Rebirth through supported employment.

In this column, the author describes how supported employment was a conduit for employment for him, and allowed for a remarkable journey of recovery, involving discovery and empowerment, incorporation, purpose, and belonging. After two decades of unemployment or underemployment, he began to see that work was possible through supported education at college, where he excelled. Federal and state grants paid for two thirds of his college education.

Requiring case management meetings to be conducted outside the clinic.

In this Open Forum a psychiatric health care consumer recounts his experience with his state's requirement to hold case management meetings outside of the clinic. Over time, the author found that meeting elsewhere amounted to being put on public display, and he felt embarrassed and powerless to change the situation. Requiring people with psychiatric disorders to meet outside a clinical setting may violate the Health Insurance Portability and Accountability Act and human rights.

Recovery centers for people with severe mental illness: a survey of programs.

Recovery centers are physical entities offering various services and resources for people living with severe mental illness. In this study we identified and surveyed 24 recovery centers recruited through snowball sampling. The goal was to understand the range, common features and nature of current incarnations of recovery centers, assessing commonalities and differences with regards to: (1) overarching philosophies; (2) organizational and operational factors; (3) clientele; (4) service offerings; (5) staffing and financing; and (6) governance and oversight.

First person accounts of long-term employment activity among people with dual diagnosis.

Objective: Evidence suggests that many individuals with dual diagnosis of mental illness and substance use disorder can be successfully employed in competitive jobs, though there remain barriers and facilitators to consistent work activity in this population. The purpose of this study is to elicit and examine first person accounts of work activity over a 16-year period from people with dual diagnosis, who were not selected for employment readiness or vocational interests.

Methods: 120 people with severe mental illness and co-occurring substance use disorder participated in this study.

Eliminating islands in high-pressure free-boundary stellarator magnetohydrodynamic equilibrium solutions.

Magnetic islands in free-boundary stellarator equilibria are suppressed using a procedure that iterates the plasma equilibrium equations and, at each iteration, adjusts the coil geometry to cancel resonant fields produced by the plasma. The coils are constrained to satisfy certain measures of engineering acceptability and the plasma is constrained to ensure kink stability. As the iterations continue, the coil geometry and the plasma simultaneously converge to an equilibrium in which the island content is negligible.

Proposed new duplex classification for threshold stenoses used in various symptomatic and asymptomatic carotid endarterectomy trials.

Current duplex ultrasound criteria for internal carotid artery (ICA) stenosis (1%-15%, 16%-49%, 50%-69%, 70%-99%) may not be applicable to threshold stenoses used in symptomatic (North American Symptomatic Carotid Endarterectomy Trial [NASCET], Veterans' Administration [VA]) and asymptomatic (Asymptomatic Carotid Atherosclerosis Study, VA) carotid endarterectomy (CEA) trials. This, along with increasing reports advocating CEA based on duplex results alone, prompted us to identify (1) new velocity criteria consistent with threshold stenoses used by these trials, and (2) velocity criteria with a high positive predictive value (PPV) (> 95%) and accuracy for detecting > or = 60% and > or = 70% ICA stenoses. This is the first study to propose criteria which can be used for all current CEA trials.