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Objective: This study evaluated the impact of a Department of Veterans Affairs outreach and residential treatment program for homeless mentally ill veterans on utilization and cost of health care services provided by the VA. Methods: Veterans at nine program sites (N = 1,748) were assessed with a standard intake instrument. Services provided by the outreach program were documented in quarterly clinical reports and in residential treatment discharge summaries. Data on nonprogram VA health service utilization and health care costs were obtained from national VA data bases. Changes in use of services and cost of services from the year before initial contact with the program to the year after were analyzed by t test. Multivariate analyses were used to examine the relationship of these changes to indicators of Clinical need and to participation in the outreach program. Results: Although utilization of inpatient service did not increase after veterans' initial contact with the program, use of domiciliary and outpatient services increased substantially. Total annual costs to the VA also increased by 35 percent, from $6,414 to $8,699 per veteran per year. Both clinical need and participation in the program were associated with increased use of health services and increased cost. Veterans with concomitant psychiatric and substance abuse problems used fewer health care services than others. Conclusions: Specialized programs to improve the access of homeless mentally ill persons to health care services appear to be effective, but costly. Dually diagnosed persons seem especially difficult to engage in treatment.
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Earlier studies have demonstrated a significant relation between scores on the Physical Anhedonia Scale-but not on the Perceptual Aberration Scale-and premorbid social adjustment in schizophrenics (Chapman, Chapman, & Raulin, 1976, 1978; Schuck, Leventhal, Rothstein, & Irizarry, 1984). A similar relation between scores on these 2 scales and interpersonal competence in college students has also been noted (Beckfield, 1985; Haberman, Chapman, Numbers, & McFall, 1979; Numbers & Chapman, 1982). The present study extends this work by examining the relation of premorbid adjustment to scores on these 2 scales among young, nonpsychotic psychiatric inpatients. Consistent with the earlier findings, anhedonic Ss had poorer premorbid social competence when compared with nonanhedonic Ss, whereas no relation was found between scores on perceptual aberration and premorbid social competence.
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A recent malpractice case involved public health nurses. Given the legal issues based on this case, recommendations can be made to help ensure legal accountability, improve practice, and minimize liability risk. Areas of concern include doctor's orders and communication relating to telephone orders, the nurse's accountability to the client, documentation and patient teaching, the physician's duty to supervise the nurse, and corporate negligence. The court's analysis of the facts in finding areas of liability can guide nurses in avoiding malpractice litigation.
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This report proposes a paradigm for technical journal deselection based on the Bradford Law of distribution, with a demonstration in biomedical communications illustrating various statistical derivations. The model employs the following operational prescriptives: (1) identification of fractional productivities in journal collections; (2) probability predictions for making successful retrievals of relevant items in any given productive fraction; (3) utilization by journal source language and origin; and (4) estimates of cost-efficiencies of searches made in print and machine-readable versions of serial publications. The results suggest that in approximately two out of three trials successful searches ('hits') are likely to be made in a `critical' core of any technical subject collection. The highest probability for retention resides in this portion, about 20% of the publications. We infer that substantial amounts of the remaining publications are candidates for deselection since their information content, as needed, may be captured more cost-effectively through electronic retrieval and document delivery access.
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The history of the Commonwealth Caribbean is replete with failed attempts at various degrees of economic and political integration. The Caribbean Sea itself is rather poor in both living and non-living resources, and the entire region-land and water-is suffering from varying degrees of environmental degradation. This article suggests that regional co-operation in the management of marine resources, particularly in the Anglophone islands of the Eastern Caribbean, could serve as an 'engine of integration'-something previous attempts lacked. There is no assurance that such an effort would be successful, however, despite good intentions, co-operation in many areas at present and some real cultural affinities. The centrifugal forces at work here are still very powerful, including parochialism and the scarcity of resources other than sun, sand and sea. © 1993.
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Does the formation of a customs union reduce and eventually eliminate tariffs among member countries to provide mechanisms or regional institutions for social, economic and political development? The literature examined suggests that, although many problems of trade liberalization continue to occur, greater benefits could be obtained by reducing tariffs on a non‐discriminatory basis, or by removing protection from domestic enterprises altogether, and by importing domestic requirements of the products of displaced industries from outside at world market prices. The literature also provides a valid case for protecting certain activities in ECOWAS — particularly trade and industrial enterprises — either for the purpose of increasing income or the rate of economic growth, or in order to achieve certain non‐economic objectives. The implications of economic integration in these terms can best be examined within a broader theoretical framework of developmental theory of trade liberalization. Copyright © 1993 John Wiley & Sons, Ltd
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