Suchergebnisse

January 1984 marked the 25th anniversary of Fidel Castro's emergence to power. The Cuban Revolution: 25 Years Later is a product of the CSIS Cuba Project, a long-term effort to focus public as well as policymaker's attention on Cuba-related affairs. The lead author, Lord Thomas of Swynnerton, is the dean of political-historical studies on Cuba, and author of the encyclopedic Cuba: The Pursuit of Freedom. A great deal of myth surrounds the evolution of Cuba since Castro's emergence to power over 25 years ago. Some of this myth is the product of official Cuban propaganda; some of it is also due to a generally misinformed American public. Sifting through available data to distinguish between fact and fiction, this book evaluates broadly the impact of Castro's regime on Cuba itself. Based on the findings of the CSIS Cuba Project, the book draws on the assessments of 18 top Cuban specialists on the political, economic, cuiturai, and social development of Cuba since 1959. In contrast to democracies such as Costa Rica, the equalization of society that has taken place under Castro's leadership has been accomplished by redistributing existing resources, not by creating new wealth. Moreover, the authors conclude that in politics, culture, and the economy, Cuba under Castro has become and remains rigid, stagnant, enormously militarized, and ideologically absolutist.

BACKGROUND: Homeless veterans often have multiple health care and psychosocial needs, including assistance with access to housing and health care, as well as support for ongoing treatment engagement. The Department of Veterans Affairs (VA) developed specialized Homeless Patient Alignment Care Teams (HPACT) with the goal of offering an integrated, "one-stop program" to address housing and health care needs of homeless veterans. However, while 70% of HPACT's veteran enrollees have co-occurring mental health and substance use disorders, HPACT does not have a uniform, embedded treatment protocol for this subpopulation. One wraparound intervention designed to address the needs of homeless veterans with co-occurring mental health and substance use disorders which is suitable to be integrated into HPACT clinic sites is the evidence-based practice called Maintaining Independence and Sobriety through Systems Integration, Outreach, and Networking-Veterans Edition, or MISSION-Vet. Despite the promise of MISSION-Vet within HPACT clinics, implementation of an evidence-based intervention within a busy program like HPACT can be difficult. The current study is being undertaken to identify an appropriate implementation strategy for MISSION-Vet within HPACT. The study will test the implementation platform called Facilitation and compared to implementation as usual (IU). The aims of this study are as follows: (1) Compare the extent to which IU or Facilitation strategies achieve fidelity to the MISSION-Vet intervention as delivered by HPACT homeless provider staff. (2) Compare the effects of Facilitation and IU strategies on the National HPACT Performance Measures. (3) Compare the effects of IU and Facilitation on the permanent housing status. (4) Identify and describe key stakeholders' (patients, providers, staff) experiences with, and perspectives on, the barriers to, and facilitators of implementing MISSION. DESIGN: Type III Hybrid modified stepped wedge implementation comparing IU to Facilitation across seven HPACT teams in three sites in the greater Los Angeles VA system. This is a cluster randomized trial. DISCUSSION: Integrating MISSION-Vet within HPACT has the potential to improve the health of thousands of veterans, but it is crucial to implement the intervention appropriately in order for it to succeed. The lessons learned in this protocol could assist with a larger roll-out of MISSION within HPACT. This protocol is registered with clinicaltrials.gov and was assigned the number NCT 02942979.