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Background: In 2020, New Mexico had the highest alcohol related death and the 11th highest drug overdose rate in the U.S. Towards the long-term goal of addressing this public health problem, we are implementing and evaluating an multi-level intervention designed to identify adults at risk of substance use disorder (SUD) and encourage linkage to and retention in treatment. The first level includes equipping the ED and medical inpatient units of a safety-net hospital with a method to screen individuals at risk of a SUD. The second level includes Seeking Safety (SS), a trauma-specific treatment for PTSD and SUD; and pharmacotherapy for SUD. Motivational Interviewing (MI) is used throughout both levels. Using the SPIRIT guidelines and checklist, this study protocol describes the multi-level intervention and the methodology we are using to assess feasibility and effectiveness. Methods: We are using a Type 1 hybrid implementation design with a non-randomized approach (ISRCTN registration # ISRCTN33100750). We aim to enroll 110 adults ( ≧ 18) who screen positive for unhealthy use of alcohol, prescription medications (used nonmedically) and/or illicit drugs. Peer support workers are responsible for screening, using MI to increase engagement in screening and treatment and delivery of SS. Pharmacotherapy is provided by addiction clinical specialists. Treatment is provided post hospital discharge via telehealth to increase access to care. Participants are identified through (1) review of electronic health records for individuals with a chief or secondary complaint or mental health condition relating to alcohol and/or other drug use, (2) referrals from clinical staff and (3) screening in the ED and medical inpatient units. Feasibility is being measured through process data. Effectiveness will be determined by changes in two primary outcomes: (i) PTSD symptom severity; and (ii) substance use. Discussion: Our study will expand on research related to the implementation of treatment strategies for patients presenting at EDs and admitted to medical inpatients units wherein there is a significant window of opportunity to link patients with follow-up behavioral and clinical services for alcohol and/or drug misuse. The challenges associated with implementation and strategies that have been helpful to address these challenges will further inform the field. [ABSTRACT FROM AUTHOR]

There are three aspects of source and issue construction in news arena, i.e., access, recognition and responsiveness. A study has been conducted with the help of a model covering the 2001-2003 World Economic Forum (WEF) meetings and protests to show how the journalists maneuvered the debates in favor elites over citizen-activists.

OBJECTIVES: This paper aims to give voice to the lived experience of faculty members who have encountered racial or ethnic discrimination in the course of their academic careers. It looks at how they describe the environment for minorities, how they manage discrimination and what institutions and majority-member faculty can do to improve medical academe for minority members. METHODS: Qualitative techniques were used for semi-structured, in-depth individual telephone interviews, which were audiotaped, transcribed and analysed by reviewers. Themes expressed by multiple faculty members were studied for patterns of connection and grouped into broader categories. A description of the faculty sample is provided, in which respondents ranked the importance of discrimination in hindering academic advancement and used Likert scales to evaluate effects of discrimination. The sample was drawn from 12 of 24 academic medical centres in the National Faculty Survey and included 18 minority-member faculty staff stratified by gender, rank and degree who had experienced, or possibly experienced, work-related discrimination. RESULTS: Minority faculty described the need to be strongly self-reliant, repeatedly prove themselves, develop strong supports and acquire a wide range of academic skills to succeed. Suggested responses to discrimination were to be cautious, level-headed and informed. Confronting discriminatory actions by sitting down with colleagues and raising the level of awareness were important methods of dealing with such situations. CONCLUSIONS: Academic medical centres may need to make greater efforts to support minority faculty and improve understanding of the challenges confronting such faculty in order to prevent the loss and/or under-utilisation of important talent. [ABSTRACT FROM AUTHOR]

PURPOSE: To evaluate the experience of gender discrimination among a limited sample of women in academic medicine, specifically, the role of discrimination in hindering careers, coping mechanisms, and perceptions of what institutions and leaders of academic medicine can do to improve the professional workplace climate for women. METHODS: In-depth, semistructured telephonic individual interviews of 18 women faculty who experienced or may have experienced discrimination in the course of their professional academic medical careers from 13 of the 24 institutions of the National Faculty Survey. A consensus taxonomy for classifying content evolved from comparisons of coding. Themes expressed by multiple faculty were studied for patterns of connection and grouped into broader categories. RESULTS: Forty percent of respondents ranked gender discrimination first out of 11 possible choices for hindering their career in academic medicine. Thirty-five percent ranked gender discrimination second to either 'limited time for professional work' or 'lack of mentoring.' Respondents rated themselves as poorly prepared to deal with gender discrimination and noted effects on professional self-confidence, self-esteem, collegiality, isolation, and career satisfaction. The hierarchical structure in academe is perceived to work against women, as there are few women at the top. Women faculty who have experienced gender discrimination perceive that little can be done to directly address this issue. Institutions need to be proactive and recurrently evaluate the gender climate, as well as provide transparent information and fair scrutiny of promotion and salary decisions. CONCLUSIONS: According to this subset of women who perceive that they have been discriminated against based on gender, sexual bias and discrimination are subtly pervasive and powerful. Such environments may have consequences for both women faculty and academic medicine, affecting morale and dissuading younger trainees from entering academic careers. Medical schools need to evaluate and may need to improve the environment for women in academe. [ABSTRACT FROM AUTHOR]

In most patients duodenal ulcer is a chronic relapsing disease. If no active maintenance treatment or eradication therapy is given after healing, around 70-100% of patients have a relapse during the first year. We conducted a double-blind multicenter study in 472 patients with duodenal ulcer. They were treated with omeprazole 20 mg every morning for four or eight weeks and when healed were randomly allocated to maintenance treatment with either omeprazole 20 mg every morning or ranitidine 150 mg at bedtime for up to six months. The patients were assessed by endoscopy at monthly intervals until healing occurred. Thereafter scheduled endoscopy was carried out after 1, 3, and 6 months of maintenance treatment or immediately in the event of a suspected relapse. Healing status (intention to treat approach) was 87% at four weeks and 93% at eight weeks. At six months the estimated remission rate was 90% for omeprazole and 82% for ranitidine (P = 0.03, 95% CI 1-15%). The incidence of adverse events was similar during the two maintenance treatments. Treatment with omeprazole 20 mg every morning maintained significantly more patients in remission than treatment with ranitidine 150 mg at bedtime. [ABSTRACT FROM AUTHOR]