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The significance of interagency collaboration in developing opioid agonist programs for inmates.
A substantial proportion of incarcerated individuals have histories of heroin addiction (Inciardi et al., 1998; Kinlock. Battjes and Schwartz, 2002), and readdiction usually occurs within one month of release from incarceration (Kinlock et al., 2002; Maddux and Desmond, 1981; Nurco, Hanlon and Kinlock, 1991). Readdiction is typically accompanied by increased criminal activity (Chaiken and Chaiken, 1990; Kinlock, O'Grady and Hanlon, 2003; Nurco, 1998), disproportionately high risk of HIV infection (Chitwood, Comerford and Weatherby, 1998; Inciardi et al., 1998), hepatitis B and C infections (Edlin, 2002; Fuller et al., 1999; Hagan et al., 2002), overdose death (Mark et al., 2001; Weatherburn and Lind, 1999) and reincarceration (Hanlon et al., 1998; SAMHSA, 2000). Therefore, the development and implementation of effective drug abuse treatment strategies for incarcerated offenders with heroin addiction histories becomes crucial, not only for the rehabilitation of such persons, but also for their survival and for the safety and welfare of the public (Kinlock et al., 2002; Smith-Rohrberg et al., 2004).
Prisons provide an important opportunity to engage individuals with heroin addiction histories in drug abuse treatment, as many heroin-dependent persons do not receive such treatment while incarcerated (Inciardi et al., 1998) or in the community (Brown and Needle. 1994; Inciardi et al., 1998; Smith-Rohrberg et al., 2004). However, evidence regarding the effectiveness of prison-based treatment is generally limited to one treatment approach--therapeutic community treatment--and research on prison-based therapeutic communities has documented that community treatment following release is necessary to sustain institutional program effects (Inciardi et al., 1997; Pearson and Lipton, 1999). Since therapeutic community treatment is not universally appropriate, acceptable or effective for all individuals with heroin addiction histories, clearly a variety of effective treatment approaches are urgently needed that span the institution and the community and that address heroin addiction as a chronic relapsing disorder.
More than 30 years of research evidence in community-based settings has found that opioid agonist therapy with methadone, Levo-alpha-acetylmethadol (LAAM) or buprenorphine is highly effective in reducing heroin addiction, HIV-related risk behavior and criminal activity (Ball and Ross, 1991; Jaffe and Senay, 1971; Johnson et al., 2000; Joseph, Stancliff and Langrod, 2000; Platt et al., 1998; Yoast et at., 2001). Furthermore, and of particular significance, methadone maintenance has been found superior to other treatment modalities in retaining addicted clients in treatment (Platt et al., 1998). Retention is essential to successful treatment outcome, as research findings have consistently demonstrated that regardless of modality, the length of time in treatment is directly related to positive post-treatment outcome (Anglin and Hser, 1990; Nurco, Kinlock and Hanlon, 1994; Simpson et al., 1999). In addition, the benefits of methadone maintenance treatment were strongly supported by a consensus development panel of experts convened by the Institute of Medicine (National Consensus Development Panel, 1998). As a result of its effectiveness, the panel strongly recommended that a national commitment should be made to increase access to methadone maintenance treatment for all heroin-dependent individuals under legal supervision.
Despite substantial evidence of the effectiveness of opioid agonist maintenance, the recommendations of the Institute of Medicine panel, and the widespread experience in providing this type of treatment in correctional facilities throughout the world (Jurgens, 2004; McSweeney, Turnbull and Hough, 2002), opioid agonist programs have rarely been implemented in jail and prison settings in the United States. The first such experimental program, initiated in 1968, involved prerelease jail inmates in New York City (Dole et al., 1969). In that study, 12 inmates were initiated on methadone approximately 10 days before their release and then referred to methadone treatment in the community for aftercare. At seven to 10 months post-release, none of the 12 became readdicted, although 10 had used heroin and three had been reincarcerated. In contrast, all 16 members of an untreated control group became readdicted during the follow-up period, and all had been reincarcerated.
A subsequent New York City methadone maintenance program for jail inmates has been operating continuously since 1987. In the Key Extended Entry Program (KEEP), newly admitted jail inmates who are heroin-dependent are started on methadone and arrestees who are enrolled in methadone treatment in the community are maintained on their medication during incarceration and returned to their original treatment programs. KEEP provides approximately 8,000 detoxifications from methadone per year (Catania, 2003). In the initial evaluation of KEEP, individuals who received methadone maintenance treatment were more likely than untreated inmates to be in treatment at the time of follow-up, an average of 6.5 months post-release (Magura et al., 1993). An 11-year analysis of KEEP suggested that jail-based methadone maintenance treatment not only facilitates post-release treatment entry, but also reduces reincarceration (Tomasino et al., 2001).
These positive New York experiences with jail-based methadone maintenance treatment and the pressing need to reduce the adverse health and criminogenic consequences associated with Baltimore's serious and persistent heroin addiction problem (Fuller et al., 1999; Gray and Wish, 1997; Kinlock et al., 2002; Wish and Yacoubian, 2001), led to a pilot study of prison-initiated opioid maintenance treatment (Kinlock et at., 2002) and to a larger, more rigorous ongoing clinical trial with prison-initiated methadone maintenance. The experience gained during these two studies in creating opioid agonist treatment in prison settings, barriers to the implementation of such programs, and recommendations for planning and conducting future studies and programs of this nature follow. The focus of this discussion is on how effective collaboration among correctional, treatment and research staff can help overcome barriers to the development and implementation of in-prison opioid agonist maintenance programs. Given the relative lack of experience in opening, operating and evaluating opioid agonist programs within correctional settings in the United States, this article may serve as a unique and practical guide for interested corrections officials, treatment providers and researchers in the implementation of such urgently needed programs.
Justification for Opioid Agonist Programs for Inmates
In summary, opioid agonist maintenance therapy is an effective and widely used treatment for heroin addiction that has rarely been used with incarcerated individuals who are nearing release. In the jail setting, initiating heroin-dependent individuals on methadone maintenance or detoxification and maintaining arrestees already enrolled in drug abuse treatment programs on their methadone dose makes sound clinical sense and has been found effective through years of practice in New York City and elsewhere (Smith-Rohrberg et al., 2004). Initiating inmates who are not currently heroin-dependent but have pre-incarceration histories of severe, persistent heroin addiction on maintenance treatment prior to release is a promising intervention that warrants research to determine its effectiveness. Such research is urgently needed because relapse to heroin addiction is typically extremely rapid following release from prison, the opportunity to engage newly released individuals in treatment is substantially diminished upon readdiction, and the life-threatening, adverse consequences associated with heroin addiction are substantial.
It is recognized that such interventions involving inmates who are previously, but not currently, heroin-addicted is an unconventional approach that is not without controversy. Yet, such approaches are in accord with long-standing federal regulations regarding opioid agonist maintenance therapy eligibility. Another potential concern regarding initiation of nondependent individuals on opioid agonist therapy involves the risk of overdose with the medication itself. For this reason, inmates who are not physiologically dependent on opioids are started at very low doses (e.g., 5 miligrams of methadone) and increased slowly (5 miligrams of methadone per week) to avoid sedating side effects. Furthermore, all inmates initiated on medication are informed that they may terminate treatment at any time without penalty, and any individuals ending treatment will be tapered off medication to minimize withdrawal symptoms. Thus, sufficient care is taken to minimize risk while providing a service that can significantly reduce the vicious cycle of relapse, recidivism and reincarceration, as well as loss of life from AIDS, hepatitis, overdose and other conditions resulting from heroin dependence.
Planning for an Opioid Agonist Program In a Prison Setting
The authors' pilot study (Kinlock et al., 2002) involved males who were heroin-dependent prior to incarceration and who were incarcerated at a Baltimore prerelease facility administrated by the Maryland Division of Correction. Unlike KEEP, which focuses on shorter-term jail inmates, this pilot project was, to the authors' knowledge, the first that focused on soon-to-be-released prison inmates who had longer periods of incarceration and were not currently heroin-dependent. Inmates with three months to serve before anticipated release and who consented to participate were randomly assigned to one of two conditions. In the experimental condition, after completing a medical examination, participants received thrice-weekly LAAM maintenance and weekly educational group counseling regarding drug abuse. The experimental treatment was provided by staff of a Baltimore community-based opioid agonist maintenance program. Upon release, experimental participants were advised by treatment staff to report to the community-based facility for continuing care. All participants, both control and experminental, received information on how to access drug abuse treatment in the community, as well as standard correctional and public safety supervision.
The in-prison treatment delivered in the pilot study generally surmounted any of the usual resistance to such programs described by Magura et al. (1993), including philosophical opposition to opioid agonist treatment (because it is viewed by some as substituting one addiction for another), and concerns about medication diversion, violence and security breaches. More than 90 percent of inmates who completed treatment with LAAM and counseling in prison entered community treatment, compared with fewer than 10 percent of other participants (Kinlock, Battjes and Schwartz, in press). In addition, 53 percent of experimental participants remained in treatment in the community at least six months, while no other participant did so. These promising findings regarding feasibility and post-release treatment attendance led the Maryland Department of Public Safety and Correctional Services (DPSCS) to pursue further, more rigorous study with methadone in the prison and to actively explore the replication of KEEP in the Baltimore City Detention Center.
In the second study, which is ongoing and builds on the pilot study experiences, males with pre-incarceration heroin dependence and three to six months remaining on their prison sentences who meet the criteria
for opioid agonist treatment are being randomly assigned to one of three conditions: counseling in prison without medication but with referral to outpatient treatment; counseling in prison without medication and with guaranteed admission to opioid agonist treatment with methadone in the community within 10 days of release; or counseling and methadone in prison with guaranteed admission to opioid agonist treatment in the community within 10 days of release. The counseling and methadone treatment are delivered by the same provider in the community, which continues to offer treatment upon release.
Both studies were planned by involving all interested parties from the very beginning. Relationships developed during the pilot study contributed to a smooth transition to the larger-scale investigation. Successful implementation of such a program requires ongoing cooperation among diverse correctional, drug abuse treatment, and research agencies, as each of these agencies has different priorities and agendas, and disparities typically surface when rehabilitation efforts are provided in prison (Field, 1998; Miller, Koons-Witt and Ventura, 2004; Senese and Kalinich, 1997). Therefore. it was essential to regularly have structured discussions with leaders from the correctional, treatment and research agencies to work out the design and plans for study implementation. Implementation issues of initial concern included choice of the correctional facility and choice of medication logistics.
The two types of facilities in which opioid maintenance programs can operate are jails, which house individuals awaiting trial and those with sentences generally less than one year, or prerelease prisons, which house individuals who are reentering society after serving sentences of more than one year. In the case of the current studies. Maryland DPSCS staff at the time did not want to conduct such a program in the jail, though it was the venue preferred by the treatment and research staff, given the success of New York City's KEEP and the need to treat inmates suffering from opioid withdrawal. However, corrections officials opposed this plan because the jail handled a much higher volume of inmates (more than 100,000 arrestees per year) with a much quicker and more unpredictable turnover. Therefore, key corrections personnel felt that it would be difficult for their staff to attend to the logistical needs of the program given the high demand on their time. Furthermore, even though the Maryland corrections secretary supported such a program, the warden of the facility at the time was philosophically opposed to opioid agonist maintenance.
The collaboration described above was essential for establishing criteria for the selection of an appropriate facility. Criteria for selection, developed jointly by corrections, treatment and research personnel, included proximity to the community-based maintenance treatment program providing service behind the walls to enable staff to more easily travel to the prison and to ensure released participants easy access to the community-based program: a facility with a sufficient number of inmates who are nearing release yet who have sufficient time remaining to carefully be stabilized on an adequate dose of medication: the extent to which the opioid agonist maintenance program would not interfere with security, transfer of inmates and other routine procedures; and a facility in which the warden and key leadership support program implementation. Only the prerelease center in which both the studies were performed met all four criteria.
In planning each of the studies, the authors collaborated with corrections and treatment personnel to develop criteria for the selection of medication, namely cost, side effects, frequency of administration and extent of stigma associated with the medication. LAAM was selected for the initial study for two reasons: (1) First, correctional staff had concerns about having to move inmates to receive medication, and LAAM had the advantage of being administered only three times per week. This was also an advantage for treatment staff, as they had to go to the prison on a less than daily basis. (2) Another advantage over methadone, which applied to LAAM and also applies to buprenorphine, is that fewer people are philosophically opposed to those medications because they are less familiar with them (Smith-Rohrberg et al., 2004). Nevertheless, methadone has a much longer track record of safety and efficacy than both LAAM and buprenorphine (Smith-Rohrberg et al., 2004) and, being a generic drug, is much less costly than buprenorphine.
Logistical concerns included how and where the medication would be stored securely, the hours of medication, designating medication stations and rooms to provide counseling sessions, and the need to provide additional security. Corrections personnel were concerned about storing opioids at the prison even though methadone is administered to pregnant women. In response to these concerns, the staff of the Baltimore opioid agonist maintenance clinic took responsibility for securing and administering medication. Thus, this provision allowed for continuity of care, with the same provider treating individuals in prison and in the community following release. With the same treatment approach provided by the same staff in the institution and community, it would seem more likely that client problems and needs would be recognized and treated in an expedient manner (Field, 1998). A safe was purchased to store the medication at the prison, and appropriate safeguards were taken for security and administration, with only treatment clinic nursing staff having access to medication. The clinic obtained approval from the U.S. Drug Enforcement Agency and the state licensing authority for a medication unit where methodane would be dispensed for the program. Finally, to facilitate access by treatment providers and research staff to the prison, both treatment and research staff obtained official Maryland DPSCS identification cards.
Nature of Collaboration
In the context of developing and evaluating new drug abuse treatment interventions for inmates, drug abuse treatment personnel and correctional employees not only represent agencies with diverse priorities and agendas, but also tend to manifest different beliefs regarding inmate control (Heckert, Jengeleski and Gordon, 1998). In general, the correctional environment places emphasis upon the maintenance of order, security and control of inmates (Heckert et al., 1998; Lombardo, 1989; Miller et al., 2004; Stoikovic and Lovell, 1997). In contrast, the therapeutic culture stresses the need to work with inmates individually as both a control function and as a reward for pro-social behavior. Thus, unlike many drug abuse treatment interventions conducted in a prison setting, such as therapeutic communities, which are set apart from the rest of the prison environment (Inciardi. 2002), opioid agonist therapies provide a humanistic intervention without attempting to interfere with usual custodial practices in a prison environment. Inmates, regardless of whether they participated in the program, remained subject to the same housing, rules, regulations and sanctions for rule violations.
In the early stages of pilot project implementation, a number of conflicts emerged between treatment and correctional staff. Although difficulties were certainly anticipated by research staff given that divergent priorities and procedures become apparent when rehabilitation efforts are implemented in prison, the nature of some of these difficulties was unique to this particular pilot project. For example, unlike many prison-based drug abuse treatment interventions, which are delivered by correctional counselors or case managers, the opioid agonist treatment was delivered by clinicians who lacked experience in providing services in a prison environment. Furthermore, the medical and counseling staff who were responsible for delivering the intervention were not accustomed to, and initially not altogether comfortable with, going outside of their community-based facility to provide services, let alone going to an environment that traditionally places a greater emphasis on security and custodial matters than on more humanistic concerns. In other words, treatment staff had been highly successful in having individuals who were currently addicted come to them for services; in contrast, these studies required treatment staff to go to a markedly different environment as well as to collaborate with others (research and correctional staff) in identifying inmates who were not currently addicted but otherwise eligible and willing to participate. Therefore, carrying out these procedures on correctional "turf" were at times seen as quite challenging to undertake on the part of treatment staff.
In the planning meetings between treatment, correctional and research staff, the significance was recognized to involve not only key staff, but also several correctional officers who would be most likely to have daily contact with program participants. Since correctional officers are involved in influencing inmates--having daily contact with them, writing passes and escorting them to treatment interventions--these behaviors can impact, positively or negatively, inmate participation in, and commitment to. rehabilitation efforts (Miller et al., 2004; Senese and Kalinich, 1997). This is further compounded by the extent of role conflict among correctional staff that is an inherent contradiction between custody and treatment goals (Farkas, 2000; Josi and Sechrest, 1998; Kifer, Hemmens and Stohr, 2003). A consensual model representing a balance between custody and human services (Farkas, 2000; Johnson, 1996) would help to identify roles more clearly and cause less confusion between officers and administrative personnel. Current rehabilitative efforts in prison are frequently compromised because officers disapprove of, or have doubts about, the effectiveness and impact of rehabilitation (Lariviere, 2001). Thus, in the beginning of the pilot study, it was essential for medical staff to conduct a series of orientation sessions at the prison with correctional officers to educate them about the potential benefits and adverse consequences of opioid agonist therapy.
Similarly, a number of correctional officers had expressed concerns about the provision of opioid agonist treatment in their facility. Some of these concerns centered around logistics, space and security, as anticipated. In addition, several officers had voiced their clear philosophical opposition to the delivery of any type of opioid agonist maintenance at the project orientation sessions. Although these officers were informed by key administrators that the project would take place as planned, some continued to express their concerns about such treatment to research staff and, more often, treatment staff.
Several steps were taken to alleviate conflicts between treatment and correctional staff. First, three monthly orientation meetings were held before the beginning of participant recruitment. These meetings established the times and locations for participant recruitment, assessment and treatment (both medication and educational counseling). Immediately prior to the start of participant enrollment, treatment staff held weekly orientation sessions at the prerelease facility. In these meetings, case management and correctional staff were informed about opioid agonist therapy, including its potential benefits and risks, and correctional officers were encouraged to ask about how the provision of opioid agonist therapy would impact security and other aspects of their day-to-day functions. Other meetings also served to reduce conflicts between treatment and correctional staff regarding study implementation.
Selection of Potential Participants
Although 92 percent of the 157 screened inmates initially consented to participate in the pilot study, identifying appropriate treatment candidates was challenging. A crucial lesson was learned during this pilot study concerning the significance of collaborating with corrections personnel to thoroughly screen potential participants for unadjudicated charges that can result in transfers to other prisons and/or extensions of prison time. As was found in the pilot study, the existence of such charges is not easily determined and requires a careful review of an inmate's criminal justice system records, including the FBI database, by the prison's case management personnel. Specifically, 15 percent of study participants were transferred to other prisons and/or received additional time, and therefore, were not able to continue study participation. It was difficult to screen out individuals with unadjudicated charges in the second, ongoing study because the prison's case management staff had to carefully examine the criminal justice system records of each potential participant prior to study enrollment. Given that this task is often time-consuming and is performed by a staff that is already overburdened, additional compensation to these personnel was provided for their assistance.
Treatment Implementation
Several obstacles were discovered in the pilot study with regard to the process of conducting the weekly educational counseling group. Group process was disrupted by the noise from correctional officer walkie-talkies, and the lack of adequate air conditioning in the rooms designated for the group during the summer months also presented problems. After a series of meetings between treatment, correctional and research staff, these problems were minimized.
As anticipated and indicated earlier, there were often conflicts in priorities and procedures between treatment staff and correctional staff. Such conflicts are typical when implementing rehabilitation efforts in correctional facilities (Senese and Kalinich, 1997). Therefore, pilot, or initial exploratory studies, are especially helpful in alleviating tension and developing feasible procedures. Such studies appear especially relevant with respect to opioid agonist maintenance treatment programs conducted within correctional facilities because, as noted earlier, such programs have rarely been developed and evaluated, and corrections officials tend to have unfavorable views of such treatment (Magura et al., 1993; Simpson and Knight. 1998).
In addition, collaboration involving corrections, treatment and research personnel was instrumental in alleviating another obstacle that emerged during the second study. An increasing number of inmates were placed on work details outside the prison. These inmates had difficulty attending group educational counseling sessions because their work detail assignment was scheduled at the same time as the group sessions. Consultation with the prison's case management manager was essential in working out these scheduling conflicts.
Policy Implications
The larger-scale study prompted the Maryland DPSCS Home Detention Unit to change its policy to allow offenders to receive methadone maintenance treatment. Prior to the implementation of the second study, the unit's policy prohibited any offenders who were being prescribed any psychotropic medication or opioid agonist medication to be eligible for home detention. However, they could receive standard parole supervision. Treatment staff and research staff conducted a series of meetings with the unit's new director, a former Maryland state police officer and an advocate of drug abuse treatment, and key unit staff, in which research and treatment staff explained to unit personnel the nature of the study and answered questions about methadone maintenance treatment. In addition to changing the Home Detention Unit's policy, treatment staff were able to coordinate with unit case managers about informing the unit when their clients reported to the community-based facility, and a receptor site was implemented at the treatment facility so the Home Detention Unit could verify when the client arrived and left. The meetings and the initial experiences in working together helped treatment staff and unit case managers to better understand and appreciate one another's work.
Dissemination of Results
Because of the unique, interagency nature of the pilot project, publications regarding that study included the perspectives of treatment and correctional staff as to the success of the program and the manner in which conflicts were handled (Kinlock et al., 2002). Although both treatment and correctional staff emphasized that opioid agonist maintenance is a worthwhile service for inmates with heroin addiction histories because of the high incidence of relapse following release, representatives of these agencies differed somewhat regarding obstacles to the program. Treatment staff indicated that securing sufficient space within the prison for conducting group counseling was difficult and stressed that the need for such space be addressed well in advance in future interventions of this nature. Treatment staff were especially encouraged by the strong tendency for program participants who remained on medication until release to promptly resume their treatment at the community-based clinic despite their long histories of relapse, recidivism and reincarceration. Correctional staff emphasized that implementing such a program in prison is an extremely challenging endeavor in view of the competing requirements of security and space constraints, but these difficulties can be alleviated through careful planning. Thus, a series of meetings are required in order for corrections, treatment and research personnel to develop and work out operational procedures before study implementation and to continue to meet periodically throughout the study so that new obstacles can be recognized and confronted.
In addition, as a result of possible differences among corrections, treatment and research personnel regarding the nature of problems and how they were resolved, it is imperative that all parties carefully review drafts of manuscripts submitted for presentation or publication. It is also common for interagency differences to emerge about how research results are examined, who should define a problem for investigation and the types of subsequent analyses conducted, and where and to whom the results are disseminated (Welsh and Zajac, 2004). Given these circumstances, it is important for the agencies involved to agree beforehand to report how the study was helpful to all agencies involved, specifically the knowledge that can be used to benefit each agency (Welsh and Zajac, 2004). For example, in the pilot study, treatment staff had been particularly impressed by the promptness by which program participants reported to their community-based facility and by their motivation to continue in treatment despite long histories of rapid relapse and recidivism following previous treatment episodes. Thus, treatment staff became more invested in the notion of expanding their services to this underserved client population. Correctional administrators and staff benefited from the pilot program by learning that another service can be added to the array of urgently needed programs for heroin-dependent offenders and that such a program can alleviate placing an additional burden on a severely overwhelmed system by reducing reincarceration.
Finally, the development of a specific memorandum of understanding at the outset of the study can serve to clarify the various roles of key players, contributing to a more smoothly run project. If an initial agreement is not implemented, it may facilitate an atmosphere of intolerance. resulting in a diminution of support. In such situations, correctional and treatment staff are far less likely to respond to urgent problems and barriers during study implementation (Miller et al., 2004).
From these experiences in conducting new opioid agonist maintenance programs in correctional settings, the following recommendations are offered to guide future endeavors of this nature.
Planning should be conducted in full partnership with drug treatment and corrections personnel, as well as with research staff when an evaluation is to be included in the program. Specify in advance the roles of treatment and corrections personnel. Conduct a series of regularly scheduled meetings (ideally, the same time and place each week) involving key drug abuse treatment, corrections and research personnel. Prepare and follow a written agenda for each meeting, with sufficient time allowed for unresolved issues. Designate one key person at the prison to be the liaison for the project. In that person's absence, designate a backup.
Involve key prison officials (i.e., warden, assistant warden and chief of security) at key meetings. Have several meetings with key prison staff and treatment staff shortly after funding begins, and before and shortly after participant enrollment begins.
In addition, have a deadline for all parties to agree on the basic design and implementation of the study. Allow for various contingencies should plans not work out. Emphasize resolving differences regarding logistics and space. Make sure that study intervention, recruitment and assessment procedures will not interfere with standard security and other operating procedures at the prison such as visiting hours, mealtimes, commissary or prison yard time, and work release/detail.
Also, emphasize the need for private rooms for all confidential activities. Emphasize that securing private rooms means that no one other than the necessary research or treatment personnel can see and hear what goes on. Finally, select medication that fits well with the structure and operation of the institution that is widely available in the community upon release.
Implications for Correctional Administrators
Implementing opioid agonist maintenance programs outside the context of research as well as the initiation of other types of prison-based therapeutic programming (e.g., drug-free substance abuse treatment, life skills training, educational training) also requires a key commitment from correctional administrators and line staff. In setting up drug abuse treatment programs in their facilities, correctional administrators must deal with multifaceted logistical and security concerns, including staffing of programs. For example, whether the treatment will be provided by counseling or case management staff within or outside the facility; hours of operation; security of the program; and inmate movement to and from these programs. Administrators and security personnel must ensure that such programs do not interfere with ongoing routines in the prison. Furthermore, administrators must set clear missions and goals of the importance of therapeutic-based programs, as correctional officers are involved in influencing inmates (favorably or unfavorably), meaning that these behaviors can impact inmate participation and morale within these therapeutic programs.
Many incarcerated offenders have heroin addiction histories but are not exposed to drug abuse treatment, neither in the institution or upon release. Opioid agonist therapy programs have the potential to fill an urgent need, as emphasized by the Office of National Drug Control Policy (2001) and the American Association for the Treatment of Opioid Dependence (2004), to ensure a continuum of treatment beginning in the institution and continuing in the community. In addition, the presently described programs deliver continuity of care in a manner consistent with Field's (1998) observation that the most promising interventions for reducing addiction and its accompanying adverse health and crime problems involve corrections-treatment collaborations, with a single team taking main responsibility for rehabilitative efforts, thus being more likely to recognize and treat client needs expediently.
Clearly, corrections, treatment and research personnel can collaborate to accomplish an extremely challenging task--to develop, implement and evaluate new opioid agonist therapy programs for prison inmates with histories of heroin addiction. As such, it can serve as a guide for planning subsequent opioid agonist programs as well as other types of therapeutic interventions in a correctional setting. Researchers evaluating such programs should not simply report on the extent to which the program reduced addiction and its adverse consequences, but also report on the nature of barriers encountered and how they were overcome.
(1) Because of changes in LAAM's labeling, resulting from its association with cardiac arrhythmias in a small number of patients, it is no longer available as a first line treatment for heroin addiction. This change occurred during the end of the pilot study, and all study participants who reported to the community-based clinic were subsequently switched to methadone.
(2) This consideration also applies to buprenorphine, which has been shown effective in an every-other-day dosing schedule (Montoya et al., 2004).
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Kinlock, T.W., R.J. Battjes and R.P. Schwartz. (in press). A novel opioid maintenance treatment program for prisoners: Report of post-release outcomes. American Journal of Drug and Alcohol Abuse.
Kinlock, T.W., K.E. O'Grady and T.E. Hanlon. 2003. Prediction of the criminal activity of incarcerated drug-abusing offenders. Journal of Drug Issues, 33(4):897-920.
Lariviere, M. 2001. Antecedents and outcomes of correctional officer attitudes towards federal inmates: An exploration of person-organization fit. Unpublished doctoral thesis. Ottawa: Carelton University.
Lombardo, L.X. 1989. Guards imprisoned. Correctional officers at work, second edition. Cincinnati: Anderson.
Maddux, J.F. and D.P. Desmond. 1981. Careers of opioid users. New York: Praeger.
Magura, S., A. Rosenblum, C. Lewis and H. Joseph. 1993. The effectiveness of in-jail methadone maintenance. Journal of Drug Issues, 23(1):75-99.
Mark, T.L., G.E. Woody, T. Juday and H.D. Kleber. 2001. The economic costs of heroin addiction in the United States. Drug and Alcohol Dependence, 61 (2): 195-206.
McSweeney, T, P.J. Turnbull and M. Hough, 2002. Review of criminal justice interventions for drug use in other countries. London: Criminal Policy Research Unit.
Miller, J.M., B.A. Koons-Witt and H.E. Ventura. 2004. Barriers to evaluating the effectiveness of drug treatment behind bars. Journal of Criminal Justice, 32(1):75-83.
Montoya, I.D., D.A. Gorelick, K.L. Preston, J.R. Schroeder, A. Umbricht, L.J. Cheskin, W.R. Lange, C. Contoreggi, R.E. Johnson and P.J. Fudala. 2004. Randomized trial of buprenorphine for treatment of concurrent opiate and cocaine dependence. Clinical Pharmacology Therapeutics, 75(1):34-48.
National Consensus Development Panel on the Effectiveness of Medical Treatment of Opiate Addiction. 1998. National Institutes of Health Consensus Conference. Effective medical treatment of opioid addiction. Journal of the American Medical Association, 280(22): 1936-1943.
Nurco, D.N. 1998. A long-term program of research on drug use and crime. Substance Use and Misuse, 33(9):1817-1837.
Nurco, D.N., T.E. Hanlon and T.W. Kinlock. 1991. Recent research on the relationship between illicit drug use and crime. Behavioral Sciences and the Law, 9:221-242.
Nurco, D.N., T.W. Kinlock and T.E. Hanlon. 1994. The nature and status of drug abuse treatment. Maryland Medical Journal, 43(January):51-57.
Office of National Drug Control Policy. 2001. The national drug control strategy annual report. Washington, D.C.: Author.
Pearson, F.S. and D.S. Lipton. 1999. A meta-analytic review of the effectiveness of corrections-based treatments for drug abuse. The Prison Journal, 79(4):384-410.
Platt, J.J., M. Widman, V. Lidz and D. Marlowe. 1998. Methadone maintenance treatment: Its development and effectiveness after 30 years. In Heroin in the age of crack-cocaine, eds. J.A. Inciardi and L. Harrison, 160-187. Thousand Oaks, Calif.: Sage.
Senese, J.D. and D.B. Kalinich. 1997. Activities and rehabilitation programs for offenders. In Corrections. An introduction, second edition, eds. S. Stojkovic and R. Lovell, 199-235. Cincinnati: Anderson.
Simpson, D.D., J.W. Joe, B.W. Fletcher, R.L. Hubbard and M.D. Anglin. 1999. A national evaluation of treatment outcomes for cocaine dependence. Archives of General Psychiatry, 56(6):507-514.
Simpson, D.D. and K. Knight. 1998. Health, addiction treatment and the criminal justice system. Report to physician leadership on national drug policy. Providence, R.I.: Brown University Center for Alcohol and Addiction Studies.
Smith-Rohrberg, D., R.D. Bruce and F.L. Altice. 2004. Research note--review of corrections-based therapy for opiate-dependent patients: Implications for buprenorphine treatment among correctional populations. Journal of Drug Issues, 34(2):451-480.
Stojkovic, S. and R. Lovell (Eds.) 1997. Corrections. An introduction, second edition. Cincinnati: Anderson.
Substance Abuse and Mental Health Services Administration (SAMHSA). 2000. Year-end 1999 emergency department data from the Drug Abuse Warning Network. Rockville, Md.: SAMHSA.
Tomasino, V., A.J. Swanson, J. Nolan and H. Shuman. 2001. The Key Extended Entry Program (KEEP): A methadone treatment program for opiate-dependent inmates. The Mount Sinai Journal of Medicine, 68(1): 14-20.
Weatherburn, D. and B. Lind. 1999. Heroin harm minimization: Do we really have to choose between law enforcement and treatment? New South Wales Bureau of Crime Statistics and Research Bulletin, 46(November):1-11.
Welsh, W.N. and G. Zajac. 2004. Building an effective research partnership between a university and a state correctional agency: Assessment of drug treatment in Pennsylvania prisons. The Prison Journal, 84(2):143-170.
Wish. E.D. and G.S. Yacoubian. 2001. Findings from the Baltimore City Substance Abuse Need for Treatment (SANTA) project. 2001. College Park, Md.: Center for Substance Abuse Research.
Yoast, R., M.A. Williams, S.D. Deitsehman and H.C. Champion. 2001. Report of the Council on Scientific Affairs: Methadone maintenance and needle-exchange programs to reduce the medical and public health consequences of drug abuse. Journal of Addictive Diseases, 20(2): 15-40.
Timothy W. Kinlock, Ph.D.. is senior research scientist at the Social Research Center, Friends Research Institute in Baltimore. and an adjunct professor in the Division of Criminal Justice. Criminology and Social Policy at the University of Baltimore. Robert P. Schwartz, M.D., is medical director of the Friends Research Institute and drug addiction treatment program officer for the Open Society Institute Baltimore. Michael S. Gordon, MS. is a project manager at the Social Research Center, Friends Research Institute.
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The Carolina Panthers announced on Wednesday that David Gettleman is the team's new general manager.
Gettleman replaces Marty Hurney, who was fired on Oct. 22 after being with the team since 2002.
Spending the prior 13 seasons as the director of pro personnel for the New York Giants, Gettleman served as a senior pro personnel analyst for New York this past season.
Prep basketball scores
Girls scores
Alexander Central 62, Hickory 52
Bunker Hill 56, Draughn 46
Bandys 76, West Caldwell 43
East Burke 52, Newton-Conover 42
Fred T. Foard 32, South Caldwell 28
Hibriten 67, St. Stephens 49
South Iredell 63, Maiden 30
Boys scores
Bunker Hill 68, Draughn 65
East Burke 72, Newton-Conover 57
When Bobcats coach Mike Dunlap looks at point guard Kemba Walker he sees the NBA's next coming of Chris Paul.
Sounds like a reach, but that's how much faith Charlotte's rookie coach has in the second-year player out of Connecticut.
Dunlap has repeatedly told Walker "we're centering our team around you. You're that guy. Now live up to that billing and own what that means."

subset: commoncrawl


text:
The George Zimmerman trial has received a lot of attention and time on cable news. In many ways it resembles the sprawling coverage of earlier sensational trials. But the Zimmerman trial also has important social and cultural questions swirling around it.
Source: NPR
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|Property type
|Minimum Stay
|2 - 3 nights
These wonderful and central apartments are part of a 30' HISTORICAL BUILDING (cited on Guida d'Italia by Touring Club Italiano, Rome, 1993: p 749) in an area rich of Roman ruins. Nearby there are the monumental Porta Maggiore, the S. Giovanni and S. Croce in Gerusalemme Cathedrals and the Colosseum within a 20 minutes walking distance. Well connected to Central Station 'Termini' (bus line n°105 stops in front of the building) and to underground lines (10 minutes walking distance). Bus n°571, stop Porta Maggiore, will take you to Forum Romanum, Campo di Fiori, Saint Peter etc. Supermarkets & banks are just a few meters away. The area has plenty of restaurants, pizzerias and pubs; the trendy districts of San Lorenzo and Pigneto are within a 10 minutes walking distance. The five self-catering apartments have been RENOVATED ON SEPT 2010 with DOUBLE GLASSES WINDOWS and are furnished luxuriously, with attention to every detail: autonomous heating, airconditioning in bedrooms, TV, Wi-Fi Internet.
The apartments do not have a private terrace, but there is a little ROOF GARDEN, which is shared by four apartments, with entrance from the courtyard (spiral staircase of fifteen steps) with a beautiful view on the ancient Roman aqueduct; it may be rented separately for exclusive use.
SHUTTLE SERVICE AND GUIDED TOURS: we cooperate with a shuttle service company to pick you up from Fiumicino and Ciampino Airports at reasonable fares. The company provides guided tours in Rome and Central Italy (Florence and Tuscany, Pompei, Amalfi etc.) with certified English speaking guides.
Please see the reviews for the rating from our reviewers.
Our family greatly enjoyed a vacation this past Christmas (2007) in Rome. Twelve of us stayed in two of Emanuela's apartments and found them to be very comfortable. Our limo drivers had considerable trouble finding the apartment, which I have to attribute to Rome's peculuarities in street naming. Once there it was difficult to see why it was hard to find. I would, however, recommend using the limo service Emanuela recommends to eliminate any problems. Although the apartments are not within the "main" tourist area, they are within walking distance of the Colosseum (a brisk 20 min. walk) and right on the 105 bus line (stop is in front of the apartment) which is only a short bus ride from the Stazione Termini. The 105 runs frequently and also late at night. From the Termini you can get anywhere in the city. We did lots of walking but made good use of the 105 to get us to our starting point each day. I highly recommend a bus/metro pass for the duration of your stay as it makes getting around so much easier. The Roma Pass which includes a 3 day bus/metro pass & 2 museum passes we found to be a very good deal. Emanuela was extremely accommodating and a pleasure to get to know. The apartments were clean, well maintained and nicely furnished. They are in a charming building with great views of a very old aquaduct. While too cold for us to use the porch, I am sure that would make the apartment even more enjoyable in the warmer weather. The apartments are in a very safe, quiet area. There is a supermarket (DICO) behind the building and a nice bakery across the street. I would heartily recommend staying in these apartments, particularly for a larger group (rates are very reasonable, comparatively).
la casa è molto bella, pulita e comoda perchè con i mezzi pubblici in breve tempo si raggiunge la città. durante il nostro soggiorno non abbiamo riscontrato alcun problema. la consigliamo a famiglie e a gruppi di amici.
We would heartily recommend these apartments (stayed in two apartments) because the service from the owner was faultless. She went out of her way to ensure our stay was as pleasurable as possible. She was very helpful right from the start, especially as we had to co-ordinate arrivals from 3 different continents, as an extended family of 7 adults and 3 children. All our questions were answered promptly and when an emergency repair had to be done to one of the apartments, this was carried out quickly and everything worked again as normal. We used the kitchen in one of the apartments a lot, and the local supermarket being so handy meant it was easy to find supplies. There is also a farmers' market most weekdays within walking distance from which we got fresh fruit and veg. The apartments are as described. There isn't a lift so you'd need to carry a pushchair / luggage up/down the stairs - worth bearing in mind when deciding what to bring along. The double-glazed windows helped with reducing the noise from the traffic, which took some getting used to for the adults, though the children slept right through it, which was a bonus.
Thank you to the owner (and to Salvatore who was very helpful with the various airport transfers and providing information about the local market) for helping to make our family reunion to celebrate my mum's birthday a memorable experience for all.
Our family stayed here for five nights with my wife's Italian cousin and her family and we were very happy with the apartment. It had plenty of room for the two families - even with five kids, and two large master bedrooms for the adults,. The kitchen was clean and had everything we needed, and despite being on a busy street we found the apartment was quiet with the windows closed. Emmanuela came to greet us and show us everything we needed, and the superintendent for the building even walked me over to the nearby supermarket to show me where it was. The apartment is a little ways from the main tourist areas, but not too far to walk if you want - and there really is a bus that frequently comes down the street and drops you at Terminale. From there you can get anywhere easily. I bought a number of three day passes and we easily got all around the city using the apartment as a base. Nice restaurants and a pastry shop are nearby and a few blocks away is the pedestrian only shopping area of Pigneto, which has a vibrant nightlife in the evenings. Pay the little extra for use of the terrace - we greatly enjoyed collecting there in the evenings to have dinner and reminisce about the day's activities.
This apartment is in a very convenient location - and you must contact Salvatore for a tour!
It's a short bus ride to the termini in a neighborhood with wonderful restaurants. There's a convenience store, restaurant and bakery right across the street. A few blocks away there are outdoor restaurants in the evenings. In that same spot there's also a great cafe (Bar Sciubba) and a supermarket nearby.
The air conditioning in the bedrooms was fantastic --- seemed that 3 of the 4 bedrooms are air conditioned, the smaller single bedroom is not. That said, there were plenty of beds in the other three bedrooms, and they were all -very- comfortable in August. Ms. Bartoccini was quite helpful and made it easy to book the apartment. The apartment was as advertised – clean and comfortable in a wonderful building. Someone was even there to let us in and leave our bags for the day until later, when we could check in.
What made our trip to Italy much richer was the tours we took with Salvatore Coppola. We had booked this apartment because we read many other positive reviews that it was in a good location and that the owner will refer you to someone for tours. We contacted Salvatore months before to book an airport pickup, a day trip to Pompeii and Mt. Vesuvius, and then a trip through Tuscany (from Rome to Florence). The airport pickup was crucial after an all-night flight. We were brought right to our apartment and we didn't have to start figuring out how to get there and where it was when we were half-asleep. The Pompeii trip was amazing. Salvatore picked us up in a new van, stopped so we could get breakfast, and even arranged for a guide in Pompeii. He also found a wonderful vineyard with a breathtaking view for lunch and then on to Mt. Vesuvius. At the end of our week in Rome we arranged with Salvatore to get from the apartment Florence and get a tour of Tuscany along the way. We stopped in Orvieto, Montepulciano, and Montereggioni- all recommendations of Salvatore. After noticing our interest as he told of a local farm, he called the owner and brought us there right away. We learned so much more information and saw so many more sights from the tours with Salvatore. Later, in another city, we took a group tour which didn't have the flexibility, knowledge or experience we got in our tours with Salvatore. He was a professional and very personable guide. We would strongly recommend him to anyone looking to get the most of your trip to Italy.
We had a very enjoyable stay. The apartment is in a great location in a non-touristy area but within walking distance of several monuments, and with food markets, shops, bars and restaurants conveniently located nearby. The apartment was perfect for us, with very friendly non-invasive owner, and all the facilities we required. We hope to make a return visit at some stage!
To/from Central Station 'Termini: bus 105 stops in front of the building. Bus 571 brings you straightly to Colosseum, Forum Romanum, Campo di Fiori, Vatican, Saint Peter, etc. Supermarket, Bank, Post office, Internet point, laundry, bakery, tabac shop, the delightful Sardinia restaurant BENTU & SOI is a few meters away. The most authentic italian ice cream (at Fassi from 1880) is at two stops of 105 bus line. Very useful!: close to the building (about 50 mt) there is the supermarket "DICO". Nearby trendy pedestrian areas: the district Pigneto (5min), the trendiest of Rome according to the Lonely Planet guide, and "San Lorenzo" (about 600 mt, 10 min). For shopping: the prestigeous brands Prada, Gucci, Furla, Petit Bateau, etc. in Via Appia Nuova and the market in Via Sannio (used clothings and leather). Within walking distance: Colosseum (20'), the Basilica of St John Lateran (12'), Porta Maggiore and Basilica Santa Croce in Gerusalemme (8'). View from the windows: Aqua Claudia aqueduct (38 B.C).
|Rate Period
|Weekend Night
LAST MINUTE - Special price
May 25 2015 - Jun 7 2015
2 night minimum stay
|Notes: Rates are based on 6 guests; add €15 per night, per additional guest
Low Season
Nov 1 2015 - Nov 30 2015
2 night minimum stay
|Notes: Rates are based on 6 guests; add €15 per night, per additional guest
High Season (Christmas)
Dec 23 2015 - Jan 8 2016
3 night minimum stay
|Notes: Rates are based on 6 guests; add €15 per night, per additional guest
My Standard Rate
3 night minimum stay
|Notes: Rates are based on 6 guests; add €15 per night, per additional guest
|No additional mandatory fees
|Refundable damage deposit
|Discounts for children under 16 years old. Children under 4 years old stay for free. Check-in time is between 4 PM to 8:30 PM; you can leave your luggage with us if you arrive earlier. Check-ins between 8:30 PM to 10:30 PM are subject to a €50 fee and require previous agreement. Check-out time is before 10 AM; as with check-in, you can leave your luggage with us for later collection during the day.
Payment is usually accepted in the quoted currency (EUR) unless the currency and the amount is specifically agreed in advance with the owner / advertiser.


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text: The large pizza came out 29$. Turned out a pinch of extra basil 2$, that is not even a toppings. They say one price when you're ordering over the phone, different when picking up – surprise … I might be wrong, but pizza for 29$ is kind of steep. Have to say no caviar or truffles on this pizza.


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Arcteryx Accelero Cap
The Accelero Cap by Arcteryx. A lightweight, short-brimmed running cap with highly breathable side panels for moisture-wicking performance. Featuring a comfortable sweatband and an adjustable stretch closure with quick release bucklette.
SPECIFICATIONS of the Arcteryx Accelero Cap
- Weight: 1.9 oz / 55 g
- DryWeb - 100% polyester
This product can only be shipped within the United States. Please don't hate us.
custy reviews
for the Arcteryx Accelero Cap
Average Custy Rating:
(based on 3 reviews)
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Never having bought a hat online with no way to try it on - I was a little skeptical. But, given my experience with other Arcteryx products I felt fairly confident this would be a high quality; well designed product - and I was correct in my assumption.Very adjustable and well-built - I expect this hat to be my constant companion in the wild for many years. I bought the darkest color to avoid sweat stains. After several trips in sand, rain, and heat - this hat has exceeded my expectations. It dries out well after hand-washing in mild soap - and it retains its original shape!
I wish Arc makes running gear in grey color, Black color is too much of heat magnet, and other color...red? Come on! So the hat is really awesome, keeps sweat out of my eyes even after running for hours. They are also very low profile, and does not have any bump on the top, so I can actually wear headset when I hit the range. Very lightweight, so I can take it anywhere, even on traveling and I don't look like tourist...maybe. Again, the color is the only beef. For running gear, gray is always good for me, because they keep sun light away yet keeps my sweat mark camoed.
Bought mine in black but am suprised at how well this hat keeps my head cool. It breathes extremely well and doesn't get soaked in sweat like every other hat. I can even wear it in the water and it dries very fast.


text:
MEIGS COUNTY — Many people grow up watching their favorite game show and dreaming of being a contestant. For one Meigs County native, that dream came true.
Evan Struble grew up in Syracuse, Ohio, and often watched Jeopardy with his grandmother, the late Mary Lou Ihle.
"I've been a Jeopardy watcher for years and years," Struble said. "In particular, I always spent my evenings with my grandmother, and she and I would play along with the show even when I was as young as nine or ten."
Struble, who now lives in Columbus, Ohio and works at the State Library of Ohio, said when he was older, he decided to try becoming a contestant instead of a viewer.
"I received tons of support from my family and friends," Struble said. "Everyone told me to go for it."
Struble said there are many steps to getting on the show, the first of which is a test that becomes available online once a year.
"I signed up on the Jeopardy website to be notified when the test would be available. This January was my fourth attempt, so fourth time is a charm," Struble said. "The test is fifty questions and timed. You have to know the answer quickly. The frustrating thing is you don't know how you did because you only get contacted if you did well enough to get to the second phase."
This second phase is a live interview and a mock game of Jeopardy. Struble said when he was contacted in July he traveled to Detroit, Michigan for the interview.
"After hearing nothing for about six months, I put it out of my mind and decided to try again next year. Then, I got a phone call asking me to come for an in-person interview in Detroit," Struble said. "You played a mock version of Jeopardy against others who were auditioning. Then, there was an interview to test your personality and charisma. Finally, we had another 50-question test. This one was hand written, and we were only given eight seconds to write each answer."
Struble said after the audition, his name was placed in a pool for 18 months. He could receive a call at any point during this time, or no call at all. Struble's call came in late August asking him to be a contestant in an episode taped in September.
"When they called to tell me I was going to come out to California to tape, I screamed," Struble said. "I didn't think it was real. I thought there was a mistake. I immediately hung up the phone and called my parents. I was excited and nervous."
Struble said he enjoyed the experience and that he felt that everyone involved in the process from producers, staff and Alex Trebek to the other contestants were very nice.
"It was so surreal to be in the studio and see the set you watched on TV, in my case, for 25 years," Struble said. "You get there and think 'Is this really happening?' I didn't realize I would be in such close quarters with the other twenty contestants scheduled to tape that day, but they kept us together and put us all in the same hotel. We became friends. The staff was just so nice to all of us."
Struble's episode aired Friday, December 13 and until then, he had to keep everything secret.
"Keeping quiet was probably the hardest part of the whole process," Struble said. "You can't talk about anything you saw. I had to watch five other shows being taped, and I couldn't even talk about what color shirt Alex Trebek wore. It made Thanksgiving this year so awkward because all of my family members kept asking me about the results, and I kept having to put them off because I had to keep the secret even though I wanted to talk about it."
"It was weird to watch," Struble said. "I've never been on television. I had a viewing party and people were cheering when I got questions right and booing when Alex said I was wrong, and I just appreciate the support."
Struble said he has been recognized by people just by being on the show.
"People come up to me and tell me they remember my face on Jeopardy and talk about how tough the board was that day," Struble said. "One thing they warned us about on the set was 'Facebook groupies' who try to send friend requests to the contestants on the show, and just a few days after my episode aired, people were trying to send me friend requests."
Struble said he came in third place, winning $1,000. He also said although he did not win, he has no reason to complain.
"I didn't have the $1,000 dollars when I went out there, but now I do," Struble said. "It's an experience I'll treasure for the rest of my life so I can't complain about that."
Struble, a 1998 graduate of Southern High School, is the son of Michael and Patricia Struble of Syracuse, Ohio, and grandson of Joseph and Martha Struble of Pomeroy, Ohio, and John Ihle of Racine, Ohio.


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Pacchionian depressions
pacchionian depressions --> granular pits
pits on the inner surface of the skull, along the course of the superior sagittal sinus, in which are lodged the arachnoidal granulations.
Synonym: foveolae granulares, pacchionian depressions.
Please contribute to this project, if you have more information about this term feel free to edit this page
This page was last modified on 3 October 2005, at 21:16. This page has been accessed 1,716 times.
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Opponents wising up to SDSU's running game
But air attack can be just as lethal
The secret is out, though no one was really trying to keep it a secret. San Diego State has a pretty good running game. Head coach Brady Hoke has done everything but buy advertising during the last two Super Bowls to proclaim to the masses that he wants to run the football. Apparently defensive coordinators have been listening. Because they're starting to throw up eight- and nine-man-roadblocks to stop the Aztecs from running crazy.
"You can go to the national convention and ask a defensive coach what's the No. 1 thing you need to do? You need to stop the run and try to make a team be as one-dimensional as you can," said Hoke.
Through the first six weeks of the season, the Aztecs averaged 185.3 rushing yards per game. That total has slipped by almost 20 yards to 168.4 yards per game following a 135-yard performance at New Mexico and a 76-yard performance at Wyoming. Part of the decline is the health of running back Ronnie Hillman, who suffered a hip pointer two weeks ago and missed most of the second half of the New Mexico game. Hoke admitted Hillman wasn't 100 percent during the Wyoming game Saturday.
But mostly it's teams doing whatever they can to stop the Aztecs from moving the ball on the ground. Wyoming, for example, at times would have 10 players dedicated to stopping the run.
"They were obsessed with stopping our run game," said offensive coordinator Al Borges . "It was a complete sellout to stop the run."
And stop it they did, but at a cost. Quarterback Ryan Lindley went over the top for three touchdowns and 365 passing yards -- his highest yardage total of the season. Opponents are learning it can be a risky proposition to overload the box against the Aztecs (6-2, 3-1 Mountain West Conference).
"If they take one thing away, we'll just go over the top," said offensive tackle Tommie Draheim. "If they take that away and step back, we'll pound them with the run."
So it's pick your poison for the Colorado State Rams (3-6, 2-3), who come to Qualcomm Stadium Saturday for a 7 p.m. kickoff. Hoke said from here on out he expects most teams to take a similar tack when scheming for the Aztecs.
Not surprisingly, SDSU's passing numbers have increased as the rushing totals have dipped. Even the threat of Hillman has opened up passing lanes and created more play-action opportunities for Lindley and Borges.
"It's part of being a balanced offense," said Lindley, who has thrown five touchdowns in the last two games. "Different teams are going to do different things to try and shut down our passing game on the outside or load up the box to stop the run. If anything, it's a perk of being balanced and having great playmakers on both the inside and outside."
But that's not good enough for Hoke and his Aztecs. They still want to be able to run the ball in despite the fact the defense is probably going to be sending more players than the line can block. The always-fiery offensive guard Nik Embernate said that shouldn't be an excuse.


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How is Graphene Currently Used and What is the Hope for the Future?
What is Graphene? Fenwick Patent Attorney Has the Answer
In the second video of a three-part series, Fenwick attorney Paul Smith talks about the growing anticipation surrounding this strong, conductive and flexible material.
Why the excitement? Simply put, graphene is easy. It's...more
The technology and life sciences communities alike have been raving about new "wonder material" graphene for the past year. From applications for wearable devices to the creation of lightweight, bendable televisions and...more
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Politicians and Election, Vote in Freedom, Actively Participate in Democracy, Vote for Change, Online referendum
Peak oil (Energy Crisis)
> global > Events > Peak oil (Energy Crisis)
Peak oil (Energy Crisis) is ready for your opinion, support and vote. Vote online NOW!
Peak oil alarmist
The point in time when the maximum rate of global petroleum extraction is reached.
Peak oil sceptic
The current round of peak oil predictions is rather "unscientific", there are large reserves and natural resources on the Earth.
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|Love is what we call the situation which occurs when two people who are sexually comptatible discover that they can also tolerate one another in various other circumstances.
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text: http://crunchbang.org – Hey, new #! user here. I installed the 32-bit version on a 32-bit Debian Virtualbox drive on a 64-bit Win8 machine to practice C on. All was looking to work well until I downloaded and installed valgrind-3.8.1 and tried to run it on a simple "Hello World"-type C program, at which point I got the following error:valgrind: Fatal error at startup: a function redirection valgrind: which is mandatory for this platform-tool combination valgrind: cannot be set up. Details of the redirection are: valgrind: valgrind: A must-be-redirected function valgrind: whose name matches the patte (HowTos)


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2006 Mazda 3 : 10.150 @ 134.000
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At Fins Attached: Marine Research and Conservation, we're all passionate volunteers. And, as far as we're concerned, nothing is more important than doing everything we can to protect these magnificent animals! If you're anything like us, after your shark dive, you'll be hooked. Whether you're interested in just diving with them, or to get more involved in the cause, we're where you want to be.
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18-12 OK State final.
Kudos to those that called the 184 result
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18-12 OK State final.
Kudos to those that called the 184 result
For some reason the live updates on the OSU website stopped after Z escaped to start the third and took a 5-3 lead.
They came back Z wins 7-3.
OSU 18 Iowa 12
About what I expected individual match scorewise, but I thought that Lofthouse and Burak would be wins for Iowa. I wasn't expecting DSJ or Oliver to get majors as Derienger and Kelly have been wrestling really tough.
Is the reason BTN didn't televise because it wasn't at a Big 10 School?
All these great matches this weekend and the BTN is showing Girls basketball! Come on man, nobody watches that crap!
This is an ESPN controlled world and ESPN chose to back Girl's Basketball thus everyone follows suit whether not anyone actually cares
A good win for OSU. A lot of 1-point matches. If any of you saw it, were these 1-point matches close and exciting, or cautious with not a lot of action?
OSU All Access is the worst ever. If it's not the constant commercials including the announcer selling us the latest herbicide instead of describing the action that is happening on the mat, or the instant replays that are shown during live action, then it's the full screen wrestler bio's displayed whenever there's a break in the action. I mean nobody wants to actually watch Smith and Brands jawing at each other while the officials are trying to sort out their botched call, and this is certainly not the time for an instant replay so that we can review the disputed call. It's much more calming to stare at an orange screen and listen to Rex Holt talk about "two mules butting heads".


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The biography of Grace Stone Coates. This page has biographical information on Grace Stone Coates, one of the best poets of all time. This PoetrySoup page also provides access to the poet's poems, best poetry, quotes, and video biographies...if available.
Grace Stone Coates (1881–1976) wrote short stories, novels, poetry, and news articles. She spent most of her time writing out of her home in Martinsdale, Montana. Coates published her first poem, "The Intruder," in 1921 and her first novel, Black Cherries, in 1931. She co-edited and wrote for Frontier, a literary magazine edited by Harold G. Merriam, a creative writing professor at the University of Montana.. Montana writer
Sorry, no poems have been posted.
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Samsung UN46ES6500F
Samsung UN46ES6500F : Angle Style-wise, the UN46ES6500F is easy on the eyes. The panel, which actually measures 45.9 inches, is framed by an ultra-slim (0.5-inch) matte black bezel and sits in a slender 1.25 inch cabinet (the bottom juts out to 1.9 inches to accommodate the down-firing speakers).
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IOS Speed Runs
Edit Page Last Edit: 2 years 4 months ago
Speed Runs
Speed Runs are Races where a driver must maintain a consistent minimum average speed along the length of a course. For example, a Race might require that the driver maintain an average speed of 150mph. Failure to meet the required speed average at the finish line results in loss of the race.
List of iOS Speed Runs:
- Uptempo - Peterson Street
- Everyday Runner - Downtown
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Community Archive
Candlelight vigil for suicide prevention to be held Sept. 12
The Clermont County Suicide Prevention Coalition will host its 12th annual candle- light vigil to remember, honor, and cherish the lives of those individuals lost to suicide in Clermont County over the past year at 7 p.m. Thursday, Sept. 12 at Veterans Park in Union Township. Five million living Americans have lost a close family [ Read More ]
Lantern Lighting Ceremony to be held at Mt. Moriah Cemetery
The Union Township Board of Trustees has announced the Sixth Annual Lantern Lighting Ceremony from 5 – 7:30 p.m. Saturday, Sept. 15, at Mt. Moriah Cemetery, 686 Mt. Moriah Drive, Union Township. Since 2008, this event has grown to be one of the most favorite annual events in the area. Created to honor loved ones [ Read More ]
'Go Lions' has a new meaning in Cameroon
When someone yells "Go Lions" in the village of Tugi, Cameroon, Africa, it can cause panic. But this soccer season in Tugi, those words may be coming from the mouth of The Fon, His Royal Highness W.M. Mbakwa, ruler of the village of 3,500. When the Tugi's Government Technical Secondary School soccer team takes the [ Read More ]
Senator Joe Uecker honored by VFW as 'Legislator of the Year'
On Saturday, Aug. 10 the Department of Ohio VFW presented Ohio Senator Joe Uecker (R–Miami Township) with its "Legislator of the Year" award at its annual Council Administration meeting in Columbus. "Veterans are grateful for Senator Uecker's commitment to our issues," said Bill Seagraves, director of VFW of Ohio Charities. His work in the legislature [ Read More ]
Public is invited to the annual Lytle Birthday Celebration
The Williamsburg Harmony Hill Association extends an invitation to the public to attend the annual Lytle Birthday Celebration and open house at Harmony Hill, 299 south Third Street on Sunday afternoon, Sept. 8. Harmony Hill was the homestead of Major General William Lytle, the founder of Williamsburg and often referred to as "The Father of [ Read More ]
Tom Ansteatt honored as CNE Distinguished Alumnus
The Clermont Northeastern High School Distinguished Alumnus Hall of Fame has been established in 2013. This award is to honor graduates who have distinguished themselves in many different fields after leaving high school. Those fields may include Arts/Literature, Business/Industry, Military/Community, Public Service, Science/Education, etc. This award has been bestowed upon Thomas L. Ansteatt, and he [ Read More ]
Clermont County Farm Bureau to hold annual meeting Aug. 29
The Clermont County Farm Bureau Annual Meeting will be held, Thursday, Aug. 29, at Bethel High School, 3420 State Route 125, Bethel. A delicious buffet dinner will be served at 6:30 p.m. The business meeting will following the dinner. During the meeting we will be electing our trustees and state annual meeting delegates; voting on [ Read More ]
Williamsburg Garden Club to meet Tuesday, Sept. 3
The Williamsburg Garden Club will meet at 6:30 p.m. Tuesday evening, Sept. 3 at at the First Presbyterian Church. Hostesses for the evening are Valerie Music and Angie McMahan. Members are to answer roll call by naming what color peonies they grow. The program entitled "A Peony for Your Thoughts" will be presented by David [ Read More ]
4-H members succeed at county and state fairs
Clermont County 4-H youth celebrated many successes during the 2013 Clermont County Fair held July 21-27 and the Ohio State Fair held July 24-Aug. 4. The following delegates from Clermont County won Clock Trophies at the Ohio State Fair: Joanie LaJoye of Wonders of the World for Beginning Cake Decorating, Sr. Division; Lauriann Esz of [ Read More ]
Literacy Network Receives $13,000 from Dollar General
The Literacy Network recently received a $13,000 grant from the Dollar General Literacy Foundation to support its Adult Literacy Services Program, which helps adult students improve their lives by learning how to read. "We are extremely grateful to Dollar General for their generous support to help more adults in Greater Cincinnati reach their goals," says [ Read More ]


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Member News
Top Five Trends in Glass at the AIA Show
As reported by USGlass Magazine, here are the top five trends in glass at the AIA show — Never one to write long if I can write short, here are the top five glass trends from the AIA 2012 convention, which just ended Saturday: 1.Dynamic and solar control glass a-go-go: The primary manufacturers were out … Read more
Posted in Glazing, Member News.
Investing In Ourselves with the AFL-CIO Family of Funds
From the May AFL-CIO Investment Trust Corporation Newsletter — Financing & Owning Our Future BIT Participates in Breakout Session at the Building & Construction Trades Departments 2012 Legislative Conference Over 100 union leaders participated in a session titled, "Financing and Owning Our Future" at the Building & Construction Trades Department's annual legislative conference. The discussion, moderated by … Read more
Did Scott Walker Lie Under Oath to Congress?
Interesting questions surface regarding Walker and the now very famous video making its rounds on the internet. Nation asks the following — …did the governor of Wisconsin lie, under oath, to Congress? The videotape of Walker talking with Diane Hendricks, the Beloit, Wisconsin, billionaire who would eventually give his campaign more than $500,000, surfaced late last … Read more
IUPAT Complete Timeline on Facebook.com/IUPATfan
See the complete IUPAT Timeline on www.facebook.com/IUPATfan beginning with when we were founded in 1887! Be sure to LIKE the page while you're there!
Ullico Inc. Welcomes Six New Board Members
IUPAT Executive General Vice President Kenneth Rigmaiden and former IUPAT Vice President, Newly Elected BCTD President Sean McGarvey Among New Members From ULLICO — May 11, 2012 — Ullico Inc. ("Ullico"), a privately held specialty insurance and investments holding company serving the union workplace, today announced that it has added six new members to its board … Read more
Armageddon in Wisconsin
The Koch brothers and Big Labor. The tea party and progressives. Teachers, gun owners, environmentalists, abortion-rights advocates, conservative billionaires, the national parties — name the interest group or outside party and chances are they've played a role in the June 5 recall campaign against Wisconsin GOP Gov. Scott Walker. Read more at POLITICO.
Contractor Pleads Guilty to Defrauding NYC Painters Local Benefit Fund
Francis Mazzella couldn't quite overcome his old temptation of getting on the take. Nominally the owner of an electrical services contracting firm, he pleaded guilty on February 27 in Brooklyn federal court to defrauding a benefit fund of a Queens, N.Y.-based union, Metal Polishers Local 8A-28A, an affiliate of the International Union of Painters and Allied Trades (IUPAT), … Read more
On C-SPAN: AFL-CIO President Richard Trumka on Newsmakers
FROM C-SPAN: Job numbers for April came out Friday, showing the U.S. unemployment rate at 8.1 percent. A total of one hundred and fifteen thousand jobs were added to the job market last month. On this week's "Newsmakers," AFL-CIO President Richard Trumka discusses these numbers and what that means for America's workers. He also talks … Read more
President Obama at the AFL-CIO BCTD Legislative Conference
From wepartypatriots.com: This video contains highlights from President Barack Obama's speech at the Building and Construction Trades Department's 2012 Legislative Conference. The speech was given at the Washington Hilton on Monday, April 30th and has naturally garnered plenty of online attention.
Mark Pocan, IUPAT Member and Candidate for Congress in Wisconsin, Addresses BCTD Conference
On Tuesday, May 1, 2012, IUPAT member Mark Pocan addressed the delegates of this year's AFL-CIO Building and Construction Trades Department Legislative Conference. An annual event that draws union political activists from around the country to learn more about the issues in this year's election, hone the skills that make them good activists and rally … Read more


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The Allahabad High Court has asked the Uttar Pradesh government to file a counter-affidavit on a petition challenging an amendment in state's urban local self-government laws giving nominated members right to vote in meetings of municipalities.
The order to file the counter-affidavit was passed by a Division Bench comprising Chief Justice D Y Chandrachud and Justice Dilip Gupta. The petition was filed by Neera Chandra, hailing from Meerut, who had contended that the provision was in violation of Article 243R of the Constitution which "specifically provides that nominated members shall not have a right to vote in meetings of the Municipality".
Issuing notice to the state's Advocate General, the court fixed July 31 as the next date of hearing even as it directed that nominated members of the Nagar Palika Parishad, Mawana, Meerut, "may participate in the meetings but they shall have no right to vote".


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|Wilderness Tripping - BWCA & Beyond
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Just reviewed Hatchet from space.
Posted by: ezwater on Apr-22-12 9:32 PM (EST)
The watershed at the guage is relatively small (about 260 square miles) and the hwy 280 put in is well above that, well above where Socatepoy Creek comes in. I would suggest doing the section from hwy 231 to the next county bridge, and you'll still have to wait for a seriously rainy period. Don't mess with Socatepoy, that's serious whitewater.
Have you checked at alabamawhitewater.com?
Portage Carts/Carriers
Paddling Accessories
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text: The Bless the Beasts and Children wiki last edited by Renchamp on 07/10/13 03:28PM View full history His name is Tower, and he's packed with power! He's made the Beast a believer, because Tower kidnapped him for his master, who wants to use the Beast for a series of dangerous gentic experiments! Note: This story was originally solicited with the title: "Bring Me The Head Of Hank McCoy"