Evaluating the Cost of Prevention Programming and Universal Screening with Discrete Event Simulation.

Discrete Event Simulation (DES) is a novel system modeling technique that allows for the evaluation of the potential costs and personnel needed for mental health services in school. A case study is presented to illustrate how DES could be used by a school's decision makers to help plan for implementation of an integrated mental health service model. Discrete Event Simulation was used to model the personnel, time, and costs of an integrated mental health service model within a school setting. In addition, costs are calculated and then compared to a business as usual model. Data from the present investigation indicate substantial cost savings of implementing a prevention oriented mental health intervention model within a school setting. In a school of 1000 students, the prevention model could result in an annual cost savings of approximately $30,000 as well as a 50% reduction in disciplinary referrals and 22% reduction in suspensions. Results from the present investigation indicate substantial savings in financial resources and overall numbers of disciplinary infractions when implementing a prevention model. The DES allows for customization of personnel and time to modify the model and resulting output to local conditions. These data may allow school administrators to modify resources to meet student needs. In addition, cost data can help address some of the common implementation barriers associated with adoption of universal screening and preventative mental health services.

Lower Serum Magnesium Concentrations are associated With Specific Heavy Drinking Markers, Pro-Inflammatory Response and Early-Stage Alcohol-associated Liver Injury§.

AIM: Chronic heavy alcohol intake frequently causes liver inflammation/injury, and altered mineral metabolism may be involved in this liver pathology. In this study, we evaluated the association of heavy drinking, changes in serum magnesium levels and biochemical evidence of liver injury in alcohol-use-disorder (AUD) patients who had no clinical signs or symptoms of liver injury. We also aimed to identify any sex-based differences in patients with mild or no biochemical evidence of liver injury induced by heavy drinking. METHODS: 114 heavy drinking alcohol-dependent (AD) female and male patients aged 21-65 years without clinical manifestations of liver injury, who were admitted to an alcohol treatment program, were grouped by alanine aminotransaminase (ALT) levels: ≤ 40 IU/L, as no liver injury (GR.1), and ALT>40 IU/L as mild liver injury (GR.2). Patients were actively drinking until the day of admission. Comprehensive metabolic biochemistry results, fatty acid panel, serum magnesium and drinking history data were collected at admission; and study-specific measures were evaluated. RESULTS: In all AD patients, lower magnesium was significantly associated with the heavy drinking marker and heavy drinking days past 90 days (HDD90). A lower serum magnesium concentration was observed in AD patients with mild liver injury. Females of both groups had mean levels of magnesium in the deficient range. A clinically significant drop in magnesium levels was observed only in the GR.2 (mild liver injury) male AD patients. Females showed a significant association between low magnesium levels and the ω6:ω3 polyunsaturated fatty acids (PUFAs) ratio. CONCLUSIONS: Specific heavy drinking markers showed an association with lower magnesium levels. Low serum magnesium levels are common in subjects with AUD and appear to be associated with the onset of liver injury.

Pneumatic displacement for management of traumatic macular hole with submacular hemorrhage.

Complications of closed-globe injury such as submacular hemorrhage (SMH) and traumatic macular hole (TMH) can be visually devastating. It is observed that TMH occurs in 1.4% of closed-globe injuries and 0.15% of open-globe injuries. There is limited data regarding the incidence of TMH with SMH, given its relatively rare occurrence. Treatment options for SMH include vitrectomy with subretinal r-tissue plasminogen activator (TPA)-assisted clot lysis, intravitreal r-TPA-assisted pneumatic displacement using an expansile gas and postoperative positioning, and finally pneumatic displacement alone. We report a unique case of a 26-year-old female with blunt trauma who developed SMH with TMH and breakthrough vitreous hemorrhage. Successful displacement of subretinal blood from the macula and resolution of the macular hole was achieved on day 1 with pneumatic displacement alone using undiluted C3F8 injection.