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Objective The current article describes efforts to develop and test a measure of recovery-oriented inpatient care. Method The Recovery-oriented Acute INpatient (RAIN) scale was based on prior literature and current Veterans Health Administration (VHA) policy and resources and further revised based on data collection from 34 VHA acute inpatient units. Results A final scale of 23, behaviorally anchored items demonstrated a four-factor structure including the following factors: inpatient treatment planning, outpatient treatment planning, group programming, and milieu. While several items require additional revision to address psychometric concerns, the scale demonstrated adequate model fit and was consistent with prior literature on recovery-oriented inpatient care. Conclusions and Implementations for Practice: The RAIN scale represents an important tool for future implementation and empirical study of recovery-oriented inpatient care. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

This article examines the relationship between inpatient mental health units' adherence to recovery-oriented care and 30-day patient readmission.The sample included patients admitted to one of 34 Veterans Health Administration inpatient mental health units. Recovery-oriented care was assessed using interviews and site visits. Patient characteristics and readmission data were derived from administrative data.Overall recovery orientation was not associated with readmission. Exploratory analyses found higher scores on a subsample of items pertaining to inpatient therapeutic programming were associated with lower patient readmissions. Additionally, patients with more prior service use and substance abuse or personality disorders were more likely to be readmitted.A growing body of literature supports the association between psychotherapeutic services in inpatient units and better patient outcomes. However, further research is needed to examine this association. More work is needed to develop appropriate psychotherapy services for the inpatient setting and support their implementation. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

The implementation of evidence-based psychotherapies, including patient-level measures such as penetration and rates of successfully completing a course of therapy, has received increasing attention. While much attention has been paid to the effect of patient-level factors on implementation, relatively little attention has been paid to therapist factors (e.g., professional training, experience). OBJECTIVE: The current study explores therapists’ decisions to offer a particular evidence-based psychotherapy (cognitive behavioral therapy for chronic pain; CBT-CP), whether and how they modify CBT-CP, and the relationship between these decisions and patient completion rates. METHODS: The study utilized survey responses from 141 Veterans Affairs therapists certified in CBT-CP. RESULTS: Therapists reported attempting CBT-CP with a little less than one half of their patients with chronic pain (mean = 48.8%, s.d.=35.7). Therapist were generally split between reporting modifying CBT-CP for either very few or most of their patients. After controlling for therapist characteristics and modification, therapist-reported percentage of patients with attempted CBT-CP was positively associated with completion rates, t (111) = 4.57, p

Clinician burnout is presumed to negatively impact healthcare quality; yet scant research has rigorously addressed this hypothesis. Using a mixed-methods, randomized, comparative effectiveness design, we tested two competing approaches to improve care-one addressing clinician burnout and the other addressing how clinicians interact with consumers-with 192 clinicians and 469 consumers at two community mental health centers. Although qualitative reports were promising, we found no comparative effectiveness for either intervention on burnout, patient-centered processes, or other outcomes. Discussion includes identifying ways to strengthen approaches to clinician burnout.

This case series of right unilateral diaphragmatic paralysis suggests peripheral nervous system involvement., Since the first identification of neonatal microcephaly cases associated with congenital Zika virus infection in Brazil in 2015, a distinctive constellation of clinical features of congenital Zika syndrome has been described. Fetal brain disruption sequence is hypothesized to underlie the devastating effects of the virus on the central nervous system. However, little is known about the effects of congenital Zika virus infection on the peripheral nervous system. We describe a series of 4 cases of right unilateral diaphragmatic paralysis in infants with congenital Zika syndrome suggesting peripheral nervous system involvement and Zika virus as a unique congenital infectious cause of this finding. All the patients described also had arthrogryposis (including talipes equinovarus) and died from complications related to progressive respiratory failure.

Measuring quality of care can transform care, but few tools exist to measure quality from the client's perspective. The aim of this study was to create concordant clinician and client self-report quality-of-care scales in a sample of community mental health clinicians (n = 189) and clients (n = 469). The client scale had three distinct factors (Person-Centered Care, Negative Staff Interactions, and Inattentive Care), while the clinician scale had two: Person-Centered Care and Discordant Care. Both versions demonstrated adequate internal consistency and validity with measures related to satisfaction and the therapeutic relationship. These measures are promising, brief quality assessment tools.

Despite the growing trend of integrating primary care and mental health services, little research has documented how consumers with severe mental illnesses manage comorbid conditions or view integrated services.We sought to better understand how consumers perceive and manage both mental and physical health conditions and their views of integrated services.We conducted semi-structured interviews with consumers receiving primary care services integrated in a community mental health setting.Consumers described a range of strategies to deal with physical health conditions and generally viewed mental and physical health conditions as impacting one another. Consumers viewed integration of primary care and mental health services favorably, specifically its convenience, friendliness and knowledge of providers, and collaboration between providers.Although integration was viewed positively, consumers with SMI may need a myriad of strategies and supports to both initiate and sustain lifestyle changes that address common physical health problems.

The objective of this study was to determine the effect of soy-based diets on mammary tumors in female cancer- prone mice. Transgenic virgin female mice expressing human pituitary growth hormone and their respective phenotypically normal littermates were fed a diet containing either casein (C), low-isoflavone soy protein (LIS), or high-isoflavone soy protein (HIS). Indices of tumor development were measured throughout the study. Both days from birth until death and days on diet until death were increased [by 20% (P = .01) and 19% (P = .02), respectively] in the LIS group when compared with the C group. Both intervals were increased also (by 16% and 17%, respectively; P.05) in the HIS group when compared with the C group. Days from birth to first tumor were increased by 7% (P.05), as was days on diet to first tumor by 5% (P.05), in the LIS group when compared with the C group. First-onset number of tumors was decreased (P = .02) by 41% and 34% in the LIS and C groups, respectively, when compared with the HIS group. Final onset of tumors was decreased (P.05) by 44% and 9% in the LIS and HIS groups, respectively, when compared with the C group. Total area of final tumors was decreased (P.05) by 30% in the LIS group when compared with the C group. Taken cumulatively, these data suggest that a diet rich in soy protein may provide protective benefits regarding tumor development in female cancer-prone mice. Furthermore, some bioactive compounds in the HIS diet appeared to confound the soy protein-induced beneficial effects.

In 1860, John Hollingshead, writing in All the Year Round, complained about the inadequate if not incompetent auditing practices of joint-stock companies. Only when company managers and shareholders are compelled to "call in professional accountants, and resort to an 'independent investigation,"' he argued, do they learn that "real auditing is a necessary part of a business organization, and that it becomes all the more costly the longer it has been neglected" (325). Victorian auditing scandals, as well as the crashes, frauds, and swindles that characterized the nineteenth century's burgeoning culture of investment, can sound uncannily familiar, affecting the way we read both the past and the present. It is tempting if not inevitable, for example, to see the dot-com bubble of the 1990s in the Railway Mania of the 1840s, or to view the Enron "debacle" as a contemporary equivalent of Overend and Gurney's collapse in 1866. In such crises, similarities between our own economy and that of the Victorians become apparent-not least because they reveal the extent to which, in both cultures, the stock market is the financial "heart" of the nation. Moving beyond simple correspondences, this special issue explores the processes through which investing, particularly investing in the stock market, became a more pervasive part of Victorian financial life. It examines the institutions and technologies that mediated between companies and those who invested in them and that, increasingly, conducted the emotions that investors were beginning to have about the performance of their "stocks and shares." Studying these distinctively Victorian ways of facilitating investment affords us a means to understand Victorian culture better as well as to trace the genealogies of current monetary assumptions and practices. Not only do we see the Victorian period through our own cultural lens, then, but we also see in nineteenth-century Britain some of the formative occasions in the subsequent history of finance. Thus the cultural moment of the

Women are occasionally governors of prisons for women, overseers of the poor, and parish clerks. A woman may be ranger of a park; a woman can take part in the government of a great empire by buying East India Stock.— Barbara Bodichon, A Brief Summary in Plain Language, of the Most Important Laws Concerning Women (1854)ON OCTOBER 5, 1860, GEORGE HENRY LEWES VISITED a solicitor in London to consult about investments. He wrote in his journal: “[The Solicitor] took me to a stockbroker, who undertook to purchase 95 shares in the Great Indian Peninsular Railway for Polly. For £1825 she gets £1900 worth of stock guaranteed 5%” (qtd. in Ashton, Lewes 210). Thus Marian Evans, called Polly by her close friends, known in society as Mrs. Lewes and to her reading public as George Eliot, became a shareholder in British India. Whether or not Eliot thought of buying stock as taking part in the government of a great empire, as her friend Barbara Bodichon had written in 1854, the 5% return on her investment was a welcome supplement to the income she had been earning from her fiction since 1857. From 1860 until her death in 1880, she was one of a select but growing number of middle-class investors who took advantage of high-yield colonial stocks.1 Lewes’s journals for 1860–1878 and Eliot’s diaries for 1879–80 list dividends from stocks in Australia, South Africa, India, and Canada. These include: New South Wales, Victoria, Cape of Good Hope, Cape Town Rail, Colonial Bank, Oriental Bank, Scottish Australian, Great Indian Peninsula, Madras. The Indian and colonial stocks make up just less than half of the total holdings. Other stocks connected to colonial trade (East and West India Docks, London Docks), domestic stocks (the Consols, Regents Canal), and foreign investments (Buenos Aires, Pittsburgh and Ft. Wayne) complete the portfolio.2

The Pennsylvania State University Life Sciences Library conducted the Wisconsin-Ohio Reference Evaluation Program survey in October 2005. The results of the survey indicated that the desk personnel do an average job in fulfilling the library user's expectations. Known-item questions were handled well but non-known questions need additional training to ensure patrons are not receiving too much information. This project raised a number of questions concerning user satisfaction and library type. It is hoped that this article can serve as the baseline for future research in the evaluation of science reference question transactions and patron satisfaction. [ABSTRACT FROM AUTHOR]

Objective: The putative selective estrogen receptor modulator (+)-Z-bisdehydrodoisynolic acid (Z-BDDA) has been found to improve cardiovascular risk in rodents. The objective of this study was to investigate the effectiveness of (+)-Z-BDDA compared with the antidiabetic drug, rosiglitazone, in treating obesity and risk factors associated with the metabolic syndrome. Research Methods and Procedures: Female Zucker Diabetic Fatty rats were randomly assigned to three treatment groups for 29 weeks: control (C), 1.8 mg (+)-Z-BDDA/kg diet [control diet + (+)-Z-BDDA (CB)], or 100 mg rosiglitazone/kg diet [control diet + rosiglitazone (CR)]. At sacrifice, physiological, biochemical, and molecular parameters were examined. Results: CB animals gained less weight and exhibited a decrease in total body lipids (p < 0.05) as compared with C or CR rats. Body weight and total body lipids were the highest in CR rats (p < 0.05). Liver weights in CB and CR rats were lower (p < 0.05) than in C rats, whereas kidney weights were lower in CB (p < 0.05) than in C and CR animals. Fasting plasma glucose was lower (p < 0.05) in the CB and CR animals when compared with C animals. C rats exhibited the highest concentration of total plasma cholesterol, and CR-treated rats exhibited the lowest concentration. Plasma triglycerides followed the same pattern as plasma cholesterol. Histomorphometry of heart vasculature revealed that CB and CR treatments produced a significant shift from small to large venules and arterioles compared with C (p < 0.05). Liver expression profiles of peroxisome proliferator-activated receptor (PPAR) α, PPARγ, and PPAR-regulated genes revealed encouraging CB-induced effects. Discussion: These results suggest that (+)-Z-BDDA may have applications in treating obesity and complications associated with the metabolic syndrome.