Systemic treatment of psoriasis with fumaric acid derivatives (FAEs) has been reported to be effective in the treatment of psoriasis, but the mode of action is still unknown. To clarify this phenomenon, keratinocytes from psoriatic patients as well as from healthy volunteers were mono- and cocultured with HUT 78 T cells with/without the addition of FAEs; the cytokine concentrations were then measured in the culture supernatants. Furthermore, mRNA expression was determined in epidermal growth factor (EGF) -activated keratinocytes as well as in phytohaemagglutinin (PHA)-activated HUT 78 T cells. Only dimethylfumarate (DMF) diminished IL-6 and TGF-alpha secretion in the psoriatic cocultures. However, it did not have this effect on cocultures from control subjects or on monocultures. DMF suppresses EGF-induced TGF-alpha mRNA induction in psoriatic keratinocytes. DMF inhibited INF-gamma secretion in all cultures but stimulated the IL-10 secretion. This immunomodulation away from the TH1 cytokine IFN-gamma to the TH2 cytokine IL-10 was confirmed in HUT 78 T cells by Northern blot analysis. An increased number of eosinophils is a known side-effect in patients treated with this drug, suggesting a clinical relevance of this immunomodulation in vivo. This immunomodulation and the suppression of cytokines from the psoriatic cytokine network could be responsible for the beneficial effect of DMF in the treatment of a hyperproliferative and TH1 cytokine-mediated skin disease.

The satisfaction of parents/guardians and their children who received services at 22 community mental health agencies in Illinois was assessed using standardized measures and procedures. The primary goal of the project was to develop a model of presenting consumer satisfaction data to stakeholders in a way that would provide meaningful bases of comparison and provide information for program improvement. A secondary goal of the project was to conduct exploratory analyses to aid in building theory about the relationship between parental/youth consumer satisfaction and other variables. Statewide analyses indicated that youths' satisfaction was significantly less than that of their parents. According to CHAID segmentation analyses, the best predictor of parents' satisfaction was their rating of the severity of their child's problem. The best predictor of youths' satisfaction was the type of school attended, though problem severity and agency location (e.g. suburban, urban, or rural) also figured prominently in CHAID's prediction model.

Adolescents with the most severe alcohol and other drug (AOD) use disorders are typically admitted to residential treatment. Of the more than 21,000 U.S. adolescents admitted to residential treatment supported by public funds in 2009, 53% received an unfavorable discharge and 76% failed to complete 90 days of treatment (United States Department of Health and Human Services, 2009), the length of stay threshold associated with better outcomes (Hser et al., 2001). Additional research has shown that 60–70% of adolescents relapse within 90 days after residential treatment (Brown, Vik, & Creamer, 1989; Godley, Godley, Dennis, Funk, & Passetti, 2002). Providing continuing care following addiction treatment can improve clinical outcomes (Dennis & Scott, 2007; Godley, Godley, Dennis, Funk, & Passetti, 2007; Kaminer, Burleson, & Burke, 2008; Kim et al., 2011; McKay, 2009; Saitz, Larson, LaBelle, Richardson, & Samet, 2008; Winters, Stinchfield, Latimer, & Lee, 2007), but relatively few adult and adolescent patients attend even one continuing care session following discharge from residential treatment (Donovan, 1998; Godley & Godley, 2011). Although some adolescent patients lack motivation to follow through with continuing care referrals, structural barriers exist as well. Residential treatment programs receiving state and/or Medicaid reimbursement typically serve large geographical areas, requiring referral to treatment organizations closer to the patient’s home after residential treatment. A recent study showed that continuing care was initiated about half the time for those with planned residential discharges and less than 10% of the time for those with unplanned discharges (Godley & Godley, 2012). Only one randomized trial of continuing care for youth discharged from residential treatment has been published, and that study examined the effects of Assertive Continuing Care (ACC; Godley et al., 2007). This intervention was developed to overcome barriers to continuing care participation by sending clinicians trained in the Adolescent Community Reinforcement Approach (A-CRA) and case management (Godley, Godley, & Dennis, 2001) to meet with youth in their school, home, or other community location within two weeks of discharge. In this experiment, adolescents assigned to ACC after residential treatment were significantly more likely than those receiving Usual Continuing Care (UCC) to receive continuing care (94% vs. 54%) and attend more sessions. Main effects of ACC were found for abstinence from their primary drug, marijuana, over a 9-month follow-up (d=.32). Decreases for alcohol and other drugs were all in the predicted direction but not significant (Godley et al., 2007). The effects of ACC may be due to the combination of (a) case management services designed to increase adherence to the requirements of school and/or juvenile justice – two common social systems in which youth are involved; (b) A-CRA for the adolescent, which uses both operant learning and cognitive behavior therapy procedures to identify and increase reinforcing pro-social activities and facilitates the development of improved communication, relapse prevention, and other skills; (c) A-CRA sessions for both the adolescent and caregiver; and (d) homework assigned after each session to practice a new skill and engage in a new or recurring pro-social activity. Despite the durable success of ACC in the initial trial relative to UCC, effect sizes for both marijuana and alcohol were small, suggesting that additional improvements to the model should be considered. Contingency Management (CM) interventions have been successfully added to the Community Reinforcement Approach and Cognitive Behavior Therapy in trials with adults to further improve substance use outcomes (Higgins, Silverman, & Heil, 2007). The effectiveness of CM in addiction treatment is rapid and reliable through the active phase by providing contingent reinforcement for drug abstinence and, in some studies, treatment attendance or verifiable activities. Only a few controlled studies combining CM with other treatments have been conducted for adolescents with AOD use disorders, and none were continuing care studies. Compared to a family court condition, a juvenile drug court intervention enhanced with Multi-Systemic Therapy plus CM evidenced large effects in decreasing substance use (ESs = 0.0.38 to 2.48) and criminal behavior (ESs = −0.04 to 1.88; Henggeler et al., 2006), and CM combined with parent training and Motivational Enhancement/Cognitive Behavior Therapy (MET/CBT) was more effective for adolescents than MET/CBT alone in increasing continuous abstinence from marijuana during the 3-month treatment phase (d=0.48) but less so over extended follow-up (Stanger, Budney, Kamon, & Thostensen, 2009). In studies by Azrin and colleagues (Azrin et al., 1994, 2001), a multi-component Family Behavior Therapy intervention including parent-mediated CM for abstinence and pro-social activities significantly reduced drug use compared to supportive counseling (Azrin et al., 1994) but in a second study, did not reduce drug use more than a cognitive behavioral problem-solving condition (Azrin et al., 2001). The available evidence suggests that adding CM to cognitive behavioral therapies is a promising strategy to improve adolescents’ drug use outcomes. Although several studies with adults found CM combined with CBT interventions to be more effective than either CM or CBT alone (Higgins et al., 2007; Kadden, Litt, Kabela-Cormier, & Petry, 2007), other studies found that CM alone was as effective (Rawson et al., 2002) or more effective than CM and CBT combined (Carroll et al., 2012). Because CM alone has demonstrated effectiveness with adults and is relatively straightforward to implement, it merits testing with adolescents as a post-treatment continuing care intervention. In summary, CM has demonstrated efficacy in producing abstinence for adults and, in combination with other interventions, for adolescents. In addition, ACC has shown promise in a single trial sustaining abstinence for significantly more youth than UCC, but the effects were relatively small. For the present study, it was expected that the immediate contingent reinforcement offered through CM would improve engagement in pro-social activities and lead to greater improvement in abstinence outcomes, but because the ACC intervention is designed to increase abstinence (through increasing pro-social activities, social skills, relationship with parents, and better adherence to education and juvenile justice requirements), it was unclear whether this would exceed ACC alone. The combination of CM and ACC might provide additional sustained benefit by rapid contingent reinforcement of abstinence and pro-social activities via CM with skills training and case management provided through ACC; however, this has never been tested. The present study reports the results of a randomized trial to assess the degree to which three experimental approaches were more successful at engaging youth in post-residential continuing care and maintaining AOD abstinence during the 12 months following residential discharge relative to a UCC alone condition: (a) CM, a well-established, replicable evidence-based intervention; (b) ACC, a multi-component intervention with behavioral, CBT, and case management elements; and (c) CM +ACC, a combination of both approaches.

Land use planning needs reliable tools to estimate a realistic wind erosion risk in a high spatial and temporalresolution for the development and implementation of sustainable concepts for a long-term environmentallycorrect and socially responsible land use. The objective of this project is the estimation of the wind erosion riskas a basis for protection strategies.Based on a Geographical Information System, the influence of soil properties and the landscape structure areanalyzed. First, the wind erosion risk for all agricultural used areas is estimated from texture and hydromorphyinformation. Then the influence of landscape elements is calculated as the reduction of the wind velocity foreight wind directions and weighted for the frequency of wind velocities above the threshold of 8 m/s. Therenewed classification of the wind erosion risk shows a decrease of about 40% from the highest to lower riskclasses and more than 30% from the medium in those classes without any wind erosion risk. That emphasizesthe meaning of landscape structure on the wind erosion which should always be included in regional analyzes.

Evidence suggests an association between alcohol consumption and psoriasis. This relationship is still undefined, although long-term alcohol intake influences the immune system. Interactions between T cells and keratinocytes are important for the pathogenesis of psoriasis, by secretion of pro-inflammatory cytokines and growth factors in psoriatic skin. IL-2, IL-6, IL-8, IFN-gamma and TGF-alpha are hallmark cytokines in a psoriatic cytokine network. We investigated whether ethanol influences the secretion of these cytokines using a co-culture model with keratinocytes from psoriatic patients (n = 9) or from healthy controls (n = 9), with HUT 78 lymphocytes, and determined the cytokine levels with or without ethanol treatment in the culture supernatants. TGF-alpha and IFN-gamma levels were elevated in the ethanol-treated psoriatic co-cultures, to 150% and 175% respectively, but neither in co-cultures with keratinocytes derived from healthy control individuals nor in monocultures. Treatment with ethanol elevated slightly the IL-6 levels in the monocultures from psoriatic and control keratinocytes to 125% but not in HUT 78 monocultures. In the psoriatic co-cultures, IL-6 levels were elevated in the culture supernatants to almost 160%, but they were not influenced by ethanol in co-cultures with control keratinocytes. The cytokine levels of IL-8 or IL-2 were not significantly influenced in the psoriatic mono- and co-cultures or in HUT 78 cultures. If ethanol influences the cytokine secretion of psoriatic keratinocytes and HUT 78 lymphocytes in co-culture conditions, these data suggest that ethanol could also influence the psoriatic cytokine network in vivo, which may explain the explain the aggravation of this disease in alcohol-consuming psoriatic patients.

Although progesterone has been recognized as essential for the establishment and maintenance of pregnancy, this steroid hormone has been recently implicated to have a functional role in a number of other reproductive events. The physiological effects of progesterone are mediated by the progesterone receptor (PR), a member of the nuclear receptor superfamily of transcription factors. In most cases the PR is induced by estrogen, implying that many of the in vivo effects attributed to progesterone could also be the result of concomitantly administered estrogen. Therefore, to clearly define those physiological events that are specifically attributable to progesterone in vivo, we have generated a mouse model carrying a null mutation of the PR gene using embryonic stem cell/gene targeting techniques. Male and female embryos homozygous for the PR mutation developed normally to adulthood. However, the adult female PR mutant displayed significant defects in all reproductive tissues. These included an inability to ovulate, uterine hyperplasia and inflammation, severely limited mammary gland development, and an inability to exhibit sexual behavior. Collectively, these results provide direct support for progesterone's role as a pleiotropic coordinator of diverse reproductive events that together ensure species survival.

Hintergrund: Zell-Zell-Kommunikation spielt eine entscheidende Rolle im Uberleben von multizellularen Organismen. Eine neu entdeckte Kommunikationsstrategie, genannt Tunneling Nanotubes (TNTs), zwischen RPE-Zellen kann durch verschiedenste Faktoren beeinflusst werden. Methoden: In dieser experimentellen Studie wurden adulte retinale Pigmentepithelzellen (ARPE-19) mit verschiedensten Stoffen (Medium ohne Serum, Cytochalasin D, Latrunculin B, Blaulicht 405nm, Blaulicht 470nm, Glyoxal 3000µM, H2O2 200µM) behandelt und anschliesend jeweils die gebildeten Tunneling Nanotubes von 300 Zellen ausgezahlt. Ergebnisse: Es zeigte sich bei allen Behandlungen eine signifikante Reduktion der TNT-Zahl im Vergleich zu den Kontrollzellen. Folgende TNT-Anzahlen liesen sich pro 100 Zellen ermitteln: 15 TNTs (Kontrolle), 9 TNTs (Medium ohne Serum), 0 TNTs (Cytochalasin D), 0 TNTs (Latrunculin B), 4 TNTs (Blaulicht 405nm), 8 TNTs (Blaulicht 470nm), 3 TNTs (Glyoxal 3000µM), 8 TNTs (H2O2 200µM). Schlussfolgerung: TNTs stellen einen Kommunikationsweg zwischen RPE-Zellen dar, welcher durch verschiedenste Einflusse eingeschrankt werden kann. Dies fuhrt zum Untergang der RPE-Zellen und damit vermutlich auch der Photorezeptorzellen.

Ejection greatly increases the risk of injury and fatality in a rollover crash. The purpose of this study was to determine the crash, vehicle, and occupant characteristics that affect the risk of ejection in rollovers. Information from real world rollover crashes occurring from 2000 – 2010 was obtained from the National Automotive Sampling System (NASS) in order to analyze the effect of the following parameters on ejection risk: seatbelt use, rollover severity, vehicle type, seating position, roof crush, side curtain airbag deployment, glazing type, and occupant age, gender, and size. Seatbelt use was found to reduce the risk of partial ejection and virtually eliminate the risk of complete ejection. For belted occupants, the risk of partial ejection risk was significantly increased in rollover crashes involving more roof inversions, light trucks and vans (LTVs), and larger occupants. For unbelted occupants, the risk of complete ejection was significantly increased in rollover crashes involving more roof inversions, LTVs, far side occupants, and higher levels of roof crush. Roof crush was not a significant predictor of ejection after normalizing for rollover severity. Curtain airbag deployment was associated with reduced rates of partial and complete ejection, but the effect was not statistically significant, perhaps due to the small sample size (n = 89 raw cases with curtain deployments). A much greater proportion of occupants who were ejected in spite of curtain airbag deployment passed through the sunroof and other portals as opposed to the adjacent side window compared to occupants who were ejected in rollovers without a curtain airbag deployment. The primary factors that reduce ejection risk in rollover crashes are, in generally decreasing order of importance: seatbelt use, fewer roof inversions, passenger car body type, curtain airbag deployment, near side seating position, and small occupant size.

In a frontal car crash, the driver’s foot and ankle may be injured due to loading by the brake pedal. The driver of a vehicle often has time to initiate emergency braking before an impending collision, which places the forefoot or midfoot over the brake pedal. During the crash, the pedal may induce dorsiflexion and axial loading of the ankle due to forward motion of the occupant and rearward intrusion of the pedal relative to the vehicle. In order to investigate the injuries caused by pedal loading, impact tests were conducted on three cadaveric lower limbs. The limbs were braced at the knee, and a pedal positioned beneath the midfoot was driven towards the knee, inducing dorsiflexion and axial loading of the cadaveric limb. Ankle injury was generated in two specimens. Both injured limbs sustained a medial malleolar fracture, and one limb also suffered a talar neck fracture. These results suggest that pedal loading may be an important injury mechanism for fractures of the medial malleolus and talar neck in drivers involved in frontal crashes.

Rollover crashes are often difficult to reconstruct in detail because of their chaotic nature. Historically, vehicle speeds in rollover crashes have been calculated using a simple slide-tostop formula with empirically derived drag factors. Roll rates are typically calculated in an average sense over the entire rollover or a segment of it in which vehicle roll angles are known at various positions. A unified model to describe the translational and rotational vehicle dynamics throughout the rollover sequence is lacking. We propose a pseudocylindrical model of a rolling vehicle in which the rotational and translational dynamics are coupled to each other based on the average frictional forces developed during ground contacts. We describe the model as pseudo-cylindrical because vertical motion is ignored but the ground reaction force is not constrained to act directly underneath the center of gravity of the vehicle. The tumbling phase of a rollover is modeled in three distinct phases: an initial brief airborne phase between roll initiation and the first ground contact, an early phase in which relative sliding between the perimeter of the vehicle and the ground causes the roll rate to increase, and a later phase in which the vehicle rolls without sliding and the roll rate decreases. In the early phase, the average vehicle deceleration is higher and is governed by sliding friction. In the later phase, the average vehicle deceleration is lower and is governed by geometric factors. Model predictions were fit to data from 12 well-documented rollover crashes in order to derive empirical values for the model parameters. In 11 out of the 12 rollovers studied, the model predictions matched the actual results with good accuracy. The results validate the underlying physical principles of the model and provide data that can be used to apply the model to real world rollovers. The proposed model provides a physical basis for understanding vehicle dynamics in rollovers and may be used in certain cases to improve the accuracy of a rollover reconstruction.

The turnover of substance use disorder (SUD) treatment staff has been assumed to adversely impact treatment effectiveness, yet only limited research has empirically examined this assumption. Representing an extension of prior organizational-level analyses of the impact of staff turnover on client outcomes, this study examined the impact of SUD clinician turnover on adolescent treatment outcomes using a client perspective. Multilevel regression analysis did reveal that relative to those adolescents who did not experience clinician turnover, adolescents who experienced both direct and indirect clinician turnover reported a significantly higher percentage of days using alcohol or drugs at 6-month follow-up. However, clinician turnover was not found to have significant associations (negative or positive) with the other five treatment outcomes examined (e.g., substance-related problems, involvement in illegal activity). Thus, consistent with our prior findings, the current study provides additional evidence that turnover of SUD clinicians is not necessarily associated with adverse treatment outcomes.

For adolescents, substance use disorder (SUD) treatment outcomes (e.g., abstinence, problematic behaviors) often cannot be measured soon enough to influence treatment trajectory. Although process measures (e.g., treatment engagement) can play an important role, it is essential to demonstrate their association with outcomes. This study explored the extent to which engagement in outpatient treatment was associated with outcomes and whether demographic/clinical characteristics moderated these relationships.This is a prospective study of adolescents (N=1491) who received outpatient treatment for SUDs at one of 28 treatment sites taking part in a national evidence-based practice implementation initiative. Information from the Global Appraisal of Individual Needs interviews at intake and six-month follow-up, as well as encounter data, were used. Adjusted hierarchical logistic models were used to estimate effects of engagement on six-month outcomes.Sixty-one percent of adolescents engaged in outpatient treatment. Adolescents engaging in treatment had significantly lower likelihoods of reporting any substance use (OR 0.60, 95% CI 0.41, 0.87), alcohol use (OR 0.63, 95% CI 0.45, 0.87), heavy alcohol use (OR 0.53, 95% CI 0.33, 0.86), and marijuana use (OR 0.64, 95% CI 0.45, 0.93). This association of engagement with abstinence outcomes was not limited to any particular group. Treatment engagement, however, was not associated with adolescents' self-report of illegal activity or trouble controlling behavior at follow-up.At the individual level, the Washington Circle engagement measure was a predictor of some positive outcomes for adolescents in outpatient treatment. Efforts to better engage adolescents in treatment could improve quality of care.

Neck muscle activation is believed to generally protect against whiplash and head injury in automotive impacts and sports activities. When the torso is struck, active tensing of the neck muscles may prevent the neck from rotating excessively due to the inertia of the head. In this scenario, neck muscle tension may also reduce the severity of a secondary head impact occurring after the primary impact with the body. In a direct impact to the head, it has been hypothesized that active neck muscle tension may reduce the acceleration experienced by the head by increasing its effective mass.Copyright © 2011 by ASME

The title compound, [Cd(C2H3O3P)(H2O)]n, was obtained from vinylphosphonic acid and cadmium nitrate. The vinyl groups project into the interlamellar space and the structure is held together via van der Waals forces. The Cd2+ ion is six-coordinate and the geometry is best described as distorted octahedral, with O—Cd—O angles falling within the range 61.72 (13)–101.82 (14)°. Five of the coordinated oxygen atoms originate from the phosphonate group and the sixth from a bound water molecule. Cd—O distances lie between 2.220 (3) and 2.394 (2) Å. The water molecule is hydrogen bonded to a phosphonate oxygen atom.

Objectives. We examined the relationships between substance abuse treatment, abstinence, and mortality in a sample of individuals entering treatment. We also estimated overall mortality rates and the extent to which they varied according to demographic, clinical severity, and treatment variables. Methods. We used data from a 9-year longitudinal study of 1326 adults entering substance abuse treatment on the west side of Chicago, of whom 131 died (11.0 per 1000 person-years). Baseline predictors, initial and long-term treatment response, and substance use patterns were used to predict mortality rates and time to mortality. Results. Older age, health problems, and substance use were associated with an increased risk of mortality, and higher percentages of time abstinent and longer durations of continuous abstinence were associated with a reduced risk of mortality. Treatment readmission in the first 6 months after baseline was related to an increased likelihood of abstinence, whereas readmission after 6 months was related to a decreased likelihood of abstinence, suggesting that treatment timing is significant. Conclusions. Our findings suggest the need to shift the addiction treatment field from an acute care model to a chronic disease management paradigm and the need for more aggressive screening, intervention, and addiction management over time.

In the cynomolgus monkey, rabbit and rat the architecture of the pars plana vasculature was investigated using scanning electron micrographs of resin casts. The most complex vessel architecture was found in the cynomolgus monkey. Here, the pars plana venules have affluxes from the ciliary processes, ciliary muscle and iris. Numerous interconnections between these venules exist in the central portion of the pars plana. Arterial affluxes reach the pars plana not until the choriocapillaries. The variations of this architecture in the rat and rabbit are not only caused by the different size of the ciliary muscle and its vascularization. In the rat the most peripheral part of the uveal supply of the retina represents a transition form between pars plana venules and the choriocapillaries. In the rabbit, two vascular layers exist in the pars plana while in the cynomolgus monkey and rat the pars plana vessels spread out in one plane. The functional significance of the vessel architecture and the species differences are discussed.

The biomechanics of ankle injury have been studied extensively, primarily through mechanical testing of human cadavers. Cadaveric testing is an invaluable methodology in biomechanics, because the magnitude and direction of the loading can be measured precisely and correlated with the resulting injury pattern. Clinical and epidemiological studies provide useful descriptions of injury patterns that occur in the real world, but their retrospective nature precludes a definitive analysis of the forces that caused the injury. Understanding the mechanism of ankle injuries is essential for developing countermeasures to prevent injury and for reconstructing injurious events. Knowledge of an injury's mechanism can also suggest potential associated injuries, which is helpful in diagnosis and treatment. The purpose of this review is to summarize the published research on ankle injury mechanisms with an emphasis on biomechanical experiments on human cadavers. Injury patterns are described based on the principal axis of force or torque producing the injury in conjunction with off-axis forces and out-of-plane foot positions. A mechanistic description of ankle injuries is complicated by the fact that the same mechanism can sometimes produce different injuries and the same injury can sometimes be caused by multiple mechanisms. Nonetheless, a framework for relating injury mechanisms and injury patterns is a valuable tool in the understanding, prevention, and treatment of ankle injuries.