William D. Kearns

Treatment of substance-abusing jail inmates Examination of gender differences

Females incarcerated for drug-related offenses represent one of the fastest growing populations within jails and prisons. The few studies of female offenders with substance abuse disorders depict a population with multiple psychosocial problems and treatment needs, and one that is characterized by frequent exposure to sexual abuse and other violence. The current study examined intake assessment results from a sample of 1,655 substance-involved jail inmates referred to a jail treatment program in Tampa, Florida, including 26% female and 74% male inmates. The study was designed to identify gender differences in psychosocial characteristics and substance abuse treatment needs among jail inmates. Results indicate that female inmates more frequently experienced employment problems, had lower incomes, more frequently reported cocaine as the primary drug of choice, and were more likely to report depression, anxiety, suicidal behavior, and a history of physical and sexual abuse. Implications for developing specialized treatment approaches for female offenders are discussed, including use of integrated treatment strategies.

Progressive hypertension in dogs by avoidance conditioning and saline infusion.

A group of dogs was trained on a free-operant avoidance-conditioning task that evoked acute increases in arterial pressure and heart rate during each of three daily 30-minute sessions. After 15 days of exposure to this procedure under conditions of normal sodium intake, 24-hour mean levels of arterial pressure remained unchanged. Another group of dogs received continuous intrarterial infusion of isotonic saline at a constant rate of 185 mEq/24 hrs for 15 days, but no avoidance sessions. Again, 24-hour mean levels of arterial pressure did not change significantly. However, 24-hour mean levels of systolic (19.5 +/- 6.2 mm Hg) and diastolic (13.7 +/- 2.9 mm Hg) pressure rose progressively over a 15-day period in a third group of dogs exposed concurrently to the avoidance schedule and saline infusion procedure. The progressive hypertension was accompanied by no consistent changes in heart rate. These experiments indicate that behavioral stress can potentiate sodium hypertension and provide a new method for the study of physiological and behavioral factors in long-term blood pressure control.

Tortuosity in movement paths is related to cognitive impairment. Wireless fractal estimation in assisted living facility residents

BACKGROUND Using traditional assessment procedures, prior research demonstrated that deficiencies in gait and balance occur in the later stages of dementia. OBJECTIVE We tested the hypothesis that an automated system capable of detecting path tortuosity (irregular movement) in elders would show that greater tortuosity was associated with greater cognitive impairment, potentially allowing early detection of dementia over time as tortuosity levels slowly increased. METHODS An ultra-wideband sensor network using wireless transponders measured daytime locomotion to an accuracy of 20 cm in 14 elderly residents in an assisted living facility (ALF) as they traversed a shared living area while performing daily activities such as going to a dining area, conversing and watching television. Transponder location was updated at 0.4 sec intervals while in motion and revealed large individual differences in activity patterns. RESULTS Fractal dimension (Fractal D), a measure of movement path tortuosity (directed vs. irregular or apparently aimless locomotion) was significantly and negatively correlated with cognitive status as measured by the Mini Mental State Examination administered to each participant at the studys end. CONCLUSIONS Previous studies of locomotion in laboratory settings that have demonstrated gait variability increases with poor cognitive status have necessarily controlled various components of gait. The present results demonstrate that directional changes and other locomotion components can be studied by monitoring free movements in normal living settings over time. Implications for assessment and management of dementia-related wandering are discussed.

Wanderers with Cognitive Impairment in Department of Veterans Affairs Nursing Home Care Units

OBJECTIVES: To explore the extent of and factors associated with male nursing home residents who wander.

Potassium infusion attenuates avoidance-saline hypertension in dogs.

Previous studies have shown that a combination of avoidance conditioning schedules and increased intake of salt and water results in progressive hypertension in dogs within 14 days. The present experiments investigated the effects of increasing potassium intake upon blood pressure and heart rate of dogs made hypertensive by avoidance conditioning and salt-water loading. Two daily 30-minute sessions of free-operant avoidance conditioning were presented for 36 days during which isotonic saline was continuously infused into the arterial circulation (1.2 liters/day; 185 mEq Na+). Daily mean levels of systolic (22 +/- 5 mm Hg) and diastolic (12 +/- 4 mm Hg) pressure increased progressively in each dog during Days 1-14. Infusion of potassium chloride (100 mEq/day) from Days 15-28 resulted in progressive decreases in daily mean levels of systolic (-11 +/- 2 mm Hg) and diastolic (-8 +/- 1 mm Hg) pressure in each dog over this period. From Day 29-36, systolic (8 +/- 1 mm Hg) and diastolic (5 +/- 1 mm Hg) pressure increased. Normotensive dogs not on the avoidance schedule showed no change in arterial pressure in response to 14 days of potassium chloride infusion. These experiments show that the level of potassium, as well as sodium, intake significantly determines blood pressure levels in this form of experimental hypertension.

Drug Abuse History and Treatment Needs of Jail Inmates

The current study evaluates the extent of prior drug use and psychosocial dysfunction related to drug use among 499 jail inmates referred to the Hillsborough County Sheriffs Office Substance Abuse Treatment Program. Results indicate that inmates were involved with drugs for an average of more than 7 years, and with cocaine for almost 5 years. The majority of inmates reported extremely heavy use of drugs in the month prior to the last arrest, including 83% that had used cocaine. Many drug-dependent inmates reported a shift over time from intranasal to freebase cocaine use. Half of all referrals indicated a pattern of regular use within a year of involvement with drugs. The need for lengthy, heavily structured, and intensive treatment approaches for drug-dependent jail inmates is underscored by a history of chronic cocaine and polydrug abuse, a compulsive pattern of drug use, few successful periods of voluntary abstinence, and severe disruption in vocational, social, and psychological functioning. Their history of infrequent and unsuccessful involvement in rehabilitation programs reflects a significant need for compulsory treatment following release from jail, community supervision to ensure compliance with treatment, and development of linkages between jail drug treatment programs, courts, and community treatment providers.

Drug Treatment in Jails: Results of a Nationwide Survey

Abstract Although the number of drug-involved jail and prison admissions has risen sharply since 1985, there is little information available regarding the development of correctional programs designed to meet the treatment needs of this population. This article examines major findings from a nationwide survey of 1,737 American jails to identify the frequency with which jails provide drug treatment services, the type of services offered, and the extent of in-jail drug treatment programs currently being developed. Findings indicate that 28 percent of jails provide drug treatment services and that only 7 percent of jails provide a comprehensive level of treatment services. Implications for development of enhanced in-jail drug treatment programs are discussed.

eHealth Technology Competencies for Health Professionals Working in Home Care to Support Older Adults to Age in Place: Outcomes of a Two-Day Collaborative Workshop

Background The demand for care is increasing, whereas in the near future the number of people working in professional care will not match with the demand for care. eHealth technology can help to meet the growing demand for care. Despite the apparent positive effects of eHealth technology, there are still barriers to technology adoption related to the absence of a composite set of knowledge and skills among health care professionals regarding the use of eHealth technology. Objective The objective of this paper is to discuss the competencies required by health care professionals working in home care, with eHealth technologies such as remote telecare and ambient assisted living (AAL), mobile health, and fall detection systems. Methods A two-day collaborative workshop was undertaken with academics across multiple disciplines with experience in working on funded research regarding the application and development of technologies to support older people. Results The findings revealed that health care professionals working in home care require a subset of composite skills as well as technology-specific competencies to develop the necessary aptitude in eHealth care. This paper argues that eHealth care technology skills must be instilled in health care professionals to ensure that technologies become integral components of future care delivery, especially to support older adults to age in place. Educating health care professionals with the necessary skill training in eHealth care will improve service delivery and optimise the eHealth care potential to reduce costs by improving efficiency. Moreover, embedding eHealth care competencies within training and education for health care professionals ensures that the benefits of new technologies are realized by casting them in the context of the larger system of care. These care improvements will potentially support the independent living of older persons at home. Conclusions This paper describes the health care professionals’ competencies and requirements needed for the use of eHealth technologies to support elderly adults to age in place. In addition, this paper underscores the need for further discussion of the changing role of health care professionals working in home care within the context of emerging eHealth care technologies. The findings are of value to local and central government, health care professionals, service delivery organizations, and commissioners of care to use this paper as a framework to conduct and develop competencies for health care professionals working with eHealth technologies.

The internet II: Future effects on cognitive behavioral practice

The Internet is a vast international network of computers linked to each other. Users can send electronic mail quickly and easily to each other—free or at low cost. Users can also access pages of information stored as computer files on publicly available locations called Websites. The development and widespread use of electronic mail and the World Wide Web (WWW) has many implications for clinical practice, prevention, education, and research related to cognitive behavior therapy. This article presents an overview of current usage on the Internet, provides examples of how mental health professionals can use the Web to enhance practice, presents speculation about possible future applications of the Internet, and discusses major changes that may take place that would affect clinicians, researchers, and consumers of cognitive behavior therapy.

A unified grid-based wandering pattern detection algorithm

The aim of this study was to develop and validate a robust algorithm for indoor and outdoor wandering pattern detection and to analyse the relationship of these patterns to other clinical measures. Much of the previous work in this area addressed the measurement of wandering indoors or outdoors and to the best of our knowledge, there has not been a unified algorithm proposed which can deal with both scenarios. We present a novel grid-based layout representation strategy to identify the patterns, which is applicable to both indoor and outdoor scenarios. The algorithm is sufficiently robust to identify interleaving and hybrid patterns and performed with identification accuracy of 90% on a real-world sample.