Working gases in thermoacoustic engines.

The best working gases for thermoacoustic refrigeration have high ratios of specific heats and low Prandtl numbers. These properties can be optimized by the use of a mixture of light and heavy noble gases. In this paper it is shown that light noble gas-heavy polyatomic gas mixtures can result in useful working gases. In addition, it is demonstrated that the onset temperature of a heat driven prime mover can be minimized with a gas with large Prandtl number and small ratio of specific heats. The gas properties must be optimized for the particular application of thermoacoustics; it cannot be assumed that high specific heat ratio and low Prandtl number are always desirable.

The appropriate role for the state hospital.

This article explores the role of the state hospital in providing long-term care. It is argued that long-term care is an important part of a mental health system, specifically for people with severe mental illness. The state hospital can be made to function more efficiently and also provide needed long-term care.

Psychiatric hospital care and changes in insurance coverage strategies: a national study.

The 1975, 1980, and 1986 sample surveys from the National Institute of Mental Health were used to predict the type of inpatient psychiatric facility where people were admitted. Predictors used were demographics (age, gender, race, marital status, and education), psychiatric diagnosis, and insurance status (primary payment source). A discriminant analysis revealed that insurance status was the most important discriminator in predicting hospital type. State hospitals were more likely to care for patients with little or no resources, whereas private hospitals cared for patients with some form of insurance. The authors discuss the implications of insurance status and access to psychiatric treatment.

The failure of the diversion process: the impact of transferring of patients to state hospitals.

The diversion of people with severe mental illness into the private sector is examined. The purpose of the diversion system is to reduce the number of admissions to the state hospitals by diverting patients into the private hospitals, which may offer more diverse treatment to these patients. Insurance is highlighted as an important factor in diverting patients from state hospitals. When the diversion system fails and the patient is transferred from the private sector to the state hospitals, continuity of care is disrupted. The failure of the diversion is more costly not only to the patient but to the federal and state governments as well. Policy issues such as cost to the mental health system and continuity of care are discussed.

Gender differences among homeless persons: special services for women.

Data from a survey of men and women in urban shelters for the homeless revealed that, while women were more likely than men to request a variety of services, most of the difference was accounted for by the subgroup of women accompanied by children. Homeless men and women without children exhibited few differences in the number of services they requested.

Trends in the inpatient care of persons with schizophrenia.

This report analyzes nationally representative data to examine inpatient services provided to persons with schizophrenia. The data are for patients admitted to general hospitals, private psychiatric hospitals, and State and county mental hospitals between 1970 and 1986 (weighted n = 860,637). The proportion of admissions diagnosed as having schizophrenia decreased from 21 percent in 1970 to 16 percent in 1986; this proportion decreased in public general hospitals and increased in private general hospitals. The rate of admissions for schizophrenia decreased in public general hospitals and State and county mental hospitals and increased in private general hospitals. The overall admissions rate decreased for whites with schizophrenia and increased for African-Americans, owing entirely to increased admissions of African-American males. Private general hospitals and State and county mental hospitals relied less over time on private insurance; the use of Medicare increased in both public and private general hospitals; and Medicaid use increased in private general hospitals. Further research on services for this population is necessary as a baseline for health care reform.

Social work outreach to homeless people and the need to address issues of self-esteem.

This article assesses self-esteem in a sample of homeless people from a major urban area. The findings indicate bivariate associations between low self-esteem and depression, family relationships, goal attainment, disability, health, and food deprivation. Multivariate analysis suggests that depression and poor health are the two most significant variables that contribute to low self-esteem. Social work outreach can provide services to positively influence homeless peoples' lives. First, however, it is important to facilitate proper psychosocial and psychiatric assessment, to make a diagnosis, and to provide on-site treatment.

Changing characteristics of schizophrenic patients admitted to state hospitals.

OBJECTIVE: Characteristics of schizophrenic patients admitted to state hospitals between 1970 and 1986 were studied to examine changes in the demographic profile of the patient population and in principal sources of payment for hospitalization over the study period. METHODS: Information on patients' demographic characteristics and principal payment sources was obtained from a nationally representative data base compiled about every five years by the National Institute of Mental Health. RESULTS: Among schizophrenic patients admitted between 1970 and 1986, the proportion of African-American males increased. By 1986 patients were less likely to pay for care through private insurance or their own resources. They were more likely to receive Medicare and to lack medical insurance. Medicare use increased largely among white patients, and medical indigency largely among African-American patients. CONCLUSIONS: Changes in the characteristics of schizophrenic patients admitted to state hospitals between 1970 and 1986 may be related to changes in nosology, in the prevalence of schizophrenia, and in the types of patients likely to be admitted to state hospitals. The increase in the number of medically indigent patients accentuates the need for more adequate finding of state hospitals.

The trade-offs of developing a case management model for chronically mentally ill people.

This article addresses the role of case management in the care of chronically mentally ill people. Trade-offs often occur because case management is frequently used to achieve the conflicting goals of reducing service use costs and raising the quality of life for clients. Despite these trade-offs, case management can be effective if it is designed so that services match client needs and the costs of services are measured accurately. Case management for chronically mentally ill people is particularly difficult to design because their level of functioning and need for intensive services are such that the cost to deliver the appropriate services is great. The profit-maximizing nature of the U.S. health care system makes some form of capitation likely in the design of case management services for this population.

Three stages of homelessness: a conceptual model for social workers in health care.

This study examined 40 homeless people and their health care needs in Baltimore. As the length of the homelessness episode increased, the person's health care needs became more complex. Health care services must be appropriate to three stages of homelessness--marginal, recent, and chronic. An understanding of these stages can help social workers ensure that homeless people receive correct medical treatment and that they are assisted in reconnecting with mainstream society.

Schizophrenia and social skills: an 'identify and train' approach.

As the majority of treatment for schizophrenia has become community based, a barrier faced by many clients as they attempt a higher quality of life is social integration. Social skill deficits are a pervasive developmental issue among this population, yet this has only been addressed peripherally as opposed to intensively in existing community rehabilitation programs. The authors outline the developmental social deficits resulting from the insidious nature of schizophrenia and propose a comprehensive treatment program that focuses on an "identify, train and support" approach. Transferring successful inpatient social skill training to the community is explored as a viable adjunct for existing community treatment.

The prospects for national health insurance reform.

This article explores the unequal access to health care in the context of efforts by the American Medical Association (AMA) and its allies to maintain a market-maximizing health care system. The coalition between the AMA and its traditional allies is breaking down, in part, because of converging developments creating an atmosphere which may be more conducive to national health care reform and the development of a reformed health care delivery system that will be accessible, adequate, and equitable in meeting the health care and related social service needs of the American people.

Strategies for overcoming barriers to community-based housing for the chronically mentally ill.

This paper reports the results of a study of community acceptance of housing for the mentally ill in Maryland. The findings indicate that community opposition is less likely to occur (1) when establishing apartmental living arrangements rather than group homes, (2) in less organized neighborhoods, (3) where other housing for specialized populations has not been previously developed, and (4) by using a "low profile" strategy which avoids informing community members in advance of start-up.

The needs of depressed homeless persons: designing appropriate services.

This article explores the incidence of depression among homeless persons in an urban area in Maryland. Similar to other studies a high incidence of depression is found; however, dissimilar to other studies its cause is correlated with low self-esteem, food deprivation, family relations, goal orientation, health, drug abuse, previous mental hospitalizations, disabilities and race. It is suggested that services to the homeless need to include more broadly based social casework services that stress basic needs and goal attainment.

The homeless mentally ill and the need for a total care environment.

The dual conditions of homelessness and Serious mental illness are examined in a group of 132 former patients of a state hospital. A naturalistic approach was used in a six-month longitudinal Study that focused on the uniqueness and distinctiveness of a homeless existence. A more total care environment that recognizes a continuous service approach is necessary to meet the challenges presented by this population.

Mothers alone and supporting chronically mentally ill adult children: a greater vulnerability to illness.

Increasingly, state hospitals are discharging large numbers of patients to their families and a significant number of these patients are severely mentally ill. The burden upon mothers who live alone and have to care for chronically mentally ill adult children is the focus of this paper. The author explores this phenomenon through the use of a qualitative research methodology to better capture the problems and struggles in these caretaking arrangements. Increased stress is found to contribute to a greater vulnerability to illness for the mother. Interventions are suggested which would reduce this burden and contribute towards a more healthy environment for the mother.

Are jails replacing the mental health system for the homeless mentally ill?

The author explores the process of how homeless mentally ill persons become involved with the criminal justice system. The unique demands of homelessness and chronic mental illness were specifically examined in this naturalistically based study. The author concludes that a combination of severe mental illness, a tendency to decompensate in a nonstructured environment, and an inability or unwillingness to follow through with aftercare contributed to involvement with the criminal justice system. Changes in the mental health system that would prevent the criminalization of the homeless mentally ill are suggested.