Estimating the Size of the Los Angeles County Jail Mental Health Population Appropriate for Release into Community Services.

In 2015, the Office of Diversion and Reentry Division (ODR), an internal department of the Los Angeles County Department of Health Services, was created to redirect individuals with serious mental illness from the criminal justice system. Part of ODR's mission is to identify individuals currently incarcerated in a Los Angeles County jail who are experiencing a serious mental health disorder and, to the extent practical, provide them with appropriate community-based care with the goals of reducing recidivism and improving health outcomes. Such redirection from the traditional criminal justice process is often characterized as diversion. To better build and scale efforts to support this work, in 2018, the Los Angeles County's Board of Supervisors asked for a study of the existing county jail mental health population to identify those who would likely be eligible for diversion based on legal and clinical factors. Researchers found that an estimated 61 percent of the jail mental health population were likely appropriate candidates for diversion; 7 percent were potentially appropriate; and 32 percent were likely not appropriate candidates for diversion. These findings will help the county determine how it would need to scale community-based treatment programs to accommodate these individuals. The authors also provide recommendations for future programming and research. This study will be of interest to state and county governments as well as other organizations serving criminal justice-involved populations with serious mental illness.

Integrating Department of Defense and Department of Veterans Affairs Purchased Care: Preliminary Feasibility Assessment.

The U.S. Department of Defense (DoD) and U.S. Department of Veterans Affairs (VA) health systems provide services through a mix of direct care, delivered at government facilities, and purchased care, provided through the private sector, mainly by community-based providers who have entered into contracts with third-party administrators (TPAs). In the interest of expanding DoD-VA resource sharing that may lead to greater efficiencies and cost savings, the DoD/VA Joint Executive Committee is exploring options to integrate DoD and VA's purchased care programs. This preliminary feasibility assessment examined how an integrated approach to purchasing care could affect access, quality, and costs for beneficiaries, DoD, and VA and identified general legislative, policy, and contractual challenges to implementing an integrated purchased care program. An integrated approach to purchasing care is feasible under current legal and regulatory authorities, but policy changes may be needed-and the practicality of such an approach depends on the contract and network design. For example, legal/regulatory changes in how contracts are established would be required to achieve any real savings to the government. There are also differences in the populations served by TRICARE (DoD health care) and VA, particularly in terms of age and geographic location. Implementation would be further complicated by contractual differences in the TPA contracts for VA and DoD as they relate to network standards, provider payments, network participation requirements, and reporting requirements and incentive structures. As a result, there are significant uncertainties with respect to increased efficiency or cost savings for the government.

Treatment of superficial and perforator reflux and deep venous stenosis improves healing of chronic venous leg ulcers.

OBJECTIVE: To evaluate the impact of three treatment modalities, superficial truncal vein ablation, perforator vein ablation, and deep venous stenting on venous leg ulcer (VLU) healing, as well as their cumulative effect on ulcer healing, in an attempt to establish the best algorithm for the treatment of chronic and recalcitrant VLUs. METHODS: Multicenter retrospective cohort study using a standardized database to evaluate patients with chronic venous ulcers treated between January 2013 and December 2017. RESULTS: Eight-hundred thirty-two consecutive patients with VLU were identified at 11 centers in the United States. All patients were initially managed with wound care and compression for at least 2 months. Compression and wound care management alone, used in 187 patients, led to ulcer healing in 75% of patients by 36 months. Ulcer recurrence in patients managed without surgery at 6, 12, and 24 months was 3%, 5% and 15%, respectively. Five hundred twenty-eight patients underwent ablation of incompetent superficial veins, and 344 of those also underwent incompetent perforator ablation. Patients who underwent truncal vein ablation alone had an ulcer healing rate of 51% at 36 months. Patients who received both superficial and perforator ablation were significantly younger, and had a 17% improvement in healing at 36 months (68% vs 51%, respectively), but there was no impact of combined superficial and perforator ablations on ulcer recurrence rates. One hundred thirty-four patients had stenosis of one of more lower extremity deep veins and 95 (71%) underwent endovenous stenting. Ulcer healing and recurrence rates for those who underwent stent placement alone was 77% and 27%, respectively, at 36 months. Patients who underwent deep venous stenting and ablation of both incompetent truncal and perforator veins had an ulcer healing rate of 87% at 36 months and ulcer recurrence of 26% at 24 months. CONCLUSIONS: This study demonstrates that correction of superficial truncal vein reflux, as well as deep vein stenosis, both contribute to healing of VLU. Patients who fail to heal their VLU after superficial and perforator ablation should have the iliocaval system imaged to identify hemodynamically significant stenoses or occlusions amenable to stenting, which facilitates venous ulcer healing even in patients with large ulcers.

The diagnostic unreliability of classic physical signs of lymphedema.

OBJECTIVE: In most communities, the diagnosis of lymphedema in the lower extremity currently rests on clinical signs. Lymphoscintigraphy, which is objective, is performed infrequently to confirm the clinical suspicion. Given absence of a curative option for lymphedema, it is essential to obtain an accurate diagnosis before committing the patient to lifelong conservative therapy. The aim of this study was to evaluate the diagnostic accuracy of clinical signs in comparison to lymphoscintigraphy, the current objective standard. METHODS: Retrospective review of contemporaneously collected data of 636 consecutive limbs with swelling (318 left, 318 right) that underwent initial evaluation during a 12-month period between 2016 and 2017 was performed. All limbs were assessed for classic clinical signs of lymphedema including dorsal hump of the foot, square toes, Kaposi-Stemmer sign, and nonpitting edema. Lymphoscintigraphy was routinely performed for objective evaluation. The 436 patients who underwent the study were scored positive for lymphedema on the basis of transit time delay for the radioisotope in minutes, presence of dermal backflow, presence of collateral channels, intensity of uptake in the main channel and lymph nodes, number of nodes in the groin, and presence of popliteal nodes. Analysis was carried out to determine sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of the clinical signs in determining whether a patient had lymphedema. In addition, regression analysis was carried out to evaluate the predictive value of different clinical signs in determining lymphedema. Patients with positive clinical signs but with normal findings on lymphoscintigraphy who did not have a medical cause for swelling underwent workup to determine a possible venous cause. RESULTS: Of 636 limbs with swelling, 436 (69%) underwent lymphoscintigraphy, the findings of which were normal in 178 (41%) and abnormal in 258 (59%). Of the 636 swollen limbs, 96 (15%) had clinical signs of lymphedema; 95% had dorsal hump, 37% had square toes, 32% had presence of Kaposi-Stemmer sign, and 12% had nonpitting edema. Of these 96, lymphoscintigraphy was performed on 66 (69%); 45 of 66 (68%) patients with clinical signs were positive for lymphedema; the remaining 32% were normal. Conversely, among 258 swollen limbs with abnormal findings on lymphoscintigraphy, only 45 (17%) had one or more of the clinical signs. Sensitivity and specificity of clinical signs in predicting lymphoscintigraphy-confirmed lymphedema were 17% and 88%, respectively. Overall accuracy was 47%. Of the clinical signs, only the Kaposi-Stemmer sign was a significant predictor of lymphedema (odds ratio, 7.9; P = .02). In patients with positive clinical signs but normal findings on lymphoscintigraphy, venous obstruction was the most common cause of swelling. CONCLUSIONS: Clinical signs of lymphedema appear to be unreliable in making a correct diagnosis of lymphedema in one-third of patients. Conversely, in lymphoscintigraphy-confirmed lymphedema, only 17% had positive clinical signs. Of the clinical signs, only Kaposi-Stemmer sign has some predictability in determining lymphoscintigraphy-confirmed lymphedema. Venous obstruction is the most common cause of clinical signs in patients without lymphedema. Routine use of lymphoscintigraphy is recommended in patients to make an objective diagnosis of lymphedema.

Peripheral venous hypertension in chronic venous disease.

BACKGROUND: Microvascular venous hypertension has emerged as a central feature of chronic venous disease (CVD). Yet, the incidence and severity of peripheral venous hypertension in the clinical setting have not been reported. This is an observational study of venous hypertension in the lower limb of a large cohort of patients with suspected CVD referred to a single referral center during a 16-year period. METHODS: Clinical and venous laboratory test data for 8868 limbs of 5792 patients with CVD symptoms seen from 1999 to 2015 were analyzed. Subset A limbs had a mix of obstruction/reflux or neither (n = 4132). These are limbs in which duplex ultrasound reflux (yes/no) status is known. The incidence and severity of obstruction in these limbs are unknown as tests of obstruction were not routinely performed. Subset B limbs had central obstruction (n = 159). These are limbs with intravascular ultrasound-proven stenosis in the iliac veins that was corrected by stent placement. Reflux was assessed by duplex ultrasound and air plethysmography (venous filling index [VFI90]). Pressure measurements included supine venous pressure, erect venous pressure, and ambulatory venous pressure (AMVP). Pressure measurements are categorized according to Clinical, Etiology, Anatomy, and Pathophysiology (CEAP) clinical class, reflux and obstruction with Venn distributions of prevalence. RESULTS: All pressures (supine, erect, and ambulatory) trended worse in higher CEAP clinical classes. Supine foot venous pressures were elevated in 70% and 76% of subsets A and B, respectively. A positive association between elevated supine pressures and reflux could not be shown in this study. Supine foot venous pressure did not worsen with increasing reflux in the two subsets, but erect foot venous pressure did. Elevated supine pressures were associated with obstruction in subset B. AMVP worsened in most higher reflux categories. Ambulatory venous hypertension was dominantly associated (Venn distribution) with reflux, less commonly with obstruction. CONCLUSIONS: Supine venous hypertension is associated with obstruction and does not worsen with reflux. In contrast, erect foot venous pressure worsens in severe reflux categories. Ambulatory venous hypertension worsens in higher CEAP clinical classes. It worsens with increasing reflux. AMVP is dominantly associated (Venn distribution) with reflux, not obstruction.

Ambulatory venous pressure, air plethysmography, and the role of calf venous pump in chronic venous disease.

BACKGROUND: Ambulatory venous pressure (AMVP) records pressure dynamics with calf exercise. Air plethysmography (APG) measures related volume detail. APG has been suggested as a noninvasive surrogate for AMVP. We examine the correlations between APG and AMVP parameters and the role of "calf pump failure" in chronic venous disease (CVD). METHODS: A total of 8456 limbs in 4610 patients investigated for CVD during a 20-year period were analyzed. APG and AMVP data were available in 4599 limbs for calculation of Pearson correlation coefficient; 1347 of these limbs had significant iliac vein stenosis, proven by intravascular ultrasound. Venn diagrams are used to explore overlapping incidence of APG and AMVP abnormalities. RESULTS: APG calf volume and reflux (venous volume, venous filling index) showed progressively significant deterioration with advancing Clinical, Etiology, Anatomy, and Pathophysiology (CEAP) clinical class, anatomic extent of reflux (superficial, deep, perforator), and reflux severity (axial reflux, segmental score). Notably, calf ejection volume increased in a nearly linear fashion (R = 0.71) to venous volume such that residual volume fraction (RVF) remained normal even in the worst of these categories. AMVP too progressively deteriorated with clinical disease and reflux severity. Venous filling time was the key parameter as the pressure drop alone was abnormal in only 4% of the limbs analyzed. There was no correlation between RVF and AMVP (R = 0.22) or between AMVP and many other APG parameters. Venn distribution showed only minor overlap (30%) between AMVP and key APG abnormalities overall, but the overlap increases from 40% to 70% in advanced clinical and reflux categories. AMVP was rarely abnormal (7%) when APG was normal. Median AMVP was normal in calf pump failure categories, however defined (subnormal ejection fraction, RVF, or both). Median AMVP is normal in venous obstruction without reflux, while AMVP abnormalities are associated three to seven times more with reflux than with obstruction. CONCLUSIONS: APG (venous filling index) is a useful index of reflux. Calf pump ejection is a powerful and plastic compensatory mechanism, and calf pump failure is rare. Ambulatory venous hypertension is dominantly associated with reflux and less with obstruction. AMVP too worsens with clinical and reflux severity categories. However, there is little correlation between APG and AMVP parameters as APG measures volume and AMVP measures pressure, each in its own domain, and the volume-pressure curve is nonlinear. AMVP may be omitted in routine clinical testing if APG is normal, as the yield (7%) will be very low. AMVP reflects venous hypertension, the end stage in CVD. AMVP should be used to identify such cases when APG is abnormal.

The headspace Brief Interventions Clinic: Increasing timely access to effective treatments for young people with early signs of mental health problems.

AIM: Timely access to treatment in the early stages of mental illness is pivotal to recovery and prevention of longer-term disablement. Yet, this can be challenging at times of growing service demands. The headspace Brief Interventions Clinic (BIC) is an innovative treatment model aiming to promote quick access to evidence-based interventions for young people presenting with early signs of mental disorders. METHODS: The BIC treatment package comprises eight skill-building and behavioural intervention modules that young people can choose from. Treatment occurs over a maximum of six sessions with graduate students under supervision. Treatment outcomes are compared at baseline and final sessions, with client satisfaction measured at the final session. RESULTS: Allocation to the BIC occurred within 2 to 3 weeks of initial referral. Most young people (73%) completed their treatment, attending on average four sessions. Significant reductions in overall psychological distress, depressive symptomatology and anxiety severity ratings were observed at completion of treatment, as well as significant improvements in social and occupational functioning. About 91% of young people stated that their outcome expectations had been entirely met and 95% were entirely satisfied with their treatment experience. A strong therapeutic relationship, specific strategies for managing emotions, coping and problem-solving and a choice of engaging in flexible and modularised content were identified as the most valued experiences by young people. CONCLUSION: The BIC might be ideally suited for health care settings aiming to promote timely access to treatments for young people with early signs of mental disorders.

Target Deconvolution Efforts on Wnt Pathway Screen Reveal Dual Modulation of Oxidative Phosphorylation and SERCA2.

Wnt signaling is critical for development, cell proliferation and differentiation, and mutations in this pathway resulting in constitutive signaling have been implicated in various cancers. A pathway screen using a Wnt-dependent reporter identified a chemical series based on a 1,2,3-thiadiazole-5-carboxamide (TDZ) core with sub-micromolar potency. Herein we report a comprehensive mechanism-of-action deconvolution study toward identifying the efficacy target(s) and biological implication of this chemical series involving bottom-up quantitative chemoproteomics, cell biology, and biochemical methods. Through observing the effects of our probes on metabolism and performing confirmatory cellular and biochemical assays, we found that this chemical series inhibits ATP synthesis by uncoupling the mitochondrial potential. Affinity chemoproteomics experiments identified sarco(endo)plasmic reticulum Ca2+ -dependent ATPase (SERCA2) as a binding partner of the TDZ series, and subsequent validation studies suggest that the TDZ series can act as ionophores through SERCA2 toward Wnt pathway inhibition.

Authorities and Mechanisms for Purchased Care at the Department of Veterans Affairs.

The Veterans Access, Choice, and Accountability Act of 2014 addressed the need for access to timely, high-quality health care for veterans. Section 201 of the legislation called for an independent assessment of various aspects of veterans' health care. The RAND Corporation was tasked with an assessment of the authorities and mechanisms by which the Department of Veterans Affairs (VA) pays for health care services from non-VA providers. Purchased care accounted for 10 percent, or around $5.6 billion, of VA's health care budget in fiscal year 2014, and the amount of care purchased from outside VA is growing rapidly. VA purchases non-VA care through an array of programs, each with different payment processes and eligibility requirements for veterans and outside providers. A review and analysis of statutes, regulations, legislation, and literature on VA purchased care, along with interviews with expert stakeholders, a survey of VA medical facilities, and an evaluation of local-level policy documents revealed that VA's purchased care system is complex and decentralized. Inconsistencies in procedures, unclear goals, and a lack of cohesive strategy for purchased care could have ramifications for veterans' access to care. Adding to the complexity of VA's purchased care system is a lack of systematic data collection on access to and quality of care provided through VA's purchased care programs. The analysis also explored concepts of "episodes of care" and their implications for purchased care by VA.

Zinc-binding cysteines: diverse functions and structural motifs.

Cysteine residues are known to perform essential functions within proteins, including binding to various metal ions. In particular, cysteine residues can display high affinity toward zinc ions (Zn2+), and these resulting Zn2+-cysteine complexes are critical mediators of protein structure, catalysis and regulation. Recent advances in both experimental and theoretical platforms have accelerated the identification and functional characterization of Zn2+-bound cysteines. Zn2+-cysteine complexes have been observed across diverse protein classes and are known to facilitate a variety of cellular processes. Here, we highlight the structural characteristics and diverse functional roles of Zn2+-cysteine complexes in proteins and describe structural, computational and chemical proteomic technologies that have enabled the global discovery of novel Zn2+-binding cysteines.

Selective 4,6-O-benzylidene formation of methyl α-D-mannopyranoside using 2,6-dimethylbenzaldehyde.

While methyl α-d-glucopyranosides and α-d-galactopyranosides selectively form 4,6-O-benzylidenes when reacted with excess benzaldehyde in the presence of acid catalyst methyl α-d-mannopyranosides does not exhibit the same selectivity because of the cis-arrangement of the C2 and C3 hydroxyl groups. The selectivity for the 4,6-O-benzylidene is restored by using 2,6-dimethylbenzaldehyde instead of benzaldehyde. In addition the excess 2,6-dimethylbenzaldehyde is easily recovered from the reaction by extraction with petroleum ether and can be reused without further purification. The 2,6-dimethylbenzylidene exhibits properties similar to the unsubstituted benzylidene with regard to chemical synthesis.

A competitive chemical-proteomic platform to identify zinc-binding cysteines.

Zinc ions (Zn(2+)) play vital catalytic, structural, and regulatory roles in protein function and are commonly chelated to cysteine residues within the protein framework. Current methods to identify Zn(2+)-binding cysteines rely on computational studies based on known Zn(2+)-chelating motifs, as well as high-resolution structural data. These available approaches preclude the global identification of putative Zn(2+)-chelating cysteines, particularly on poorly characterized proteins in the proteome. Herein, we describe an experimental platform that identifies metal-binding cysteines on the basis of their reduced nucleophilicity upon treatment with metal ions. As validation of our platform, we utilize a peptide-based cysteine-reactive probe to show that the known Zn(2+)-chelating cysteine in sorbitol dehydrogenase (SORD) demonstrates an expected loss in nucleophilicity in the presence of Zn(2+) ions and a gain in nucleophilicity upon treatment with a Zn(2+) chelator. We also identified the active-site cysteine in glutathione S-transferase omega-1 (GSTO1) as a potential Zn(2+)-chelation site, albeit with lower metal affinity relative to SORD. Treatment of recombinant GSTO1 with Zn(2+) ions results in a dose-dependent decrease in GSTO1 activity. Furthermore, we apply a promiscuous cysteine-reactive probe to globally identify putative Zn(2+)-binding cysteines across ∼900 cysteines in the human proteome. This proteomic study identified several well-characterized Zn(2+)-binding proteins, as well as numerous uncharacterized proteins from functionally distinct classes. This platform is highly versatile and provides an experimental tool that complements existing computational and structural methods to identify metal-binding cysteine residues.

An isotopically tagged azobenzene-based cleavable linker for quantitative proteomics.

Putting a number on it: Cleavable linkers are widely utilized in proteomics applications. In particular, the azobenzene-based linker cleaves under mild conditions that are mass-spectrometry-compatible. Here, we adapt this linker for quantitative proteomic applications by incorporating an isotopic label. These light- and heavy-tagged linkers enable the identification and quantitation of labeled peptides from multiple proteomes.

1,3,5-Triazine as a modular scaffold for covalent inhibitors with streamlined target identification.

Small-molecule inhibitors can accelerate the functional annotation and validate the therapeutic potential of proteins implicated in disease. Phenotypic screens provide an effective platform to identify such pharmacological agents but are often hindered by challenges associated with target identification. For many protein targets, these bottlenecks can be overcome by incorporating electrophiles into small molecules to covalently trap interactions in vivo and by employing bioorthogonal handles to enrich the protein targets directly from a complex proteome. Here we present the trifunctionalized 1,3,5-triazine as an ideal modular scaffold for generating libraries of irreversible inhibitors with diverse target specificities. A divergent synthetic scheme was developed to derivatize the triazine with an electrophile for covalent modification of target proteins, an alkyne as a click-chemistry handle for target identification, and a diversity element to direct the compounds toward distinct subsets of the proteome. We specifically targeted our initial library toward cysteine-mediated protein activities through incorporation of thiol-specific electrophiles. From this initial screen we identified two compounds, RB-2-cb and RB-11-ca, which are cell permeable and highly selective covalent modifiers for Cys239 of ß-tubulin (TUBB) and Cys53 of protein disulfide isomerase (PDI) respectively. These compounds demonstrate in vitro and cellular potencies that are comparable to currently available modulators of tubulin polymerization and PDI activity. Our studies demonstrate the versatility of the triazine as a modular scaffold to generate potent and selective covalent modifiers of diverse protein families for chemical genetics applications.

Diverse functional roles of reactive cysteines.

Cysteine residues on proteins play key roles in catalysis and regulation. These functional cysteines serve as active sites for nucleophilic and redox catalysis, sites of allosteric regulation, and metal-binding ligands on proteins from diverse classes including proteases, kinases, metabolic enzymes, and transcription factors. In this review, we focus on a few select examples that serve to highlight the multiple functions performed by cysteines, with an emphasis on cysteine-mediated protein activities implicated in cancer. The enhanced reactivity of functional cysteines renders them susceptible to modification by electrophilic species. Toward this end, we discuss recent advancements and future prospects for utilizing cysteine-reactive small molecules as drugs and imaging agents for the treatment and diagnosis of cancer.

Employer Self-Insurance Decisions and the Implications of the Patient Protection and Affordable Care Act as Modified by the Health Care and Education Reconciliation Act of 2010 (ACA).

The Patient Protection and Affordable Care Act as amended by the Health Care and Education Reconciliation Act of 2010 (ACA) changes the regulatory environment within which health insurance policies on the small-group market are bought and sold. New regulations include rate bands that limit premium price variation, risk-adjustment policies that will transfer funds from low-actuarial-risk to high-actuarial-risk plans, and requirements that plans include "essential health benefits." While the new regulations will be applied to all non-grandfathered fully insured policies purchased by businesses with 100 or fewer workers, self-insured plans are exempt from these regulations. As a result, some firms may have a stronger incentive to offer self-insured plans after the ACA takes full effect. In this article we identify factors that influence employers' decisions to self-insure and estimate how the ACA will influence self-insurance rates. We also consider the implications of higher self-insurance rates for adverse selection in the non-self-insured small-group market and whether enrollees in self-insured plans receive different benefits than enrollees in fully-insured plans. Results are based on data analysis, literature review, findings from discussions with stakeholders, and microsimulation analysis using the COMPARE model. Overall, we find little evidence that self-insured plans differ systematically from fully insured plans in terms of benefit generosity, price, or claims denial rates. Stakeholders expressed significant concern about adverse selection in the health insurance exchanges due to regulatory exemptions for self-insured plans. However, our microsimulation analysis predicts a sizable increase in self-insurance only if comprehensive stop-loss policies become widely available after the ACA takes full effect and the expected cost of self-insuring with stop-loss is comparable to the cost of being fully insured in a market without rating regulations.

Religious practice, blood transfusion, and major medical procedures.

In this debate, we explore the dilemmas between the law, the ethical issues, the good clinical practice, and the wishes of the family. In the scenario chosen, the issues center around not only the senior family members but also of an older child with some rights to self-determination. There are no absolute rights or wrongs to this case, which is based on a synthesis of other actual clinical scenarios. The maze of considerations are not easy to negotiate, and in the final analysis, the surgeon and the anesthetist must also be comfortable with the decisions as they are the active elements that have to practically manage a clinical crisis should it occur. The participants in this debate are all UK based, and as such the legal standpoint reflects UK legislation, and the ethical and clinical reviews are strongly influenced by current attitudes within UK and Europe that may not be exactly mirrored in different cultural frameworks. However, in this article, it is the broad principles behind the differing responses that are important, which it is hoped will stimulate reflection of attitudes and management in different cultural frameworks.

Normal incidence reflection loss from a sandy sediment.

Acoustic reflection loss at normal incidence from a sandy sediment, in the Biodola Gulf on the north side of the island of Elba, Italy, was measured in the frequency band 8-17 kHz, using a self-calibrating method. The water depth was approximately 11 m. The mean and standard deviation of the sand grain diameter were 2.25 (0.21 mm) and 0.6 phi, respectively. The reflection loss was measured using an acoustic intensity integral method, which is insensitive to roughness effects within the selected frequency band. The measured value of reflection loss was 11 dB, +/- 2 dB. The result is consistent with previous measurements in the published literature. The computed reflection loss for a flat interface between water and a uniform fluid or visco-elastic medium with the same properties is 8 dB, +/- 1 dB. The theoretical and experimental values do not significantly overlap, which leads to the conclusion that the visco-elastic model is inappropriate. The Biot model is suggested as a better alternative but more work is needed to ascertain the appropriate parameter values.