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Although a significant proportion of adults recover from substance use disorders (SUDs), little is known about how they reach this turning point or why they stop using. The purpose of the study was to explore the factors that influence reasoning and decision making about quitting substance use after a long-term SUD. Semistructured interviews were conducted with 18 participants, each of whom had been diagnosed with a SUD and had been abstinent for at least 5 years. A resource group of peer consultants in long-term recovery from SUDs contributed to the study’s planning, preparation, and initial analyses. Participants recalled harmful consequences and significant events during their years of substance use. Pressure and concern from close family members were important in their initial efforts to abstain from substance use. Being able to imagine a different life, and the awareness of existing treatment options, promoted hope and further reinforced their motivation to quit. Greater focus on why those with SUDs want to quit may help direct treatment matching; treatment completion may be more likely if the person’s reasons for seeking help are addressed. Why Do Those With Long-Term Substance Use Disorders Stop Abusing Substances: A Qualitative Study The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This study was funded by Innlandet Hospital Trust, Norway

Intrahepatic congenital portosystemic venous shunts are rare vascular anomalies. We report a unique case of a neonate with an intrahepatic congenital portosystemic venous shunt with concurrent congenital duodenal web. Such association has not been previously reported to our knowledge. Interestingly, the shunt became apparent on the seventh day, after a delayed start of oral feeding due to the neonate’s recovery from the duodenal web surgery. The shunt was small and the clinical symptomatology mild. No direct treatment was required. The laboratory and the ultrasound follow-up of the child noted a spontaneous resolution of the shunt by the age of six months.

Background In active run-in trials, where patients may be excluded after a run-in period based on their response to the treatment, it is implicitly assumed that patients have individual treatment effects. If individual patient data are available, active run-in trials can be modelled using patient-specific random effects. With more than one trial on the same medication available, one can obtain a more precise overall treatment effect estimate. Methods We present a model for joint analysis of a two-sequence, four-period cross-over trial (AABB/BBAA) and a three-sequence, two-period active run-in trial (AB/AA/A), where the aim is to investigate the effect of a new treatment for patients with pain due to osteoarthritis. Results Our approach enables us to separately estimate the direct treatment effect for all patients, for the patients excluded after the active run-in trial prior to randomisation, and for the patients who completed the active run-in trial. A similar model approach can be used to analyse other types of run-in trials, but this depends on the data and type of other trials available. Limitations We assume equality of the various carry-over effects over time. Conclusions The proposed approach is flexible and can be modified to handle other designs. Our results should be encouraging for those responsible for planning cost-efficient clinical development programmes.

Objectives: This South African study compared the views of 15 Muslim and 8 Hindu traditional healers regarding the etiology and treatment of craniofacial clefts, reasons for people consulting with them, and collaboration with Western professionals. Data Analysis: The original data were collected via individual interviews. Secondary data analysis was conducted to highlight common themes. Results: Four Hindu and 12 Muslim healers believed that the condition was God sent. Both groups acknowledged the existence of various superstitions within their communities. For example, if a pregnant woman handled a sharp object during an eclipse, her infant could be born with a cleft. All Hindu healers also attributed clefts to karma. All the Muslim healers counseled patients and families. Fourteen referred people for medical help, 10 emphasized the importance of prayer, and 3 recommended the wearing of amulets containing a prayer. No Hindu healers provided direct treatment. Three advised parents to fast, six arranged fire and purification ceremonies in the temples, and three consulted the person's astrological chart to dispel any bad karma. Both groups of healers advised people to give to charity. Eight Hindu healers and eight Muslim healers believed that people consulted with them because of cultural influences and because they alleviated feelings of guilt. Four Hindu and 13 Muslim healers favored collaboration with Western practitioners. Conclusions: Findings highlight the need for culturally sensitive rehabilitation practices, collaboration, referrals, and information sharing between Eastern and Western health care practitioners.

In this paper we consider a variant of the traditional noncircular model for crossover designs. Instead of assuming that ea.Ch treatment - applied to an experimental unit imparts the same carryover effect regardless of the treatment applied to the next period on the same unit, we consider the model which assumes two types of carryover effects that extend from a period to the next period. One type is called self carryover effect when a treatment is followed by itself in the next period on the same unit and the other type is called mixed carryover effect when a treatment is followed by any other treatment in the next period. Such models are useful in sensory trials. Efficient estimation and testing of the direct treatment effects (imparted by the treatment itself on the experimental unit of application) as well as the carryover effects under different models are of interest to the practitioners from application and model building point of view and have been addressed by many researchers. In the present article the problem of identification of optimal designs for the estimation of the mixed carryover effects has been taken up. It is shown that under the self and mixed carryover model generalised Patterson's balanced designs (termed also totally balanced designs in the literature}, which are known to be universally optimal for the estimation of the direct treatment effects are also universally optimal for the estimation of the mixed carryover effects provided that the number of periods exceeds two. AMS (2000} Subject Classification : 62K05.

[The article explores the possibilities for a constructive theology of priesthood drawn from the work of Edward J. Kilmartin, S.J. (1923–1994). Placing Kilmartin's direct treatment of church office within the context of his larger theological project, the author names the unstated thesis guiding Kilmartin's approach: the ministerial priesthood serves the memory of Christ. The article concludes that Kilmartin's understanding invites reflection on the ministerial priesthood in light of Jesus' life, pneumatology, faith, and the category of priesthood itself.]

The purpose of this report was to document phonological changes in a pair of identical twin boys diagnosed as language delayed. The boys were not enrolled in direct treatment, but were evaluated four times between the ages of 3;5 and 4;9. Speech samples were analyzed for phonetic inventories, phonological process use, and syllabic shapes. Observed changes in their speech generally followed normal developmental patterns.

Assessment of balance control is essential to guide physical rehabilitation poststroke. However, current observational assessment tools available to physiotherapists provide limited information about underlying dyscontrol. This paper describes a force plate-based assessment of quiet standing balance control that we have implemented for individuals attending inpatient stroke rehabilitation. The assessment uses two force plates to measure location of ground reaction forces to maintain stability in quiet standing in five conditions (eyes open, eyes closed, standing symmetrically, and maximal loading on the less-affected and more-affected limbs). Measures of interest are variability of the centers of pressure under each foot and both feet combined, weight-bearing asymmetry, and correlation of center of pressure fluctuations between limbs. We present representative values for the above-mentioned measures and case examples to illustrate how the assessment can reveal patient-specific balance control problems and direct treatment. We identify limitations to our current assessment and recommendations for future research.

The study of the staff, services, and patient population of the East Los Angeles Mental Health Service seven years after its initial operations revealed that: 1 the staff remained predominately bilingual and bicultural; 2 there was a greater demand for direct treatment services than anticipated; 3 the majority (79%) of the patient population was Mexican American, with an increase of foreign-born Mexican Americans; 10% were of other Latin descent; 4 there was an increase of Spanish speaking patients totalling 44% of the entire patient population; 5 the majority of the patients were unemployed or on Medi-Cal; and 6 self referrals increased to a total of 29%, and 10% were referred by former patients of ELAHMS. These conclusions strongly support the argument that Mexican Americans and other Latins would utilise mental health services if personnel and policies were responsive to bilingual and bicultural needs.

Most correctional mental health services suffer from diffi culties in recruiting and maintaining well-qualified staff members and from producing much nonfunctional work. The use of a Clinical Resources Center (CRC), in which staff and functions are directed toward specific performance objectives, is suggested as an alternative organization of services. The CRC would offer (1) screening, targeted to actual transfer and organizational de cisions and conducted at the lowest staff level necessary; (2) in tensive individual evaluations for early identification and agency program planning; (3) direct treatment services; (4) field and consultation services throughout the system and within the in stitution, including management and training functions; and (5) program development, personnel development and training, and research. By concentrating substantial numbers of behavioral professionals in one location, the CRC mobilizes their skills toward meeting specific departmental objectives. It is designed to serve as both a test laboratory for program ideas and a means of extending mental health resources and skills through a cor rectional system.

Static and dynamic assessment procedures were used to determine actual and potential levels of functioning for two preschool language-impaired children at the single-word stage of development. The information obtained from both types of assessment was used to predict the children's onset and rate of correct performance in a context-dependent situation (i.e. treatment) and a context-independent situation (i. e. generalization). Results of this study provide preliminary direction to clinicians as they decide who should receive direct treatment and how best to monitor learning during the therapy process.