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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).

Etonnamment peu d’etudes critiques ont porte sur l’influence de Jonathan Swift sur la litterature victorienne. Cet article est fonde sur l’idee que Swift est l’un des intertextes importants, quoique sous-estimes, des œuvres de George Eliot, notamment dans son dernier ouvrage, Les Impressions de Theophraste Untel. Certaines references explicites ou allusions indirectes dans son œuvre de fiction, ainsi que certaines mentions dans ses notes de travail, ses journaux et sa correspondance, montrent qu’Eliot connaissait et appreciait l’œuvre de Swift, en particulier Le conte du tonneau et les Voyages de Gulliver. Se pencher sur Swift permet d’expliquer certains aspects originaux de son ecriture, tels que son penchant anti-scientifique ou sa tendance a la satire. Des travaux recents ont etudie la presence des animaux chez Eliot a partir des notions darwiniennes ; cependant, une analyse de l’influence du quatrieme livre des Voyages de Gulliver sur son ecriture permet de mieux comprendre ses representations des animaux, en general, mais aussi son utilisation de la satire et de la fable, en particulier dans Les Impressions de Theophraste Untel.

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.

Drawing on recent work by Paul Fyfe and Ruth Livesey, the essay explores the dangers of relying on horses for transportation, economic gain and pleasure, showing how Eliot transmuted this reality into formal conventions that marked turning points in her narratives. On a trip to Italy in 1861, Eliot’s horse falls on the edge of a precipice. She is unhurt, but Lewes, who sees her fall, feels “very sick and faint from the shock” (Lewes Journals). While such hazards of foreign travel may seem extraordinary, accidents involving horses were common both in everyday life and in Victorian fiction. Horse accidents appear in Eliot’s fiction including “Janet’s Repentance,” The Mill on the Floss, Silas Marner, Middlemarch, and Daniel Deronda. The essay concludes with a discussion of the tension between Eliot’s representation of horses as commodities and her sympathy with horses as sentient creatures.

In their collection of essays,The New Economic Criticism: Studies at the Intersection of Literature and Economics(1999), Mark Osteen and Martha Woodmansee identified and named a movement in economic literary studies and sought to place it alongside a cultural turn in economics. In their introduction, they offer possible reasons for the proliferation of scholarship in literature, culture, and economics. One is that “the critical pendulum has decidedly swung back toward historicist methods” and away from formalist approaches (3); another is that the 1980s thrust “interest rates, stock market speculation, takeovers, leveraged buyouts, and so on, into the public attention as never before since the 1930s” (4). Today, the proverbial pendulum has swung back toward formalism, and it is now surprising to encounter their comparison of the 1980s to the 1930s because we have become so accustomed to claim that comparison to the 1930s for our own post-2008 economy.

This chapter discusses the most important financial novelist of the Victorian period, known in her time as the “novelist of the City” for works such as George Geith and Austin Friars. Yet, today Riddell remains one of the most forgotten of popular Victorian novelists. Henry provides new information about Riddell’s personal financial troubles—which may be traced back to her mother’s financial distress as a young woman in Liverpool—and the lawsuits in which Riddell was involved following the bankruptcy of her husband, a failed inventor and businessman in London. Riddell’s unique perspective on business ethics in her novels is a result of her own financial entanglements.

This chapter shows that Oliphant was beset by financial problems and anxieties throughout her adult life, and that these troubles are reflected in the economic plots of her fiction. Oliphant grew up in Liverpool, and her first three novels were set there. Her short stories and better-known novels such as Hester (1883) and Kirsteen show the ways in which she complicates representations of women and money. Oliphant treats the subjects of slavery’s legacy, life insurance, and the struggles of women to achieve financial independence, evincing a distinctly ambivalent attitude toward new opportunities for women that situate her in the same context as her late nineteenth-century contemporaries Riddell and Gissing.

This chapter considers the ethics of inheriting money perceived to be tainted by a corrupt past and the choices that Eliot’s characters face when considering how to invest for the future. Henry situates Middlemarch and Daniel Deronda in the context of the investment cultures of Eliot’s late career, specifically her relationship to her financial advisor and future husband, John Walter Cross. She pays particular attention to Eliot’s uniquely progressive portfolio of diversified investments, overseen by Cross, which put her at the forefront of modern investing practices.

This chapter focuses on how influential male authors of the Victorian period represented women investors. W.M. Thackeray represents female investors in the East India Company with ironic skepticism about their power as voting shareholders. Anthony Trollope introduces various types, including the widow of business and the timid investing spinster. Charles Dickens railed against the American worship of dollars and the regime of shares. Strongly influenced by Dickens and Trollope, George Gissing focuses on lower-middle-class women investors. His novels explore the ambiguities of the New Woman’s place in society, suggesting that limited financial empowerment did not always lead to independence.

In the eighteenth century, women were voting shareholders in the East India Company and Bank of England. In the mid-nineteenth century, financial legislation expanded opportunities for investing in publicly traded shares by limiting the liability of shareholders. The Married Women’s Property Acts of 1870 and 1882 brought married women into the market as independent investors. This chapter discusses patterns of women’s investments in government securities, canals, docks, and banks, as well as in domestic, foreign, and colonial railways to set the stage for the following literary analyses and to support the argument that female authors’ personal experiences of gaining independence through investing moderated their critique of capitalism compared to that of their male contemporaries.