Treatment outcome of an outpatient treatment program for dually-diagnosed veterans: the Cincinnati Veterans Affairs Medical Center.

The Dual Diagnosis Clinic at the Cincinnati VA Medical Center is an integrated treatment program for veterans who have an Axis I psychiatric illness in addition to a substance dependence problem. With a high staff-to-patient ratio and an individualized approach, the DDC treats many dual diagnosis patients effectively. To demonstrate the effectiveness of this approach, an outcome study was conducted looking at the psychiatric emergency room visits, hospitalization rates, and the average length of stay for 557 DDC patients. Patients were divided into two groups: those who completed the assessment period, and those who did not. Equal periods of time before and after this assessment period were studied. Those who completed were more likely to have had fewer psychiatric emergency room visits (p < 0.000001) after the assessment period than before when compared to dropouts. The engaged group had the same or more hospital admissions after the assessment period than before, while the dropout group had fewer. This suggests that there is a significant disorder of engagement for the dual diagnosis populations, and that the first impact of successful treatment is engagement.

Thermodynamic basis for a variational model for crystal growth.

Variational models provide an alternative approach to standard sharp interface models for calculating the motion of phase boundaries during solidification. We present a correspondence between objective functions used in variational simulations and specific thermodynamic functions. We demonstrate that variational models with the proposed identification of variables are consistent with nonequilibrium thermodynamics. Variational models are derived for solidification of a pure material and then generalized to obtain a model for solidification of a binary alloy. Conservation laws for internal energy and chemical species and the law of local entropy production are expressed in integral form and used to develop variational principles in which a "free energy," which includes an interfacial contribution, is shown to be a decreasing function of time. This free energy takes on its minimum value over any short time interval, subject to the laws of conservation of internal energy and chemical species. A variational simulation based on this model is described, and shown for small time intervals to provide the Gibbs-Thomson boundary condition at the solid-liquid interface.