How service users become empowered in human service organizations: the empowerment model.

This article presents an empowerment model (EM) to be used by service users in human service organizations (HSOs). The EM is a structure for service user input to be integrated within the HSO at various administrative levels through a four-step sequential process. The article fills a distinct void in the literature as there are numerous accounts about the importance of empowerment, but few on processes that need to be defined to operationalize the concept. Implications are directed toward administrators as they need to take leadership in implementing the EM in order to deliver more efficient and relevant services to their clients.

Effectiveness of case management with severely and persistently mentally ill people.

This meta-analytic review synthesizes the findings of 24 published studies dealing with the effectiveness of case management with the severely and persistently mentally ill. Summative findings were: (1) Overall, case management interventions are effective--75% of the clients who participate in them do better than the average client who does not; (2) The estimated preventive fraction (e.g., prevention of re-hospitalization) among clients who experience relatively intense case management service (case loads of 15 or less, 89%) is nearly 30% greater than that estimated among similar clients receiving less intensive service; and (3) Various case management practice models did not differ significantly on estimated effectiveness. Important questions concerning the differential effectiveness of case management by specific program, worker, client, and client-worker relationship characteristics remain to be answered.

The prevalence of child sexual abuse: integrative review adjustment for potential response and measurement biases.

This integrative review synthesizes the finding of 16 cross-sectional surveys (25 hypotheses) on the prevalence of child abuse among nonclinical, North American samples. It is essentially a research literature on sexual abuse; only one of the studies assessed physical abuse, and there has not yet been a single study of prevalent child emotional abuse nor neglect. The following summative inferences were made: (1) response rates diminished significantly over time, M = 68% prior to 1985 and M = 49% for more recent surveys, p < .05; (2) unadjusted estimates of the prevalent experience among women and men of childhood sexual abuse was 22.3% and 8.5%, respectively; (3) study response rates and child abuse operational definitions together accounted for half of the observed variability in their abuse prevalence estimates, R2 = .500, p < .05; (4) female and male child sexual abuse prevalence estimates adjusted for response rates (60% or more) were respectively, 16.8% and 7.9%, and adjusted for operational definitions (excluding the broadest, noncontact category) they were 14.5% and 7.2%; (5) after adjustment for response rates and definitions, the prevalence of child sexual abuse was not found to vary significantly over the three decades reviewed. Given the large human costs, both personal and social, of child abuse, and the identified gap in the requisite knowledge needed to steer effective preventive and treatment interventions, it is time to invest in a large, methodologically rigorous, population-based study of child abuse which, if it does nothing else, spares no expense in ensuring very high participation.

Correlation of intracranial pressure and transcranial Doppler resistive index after head trauma.

PURPOSE: To investigate the usefulness of transcranial Doppler ultrasonography in the evaluation of intracranial pressure changes after head injury. METHODS: Transcranial Doppler examinations and intracranial pressure measurements using intraparenchymal monitors were performed in 12 cases of closed head injury. Twenty-four sets of data, including the Glasgow Coma Scale, intracranial pressure, transcranial Doppler, and carbon dioxide pressure were compared. The side-to-side difference in the resistivity index was also assessed. RESULTS: There was a significant correlation between increased pressure values and resistivity index when comparing measurements from the same side. There was no correlation between carbon dioxide pressure and any transcranial Doppler parameter or intracranial pressure measurement. No significant correlation was found between the resistivity index and the Glasgow Coma Scale. End diastolic velocity was a stronger determinant of resistivity index than peak systolic velocity. CONCLUSION: The relationship of ipsilateral measurements of intracranial pressure to resistivity index is valid. The resistivity index must be analyzed within the context of the particular disease studied, especially with respect to the hemodynamic alterations. Initial findings suggest that intracranial pressure monitoring cannot be replaced by serial transcranial Doppler measurements in the treatment of the patient with acute head injury.

Cerebral blood flow velocity after head injury: transcranial Doppler evaluation. Work in progress.

To study blood flow velocity (BFV) changes, serial transcranial Doppler ultrasound (US) examinations of basal cerebral arteries were performed in 47 patients with head injury. Computed tomographic (CT) scans obtained at admission were analyzed for the presence of intracranial hemorrhages. Glasgow Coma Scale scores were obtained at admission in 46 patients. The prevalence of posttraumatic increased BFV was 77% (n = 36). Two groups of patients were identified according to the time of onset of increased BFV. They differed with respect to duration and severity of changes, Glasgow Coma Scale score, and evidence of intracranial hemorrhagic lesions. Low Glasgow Coma Scale scores were predictive of increased BFV within 72 hours after injury (P < .001). Patients with hemorrhages were significantly more prone to experience increased BFV within 72 hours (P < .05); 34% of patients who did not have hemorrhage, however, developed increased BFV. Increased BFV after head trauma is not uniformly found and cannot be explained by one pathologic mechanism.

Trigeminal neuralgia: MR imaging features.

Magnetic resonance (MR) imaging was used to evaluate the relationship of the cisternal portion of the fifth cranial nerve to surrounding vascular structures in six patients with documented trigeminal neuralgia and in 85 asymptomatic patients. MR imaging clearly demonstrated the course of the fifth nerve from its root entry zone (REZ) to the Meckel cave and its relationship to the surrounding vertebrobasilar system. In the six patients with trigeminal neuralgia, the presence of a vascular structure at the REZ of the fifth nerve was identified. In the 85 asymptomatic patients, examination of 170 trigeminal nerves revealed that 30% had contact between a vascular structure and the fifth nerve at the REZ, but only 2% had actual deformity. These results indicate that although neurovascular contact may be asymptomatic, MR demonstration of a vascular structure at the REZ of the fifth cranial nerve in a patient with trigeminal neuralgia may implicate this as the cause of symptoms, which may influence the treatment of choice. Because of the inherent limitations of computed tomography in the visualization of posterior fossa structures, MR imaging should be considered the initial screening procedure in the assessment of patients with trigeminal neuralgia.

Solitary diverticulum of the caecal area.

Two cases of acute inflammation of a solitary diverticulum of the caecal area are reported, which illustrate the unusual, but well documented, problems that may arise in this condition. The first patient presented with clinical symptoms and signs of acute appendicitis, but the operative findings suggested carcinoma of the caecum. The second patient presented with pyrexia of unknown origin, and the preoperative diagnosis was that of cholangitis. The treatment by right hemicolectomy was successful in both cases, and this operation is recommended for patients who present with a complication of a solitary diverticulum in the caecal area.

13C nuclear magnetic resonance studies of the composition and fluidity of several chloroplast monogalactosyldiacylglycerols.

The motional properties of four monogalactosyldiacylglycerols isolated from photosynthetic membranes, and containing different fatty acid chain lengths and degrees of unsaturation, have been determined using 13C nuclear magnetic resonance. These properties have been compared with those of a lipid containing only saturated fatty acids. The 13C longitudinal relaxation times (T1) of the carbon atoms of the acyl chains in [2H4] methanol were measured as an index of the rates of motion of the lipid molecules and used to compare the relative fluidity of the acyl chains. The T1 values of the glyceryl and galactosyl carbon atoms in each monogalactosyldiacylglycerol are essentially constant, when allowance is made for concentration differences and the presence of two hydrogens on a methylene carbon versus one on a methine carbon. These results indicate similar rates of motion for the headgroup carbons in each lipid. However, for the acyl chains, the T1 values increase with the introduction of a double bond and increase further with additional unsaturation. This increase in the rate of motion only occurs at carbon atoms beyond the first double bond in an acyl chain. These results differ to those reported for monolayer experiments where changes in packing characteristics are predominantly dependent on the introduction of the first double bond and then vary little between species.