Measurement-Based Care in the Adolescent Partial Hospital Setting: Implementation, Challenges, & Future Directions.

In this paper, we describe the process of implementing measurement-based care (MBC) in the adolescent partial hospital program setting. First, we outline the rationale for incorporating MBC in this treatment setting. Second, we describe the partial hospital setting in which implementation took place, including the patient population, treatment providers, and structure of programming. Next, we outline the initial implementation of standardized assessments into our programming, including key initial considerations and challenges during implementation. We describe the importance of considering the primary symptom presentations of the patient population when selecting assessment tools, the importance of leveraging existing electronic health record tools to efficiently track and record data collection, and the ability to integrate assessments into clinical workflows. Fourth, we present data describing compliance with implementation, patient outcomes, and providers' attitudes towards and knowledge of MBC following implementation. We found after the initial implementation period, compliance was high. We also found providers had an overall positive perception of the use of MBC, reporting they perceived it to be helpful to both their clinical practice and patient outcomes. Finally, we discuss future directions for best utilizing standardized assessments in intensive treatment settings.

Estrogen receptor-alpha dependency of estrogen's stimulatory action on cancellous bone formation in male mice.

We examined whether estrogen receptor (ER)alpha is required for estrogen to stimulate cancellous bone formation in long bones of male mice. 17 beta-Estradiol (E(2)) was administered to ER alpha(-/-) male mice or wild-type (WT) littermate controls at 40, 400, or 4000 microg/kg by daily sc injection for 28 d and histomorphometric analysis performed at the distal femoral metaphysis. In WT mice, treatment with E(2) (40 microg/kg per d) increased the proportion of cancellous bone surfaces undergoing mineralization and stimulated mineral apposition rate. In addition, higher doses of E(2) induced the formation of new cancellous bone formation surfaces in WT mice. In contrast, E(2) had little effect on any of these parameters in ER alpha(-/-) mice. Immunohistochemistry was subsequently performed using an ER alpha-specific C-terminal polyclonal antibody. In WT mice, ER alpha was expressed both by cancellous osteoblasts and a significant proportion of mononuclear bone marrow cells. Immunoreactivity was also observed in cancellous osteoblasts of ER alpha(-/-) mice, resulting from expression of the activation function-1-deficient 46-kDa ER alpha isoform previously reported to be expressed in normal osteoblasts and bones of ER alpha(-/-) mice. Taken together, our results suggest that estrogen stimulates bone formation in mouse long bones via a mechanism that requires the presence of full-length ER alpha possessing activation function-1.