1. The food chain of the Southern Ocean has often been characterized as simple and homogeneous. However, the population processes of a key prey organism, krill Euphausia superba, operate over ocean basin scales and are strongly influenced by large scale abiotic factors. 2. A model was developed in which the local prey abundance was regulated by a continuous, hydrodynamically mediated, supply rate and the concentrating effects of abiotic-biotic interactions. This model was used with estimates of the annual predator demands and the prey concentration for the South Georgia area to investigate the relationship between flow rate and depletion in prey concentration as a function of distance from a predator colony. 3. The model results indicated that concentrating factors need to be large to produce the build-up of krill densities of the order estimated to occur in the South Georgia area, with the peak retention rates required some distance offshore. It was, however, found that, for the estimated supply rates, the region does not need to be an area of particularly high prey concentration to support the estimated predator impact. 4. Differential predator foraging ranges produced a more complex response to the reduction of the abundance of particular predators by harvesting, than in the situation where foraging ranges overlapped completely. In such a system the more inshore foraging predators encountered the greatest changes in prey abundance. 5. Random fluctuations in the interannual prey availability were introduced into the simulation of the flow system. This could lead to apparent population cycling in predator and prey abundance due to the interactive form of the system, although the prey population dynamics were not involved. The system enhanced variability such that inshore foraging predators encountered greater variation in prey supply. 6. The model results emphasize the importance of investigating the magnitude and timing of the horizontal fluxes of secondary production in this spatially distributed ecosystem.
The Advertising Standards Authority (ASA) today published a complaint about Ace Relocations, a hybrid HMO landlord that offers professional renters in London rooms within shared properties and blocks of flats and calls itself a ‘house share company’.The complaint was about an advert that the company had place on Spareroom.com, which stated that all bills were included and a cleaner provided. The ASA considered that the advert was likely to have breached its advertising code because “it does not make it clear that the cleaner, and some other costs, are not included in the monthly rent despite the main claim made in the ad”, the ASA said.Ace Relocations agreed to amend both its current website listings and any future adverts, and the ASA file case was closed.What this highlights is the emerging world of hybrid-landlords-cum-property-managers like Ace Relocations. It offers agents and indirectly landlords the opportunity to rent properties outside the traditional tenancy model. Ace Relocations says it is ‘not an estate agent’. It rents properties directly from agents via a ‘commercial contract’ and then rents them to professional tenants.The company doesn’t describe itself as a landlord but, like one, collects the rent and holds the deposit while, like an agent, it charges agency fees when tenants move in. On the other hand it also fulfils the role of a managing agent on behalf of the original landlord because it cleans the property and manages repairs and maintenance.Ace Relocations does not mention deposit protection on its website but the company’s relocation manager Greg Elliot (pictured) says “all our deposits are held legally”.“We also employ the most established property lawyers in the country – Anthony Gold – at great expense in order to ensure that we work strictly within the law. They create all of our licences, deeds, company contracts and advise us of any impending legislation way in advance so we can prepare and adapt to any situation.“Also, we work closely with the National HMO Network and in particular, [consultant] Michele Glazebrook…who has been very impressed with how seriously we take the law and regularly comments on how she wishes other company’s would care and operate like we do.”The company was set up just under three years ago by managing director Christopher Florence, who on the company’s website says he established Ace Relocations because he believed ‘the lettings market was outdated and recognised the ever growing demand for all-inclusive living for professional people in London’.hybrid letting agent ace relocations advertising standards authority December 14, 2016Nigel LewisWhat’s your opinion? Cancel replyYou must be logged in to post a comment.Please note: This is a site for professional discussion. Comments will carry your full name and company.This site uses Akismet to reduce spam. Learn how your comment data is processed.Related articles Letting agent fined £11,500 over unlicenced rent-to-rent HMO3rd May 2021 BREAKING: Evictions paperwork must now include ‘breathing space’ scheme details30th April 2021 City dwellers most satisfied with where they live30th April 2021 Home » News » Agencies & People » Fees complaint to ASA highlights new ‘hybrid’ landlord previous nextAgencies & PeopleFees complaint to ASA highlights new ‘hybrid’ landlordAce Relocations is part landlord, asset manager and tenant finder in oneNigel Lewis14th December 201601,842 Views
The Silk Road Panel, an event initially scheduled to take place at the Oxford Union in early November, has relocated to a college venue following concerns over “anticipated anti-free speech protests” incited by another event being hosted at the Oxford Union on the same day. The Panel, organised by the Oxford Silk Road Society, will represent the first time senior diplomatic leaders from all five Central Asian states – the Republics of Kazakhstan, Kyrgyzstan, Tajikistan, Turkmenistan and Uzbekistan – sit on the same panel at a British university. The panel discussion coincides with Alice Weidel’s visit to the Union, which is also scheduled for Wednesday 7th November. Weidel’s visit has attracted a flurry of negative attention in recent weeks, with Stand Up to Racism Oxford and Unite Against Fascism coming together to organise a protest against the Alternative für Deutschland (AfD) party leader’s visit on grounds that her party “built up its following by stoking up racism against migrants, Muslims, and refugees.” Protestors plan to gather on St Michael’s Street from 6pm on the day of Weidel’s speaker event – at the same time diplomats speaking on the Silk Road Panel were scheduled to dine at the Union, their panel having taken place in that afternoon. Oxford Union President Stephen Horvath told Cherwell: “We regret that the Silk Road Society have chosen to move their exciting panel out of our premises, but we respect their decision.“There were some constraints on our end [to host the Panel on Union premises] due to the anticipated anti-free speech protests that evening (e.g. the inability to host an enjoyable post-event dinner in the Macmillan Room if there are megaphones being used in St Michael’s Street, difficulty for the exit of speakers by car). “There were also points from the Silk Road Society (e.g. the sensitivity of diplomats in thinking the protest might be about them, the request that there must be a dinner). “In light of this, our two societies explored a number of avenues for rescheduling the event, including cancelling the dinner, or changing to one of two possible dates in a seven day window surrounding the scheduled event. “The Silk Road Society then unilaterally (and I don’t mean this in a pejorative way – it is of course their right) decided to move the event off premises and cease any logistical co-operation with the Union in this event.” Silk Road Society President Marcello Fantoni told Cherwell: “Due to the expected protests at the Union on the day that the panel was to be held, we decided to relocate the event to ensure that everything goes smoothly for all parties. “We are confident that we will still be able to host a very productive discussion at our new location, but we regret that it seems preference is being given to controversial speakers.”Fantoni also cited concerns about “forced association through proximity” with the Weidel event. Horvath confirmed that the Union also asked Weidel if she might reschedule so the the Silk Road event could go ahead. However, the far-right politician was “unable to amend her intended travel schedule” to accommodate for a date change. The Silk Road Panel is will now take place in the Nissan Lecture Theatre at St Antony’s College, at the same time as previously scheduled. Oxford Union members will still be able to enjoy free entry for the event.The UK embassies of all five Central Asian Republics have been contacted for comment.
The Cape May County Municipal Utilities Authority (CMCMUA) is replacing/rehabilitating the force mains that carry wastewater to the treatment plant on the bay at 45th Street. The work will be on 31st Street from Haven Avenue to Bay Avenue; and Bay Avenue from 31st Street to Eighth Street.By Oct. 2, the contractor will have completed excavating and securing the tie-in pit at the southern terminus of the project on 31st Street. Consequently, 31st Street will be closed between Simpson and Haven avenues for at least the next week.Starting on Monday, Oct. 5, the contractor will begin excavating a pit at the intersection of 31st Street and Bay Avenue for the purpose of slip-lining a new 16″ HDPE pipe through the existing 20″ DIP pipe to the tie-in pit.Once the tie-ins are completed, the tie-in pit will be backfilled and temporary paved. The slip-lining pit at 31st St and Bay is expected to stay open for two weeks to enable the slip-lining process going north on Bay Avenue.While this pit is open, 31st Street will be closed at Bay Avenue and local detours will be required.Also next week, Video Pipe Services (VPS) will continue with the cleaning of the existing 20″ pipe on Bay Avenue from 15th Street to 8th Street. Traffic control around the VPS trucks will be handled with lane shifts.See full project update. Motorists should watch out for detours on Bay Avenue during construction work.
Erik Wagner and Ruby Doran perform in the Ocean City Theatre Company’s 2019 production of “Little Shop of Horrors.” (Photo courtesy of Erik Wagner) By MADDY VITALEThe Ocean City Theatre Company has struggled during the COVID-19 pandemic with shows canceled and shrinking funds.But with a program that has helped shape and hone so many local talents and delighted audiences at venues throughout the city, the City Council came together to show its support.In a 7-0 vote, Council gave preliminary approval to a five-year extension of the Ocean City Theatre Company’s lease during a meeting Thursday night.During the public comment portion of the meeting, several members of the theatre company said a few words about what the organization and the building means to them.Emile Chevere, 19, of Ocean City, is a performing arts student at Atlantic Cape Community College.Chevere moved to New Jersey four years ago and joined OCTC to help him get involved in the community and get to know people, he said.“I saw how impactful this organization was on my life,” Chevere told the Council members.The Ocean City Theatre Company has leased the space at 1501 West Ave. since 2015.OCTC leases a city-owned building at 1501 West Ave. It has been home to countless rehearsals over the years of novice and veteran performers, singers and dancers.“I think this is excellent,” City Council President Bob Barr said of the lease extension. “It gives the theater company time for long-term planning and to grow their program. This is exactly the type of thing that local governments should do.”In addition to safely securing the building for another five years, there is also wording that states there is an option for two additional five-year lease extensions.Effectively, it becomes a 15-year lease, Barr said.The final vote and public hearing for the lease extension are scheduled for the March 25 Council meeting.City Councilman Jody Levchuk noted that not everyone is into sports at school and the theatre company is a place for artistic talents to shine.“The theatre company offers an outlet for everyone. Not everyone is into sports,” Levchuk noted. “I fully support this, and hopefully in 15 years we will be talking about another 15-year lease there.”Some current OCTC members showed their appreciation to city officials for extending the lease.One of them was Erik Wagner, 18, a senior at Ocean City High School who starred in the theatre company’s 2019 production of “Little Shop of Horrors.”“I have been performing with the OCTC for 10 years,” said Wagner, who lives in Ocean City. “I would like to thank the mayor and the Council for your constant support.”He also spoke of how the theatre company has been a gateway to performing arts for young students.Wagner said the OCTC is essential for nurturing the “creative practices” of performers.Ocean City Theatre Company member Erik Wagner addresses City Council during Thursday’s meeting.Fellow theatre company member Mark Faverzani, who attends St. Augustine Prep, said, “OCTC has had the greatest impact on me. All of the skills I have learned have been completely from the OCTC.”He continued, “We feel so strongly about the theatre company and having that space.”Faverzani also said it is not only important for current members but for future members of OCTC to keep the building at 1501 West Ave.He noted that there could be talents that come from the Intermediate and Primary Schools who have yet to step on the stage.“I hope that you will continuously support the theatre company at 1501 West Avenue,” he added while addressing the Council members.Michael Hartman, a former city employee who founded OCTC, said in a previous OCNJDaily.com interview how vital the theatre company is to the kids and the community.“As always, OCTC provides a safe space for performers of all ages to push their creativity and develop confidence,” Hartman said.For more information, contact [email protected] or to make a donation, mail checks payable to OCTC to 1501 West Avenue, Ocean City, N.J. 08226.Pre-pandemic instructors teach students about performing.
Linpac Packaging has launched a new polyolefin stretch film called MagicLIN. The film has been designed to be easier to cut than traditional cling films, and can be cut by hand, removing the need for a blade.The film is made from multi-layer polyolefin, and can be used to cover food in a refrigerator or a container used in microwave cooking. The film has been manufactured to provide ease of use, strength and visual appeal.[http://www.linpac-plastics.co.uk]
Bakers are encouraged to sign up to take part in Craft Bakers’ Week to maximise the support available.Almost 100 bakeries have registered for this year’s campaign, which takes place from 29 September to 5 October, and will all receive free POS material including bunting and window posters.TV baking stars The Fabulous Baker Brothers Tom and Henry Herbert will return for 2014 and support the campaign on social media and through media interviews, as well as sharing their recipes.Keith Houliston, sales director (craft sector) at British Bakels and chair of Craft Bakers’ Week 2014, said: “We are delighted with the interest so far and excited by hearing what bakers already have planned for the week. The earlier that you sign up, the more time you will have to plan your activities and promotions, and to highlight these to local media and customers. You’ll also feature on the Craft Bakers’ Week website for longer and benefit from the additional exposure that brings.”Register at www.craftbakersweek.co.uk for a small fee, which will be donated to chosen charity Make-a-Wish Foundation UK, which works for children with life-threatening illnesses.
One of the great things about being a Frank Zappa fan is the period installments of new, unreleased material from the vault. Despite family tensions, the Zappa Records label has announced two albums for release on July 15th. Frank Zappa For President and Crux Of The Biscuit are both on their way!In the throes of a heated presidential election, Zappa Records has released a collection of unreleased music composed by Zappa for the Synclavier. With these compositions and a number of politically-themed gems to be mined from the vault, the album is sure to be an ode to Zappa’s witty tendencies. The second album is a companion to ‘ (Apostrophe), with session outtakes, alternates, and live performances. Check out the tracklisting for each, below.FRANK ZAPPA: Frank Zappa for President1. Overture to “Uncle Sam”2. Brown Shoes Don’t Make It (Remix)3. Amnerika (Vocal Version)4. “If I Was President”5. When the Lie’s So Big (Live)6. Medieval Ensemble7. America the Beautiful (Live)FRANK ZAPPA: The Crux of the Biscuit1. Cosmik Debris2. Uncle Remus (Mix Outtake)3. Down In De Dew (Alternate Mix)4. Apostrophe’ (Mix Outtake)5. The Story Of Don’t Eat The Yellow Snow/St. Alphonzo’s Pancake Breakfast6. Don’t Eat The Yellow Snow/St. Alphonzo’s Pancake Breakfast (Live)7. Excentrifugal Forz (Mix Outtake)8. Energy Frontier (Take 4)9. Energy Frontier (Take 6 with OD’s)10. Energy Frontier (Bridge)11. Cosmik Debris (Basic Tracks Take 3)12. Don’t Eat The Yellow Snow (Basic Tracks- Alternate Take)13. Nanook Rubs It (Basic Tracks- Outtake)14. Nanook Rubs It (Session Outtake)15. Frank’s Last Words…..
Death rates from heroin overdose nearly quadrupled in the United States between 2002 and 2013, when the number of people reporting past-year heroin abuse or dependence rose to 517,000, a nearly 150 percent increase from 2007. In 2014, the use of heroin and other opioids killed 1,256 people in Massachusetts, an increase of 34 percent over 2013 and 88 percent over 2012.The Gazette sought insights across several disciplines for a three-part report on the crisis and new ideas for fighting it. Read the first part, on the science of addiction, here. Read the second part, on policy responses, here.For many, Nalan Ward’s daily routine might seem unbearably depressing. As the director of Massachusetts General Hospital’s West End Clinic, an outpatient facility focused on drug-use disorders, Ward regularly treats patients caught up in a cycle of addiction.Thirty-five percent of patients who walk through the doors of her clinic are suffering a primary opioid-use disorder. And 70 percent of those patients arrive with another serious medical condition directly related to or worsened by the drug use, such as hepatitis C, endocarditis (an inflammation of the inner layer of the heart), or sepsis.Then there is a whole group of complications closely tied to addiction. Seventy to 85 percent of the clinic’s patients, Ward said, are depressed, anxious, or experiencing post-traumatic stress disorder. Such a range of symptoms often presents a confusing tangle of cause and effect, one that makes addiction particularly hard to treat.“It’s a complicated, sick population with psychosocial needs complicated by unemployment, no stable place to live, legal issues … these are the kind of patients we see,” said Ward.But for the Turkish-born doctor, the work is anything but depressing. Her attitude is “positive,” not “burned out and negative,” she says, and she finds nourishment in the knowledge that her efforts save lives.It wasn’t always so. As a young psychiatric resident at Boston Medical Center, Ward became frustrated struggling to treat “hard-to-engage” patients who landed in the emergency room in the middle of the night suffering from withdrawal.“It’s just a very bad setting to encounter patients with addictions. You are trying to rationalize or figure out what’s going with someone who is totally intoxicated. There is not a lot to offer in an acute-care setting. Those are some of the things that shape residents’ views and feelings about addiction, and they don’t necessarily see the good, see the long-term outcome.”Ward is just one of many people in the Harvard medical community attacking the scourge of addiction as users of heroin and other opioids continue to fill emergency rooms, hospital beds, and treatment centers.From 2011 to 2012 McLean Hospital saw a 10 percent jump in opioid-addicted patients in its detox unit, said Kevin Hill, director of the hospital’s Substance Abuse Consultation Service. The increase came despite a rise in the number of patients turned down for inpatient treatment by insurance companies that preferred outpatient options, he said.Brigham and Women’s Faulkner Hospital has accepted more than 200 patients at a treatment clinic that opened in 2013. More than half of the clinic’s 100 active patients have histories of heroin use. At Brigham and Women’s itself, in six years the rate of opioid-related inpatient consults for addiction has increased from 22 percent to 75 percent, said addiction psychiatrist Joji Suzuki, who works with patients at both hospitals.Suzuki noted that the profile of opioid users has also changed. “Today they are younger, more educated, less likely to have HIV … patients come from all walks of life.”What’s happening locally reflects what’s happening across the state. According to the Massachusetts Department of Public Health, the number of patients admitted to programs contracted by or licensed to the Bureau of Substance Abuse Services who listed heroin as their primary drug rose from 38.2 percent in 2005 to 53.1 percent in 2014.‘The more I work with those who suffer, the more I am encouraged by how people change, their ability to change, and the ways we can help.’Doctors, nurses, and counselors at Harvard-affiliated hospitals and institutes are determined to offer hope, providing inpatient and outpatient care and drug-assisted therapies. Research is regularly shining new light on the best treatment options. And addiction specialists across Harvard are working to integrate medical and psychiatric services, facilitating treatment in primary-care settings, addressing co-existing conditions, and ramping up access to effective medications.There also has been a concerted effort to remove the stigma surrounding substance use. Addiction, experts agree, needs to be considered a chronic disease, not unlike asthma, diabetes, or high blood pressure, and managed the same way, with interventions such as medication and regular monitoring, and an understanding that relapse is often a routine part of recovery. The treatment standard needs to shift from an acute-care model, they argue, to one of long-term recovery management.“We really have to embrace the idea,” said Ward, “that this is a chronic disease.”Assessing the landscapeAddiction specialists agree that opioid-use disorders demand a multilayered approach, with medication, self-help, counseling, and family support all key to sustained recovery. It’s an addiction known to be particularly difficult to treat, with first-year relapse rates surpassing 80 percent, according to some estimates. Clinical trials have shown that medication-assisted therapies, often in combination with other treatments, offer opioid addicts some of the best chances at long-term recovery.For years, two drugs have led the way in helping ease people off their dependence on opioids: methadone and buprenorphine. Both medications mimic the drugs they are meant to overcome by activating opiate receptors in the brain, yet their longer-acting formulas prevent the “high” of a drug such as heroin while helping reduce the cravings and withdrawal symptoms that can trigger relapse.Approved for use by the Food and Drug Administration in 1972, methadone is still considered one of the most effective medications available for opioid addiction. To be eligible for methadone maintenance treatment a patient must have been suffering from opioid addiction for at least a year and must have failed at least one other type of intervention. The drug is strictly controlled: Patients must visit a federally regulated methadone clinic to receive their daily dose. For some, such a structured treatment works well. But for others the demands of the regimen rule it out, often in tandem with a sense of shame.“Methadone is an incredibly effective treatment option, but there continues to be a lot of stigma around its use,” said Sarah Wakeman, medical director for the substance-use disorder initiative at Massachusetts General Hospital. “People call it the liquid handcuffs because you are sort of linked to the clinic. You have to be there every morning, no matter what, rain or sun. It’s hard to go on vacation, it’s hard to build your work schedule around it.”In October 2002, the FDA radically changed the treatment landscape when it approved buprenorphine for opioid addiction. Instead of referring patients to a special clinic, certified doctors could prescribe the drug in their offices, enabling patients to take the medicine on their own. “It put addiction treatment back into the mainstream of medical practice,” said Roger Weiss, chief of McLean’s Division of Alcohol and Drug Abuse and director of the hospital’s alcohol and drug abuse research program.Weiss is well-versed in the effectiveness of buprenorphine. In 2011 he released the findings of the largest study to date on treatment for prescription-opioid dependence. The findings demonstrated both the difficulty of beating an opioid addiction and the promise of buprenorphine.In the study’s first phase, addicts used buprenorphine for four weeks, tapering off the drug, and then received no further medication. The pull of opioids was illustrated by the rate of patients — just 7 percent — who were subsequently successful at staying clean.In the second phase, directed at the relapse population, subjects received 12 weeks of buprenorphine treatment, at the end of which 49 percent, seven times as many, were doing well. During the four-week taper from buprenorphine, half of those patients relapsed. There were more relapses — two-thirds of the remaining group — in the two months after the taper period ended.“It showed the effectiveness, at least in a short-term treatment like this, of staying on medication,” Weiss said.A follow-up study of the same patients showed that 3½ years later, many were coping better than they had in the short term, including those who received no medication and had high relapse rates.“The course of this disorder is not constant,” Weiss said. “People have periods of recovery, then periods of relapse and, over time, a number of people do well, but not everybody. There’s a high relapse rate.”Yet even with research supporting the efficacy of buprenorphine, patients across the country routinely struggle to get it. When the FDA sanctioned the drug 13 years ago, the hope was that doctors would begin prescribing it for appropriate patients in their practices. But few actually have. According to the nonprofit National Alliance of Advocates for Buprenorphine Treatment, only 3 percent of the 800,000 doctors in the United States are certified to prescribe it. In Massachusetts, just 751 doctors authorized to treat opioid addiction with buprenorphine are listed on the website of the federal Substance Abuse and Mental Health Services Administration.“The drug companies are manufacturing it, the treatment exists,” said Wakeman, long a licensed prescriber. “There’s not a drug shortage, there’s a doctor shortage.”One hurdle facing physicians is the added training required for certification. Doctors must take an eight-hour course, pass a test, and then register with the Drug Enforcement Agency, which grants prescription licenses. Doctors in their first year are allowed to treat a maximum of 30 patients and must reapply in order to increase their patient capacity to 100. Insurance is also a factor. Some providers require prior authorizations, set arbitrary dose limits, or even encourage doctors to stop prescribing buprenorphine altogether.One treatment obstacle Mark Albanese of Cambridge Health Alliance occasionally encounters is the idea that medication might replace rather than subdue addiction. Kris Snibbe/Harvard Staff PhotographerEven among the certified, the number of prescriptions for buprenorphine remains low, partly because many doctors simply aren’t comfortable treating addiction.“They don’t feel they know enough about it, and they find it kind of a daunting task,” said Weiss, “and so they just say ‘Let somebody else do it.’ I think that’s really the issue.”Ward agreed.“People get trained to prescribe this medication. They hold a license for it but they don’t necessarily treat patients because they don’t feel comfortable.”Another issue is the idea of total abstinence espoused by many 12-step programs and residential treatment facilities. It’s not unheard of for patients to resist medication regimens. Mark Albanese, the director of Adult Outpatient and Addictions Services at the Cambridge Health Alliance (CHA), said sometimes his patients complain that they feel as hooked on their prescriptions as they had been on heroin. To calm their fears, Albanese offers a little perspective.“I say, ‘Let’s step back for a second. Tell me how much alike your life is now versus what it was when you were actively using heroin?’ And they just laugh at me and say, ‘It’s nothing like that.’”Collaborative thinking One model of care, in place at Brigham and Women’s for years, focuses on treating patients in non-specialized settings.“We still need the specialty addiction clinics for patients who want it, who can access it, but here at the Brigham we focus on offering similar approaches without sending patients somewhere else,” said Suzuki. “We try our best to actually take ownership of it and say, ‘This is a major health issue that’s impacting your health and we’d like to help you.’”When an opioid-addicted patient checks in at the Brigham seeking treatment for anything from a broken leg to pneumonia, a dedicated team, including an addiction physician, a group of addiction fellows, and a social worker, is activated. The group meets with the patient to discuss treatment options and to offer to immediately start him or her on buprenorphine.“Beginning treatment while they are here in the hospital … while it seems like such a small thing, at many hospitals it’s simply not done,” said Suzuki, the team’s attending addiction psychiatrist.Suzuki and his team help connect hospitalized patients with outpatient treatment options and community-support groups, enlist the aid of family and friends, and review relapse-prevention skills. Suzuki also works closely with the Brigham’s primary-care clinics, offering specialized guidance.“We’re not trained; we don’t have any expertise; we don’t have any clinical support; we don’t have enough time; I am afraid of these patients … there’s a long list of barriers that people working in the clinics describe,” he said.Undergraduate health coaches support the clinics. The students, often on a pre-med track, call patients to check on mood, cravings, and pain, as well as to monitor prescriptions and issue appointment reminders. They also relay any concerns they may have about the patient back to the team.For doctors trying to manage their already-stretched time, the support model, said Suzuki, “has a potential of actually making a big difference on a wider scale.”A similar approach is underway at MGH, which is building on early efforts to offer buprenorphine in its community health centers in 2003, soon after the drug received FDA approval.Last year an updated strategic plan in which MGH re-examined its long-range clinical mission made targeting addiction a top priority. In the next three years the hospital will spend $3.5 million on long-term substance-use disorders.The effort calls for collaborations among medical and psychiatric services to enhance addiction care, including a recently formed hospital-based Addiction Consult Team, similar to that at the Brigham. The team consists of psychiatrists, primary-care doctors, nurses, and social workers, and is called when a patient suffering from addiction is identified.“This is a new formal consult service where folks are working together and bringing the best state-of-the-art treatment together for all types of substance-use disorders,” said James Morrill, chief of the Adult Medicine Unit at MGH’s Charlestown HealthCare Center.The team helps connect hospital patients with outpatient services, in part through recovery coaches, ex-users affiliated with one of MGH’s three community health centers. The coaches also work directly in the centers, helping patients with everything from recovery support to how to find housing.Focus on trainingImproving access to treatment includes easing doctors’ interactions with patients fighting substance-abuse disorders. And that engagement has to happen as early as possible.At Harvard Medical School, students first learn about addiction during an introductory psychiatry course in their second year. The class covers the epidemiology, public health impact, and neuroscience of addiction, as well as the range of treatment options and community support available. Students also learn how to interview and screen drug users. During clinical clerkships at Harvard-affiliated hospitals in their third year, HMS students engage directly with patients suffering from opioid addiction in a variety of settings.But among teachers at HMS, which is currently overhauling its curriculum, there is a growing realization that perhaps the best way to help prepare students to treat addiction is to connect them with patients sooner.“One way that the curriculum is moving as part of the HMS curricular reform is toward covering the really important parts of lots of important topics in a shorter period of time pre-clinically, and then getting students involved with patients from the get-go,” said Todd Griswold, a psychiatrist at the Cambridge Health Alliance and the director of medical student education in psychiatry at HMS.Asked if addiction training could be increased for Harvard’s medical students, Griswold said “absolutely,” but with the caveat that so too could training in a range of other areas. “If you add to a particular topic, you have to think about what you are going to remove.”When it comes to prescribing buprenorphine, more doctors and students need to learn how to do it, experts say. At MGH, Ward is making that happen. Together with a group of colleagues she has helped offer training in buprenorphine treatment to doctors across the hospital, positioning them to receive DEA approval. Last month she helped train primary-care residents during an annual retreat that for the first time focused on buprenorphine.Wakeman is also working to sharpen residents’ training. As chief resident at MGH in 2012, she helped develop a survey of internal-medicine residents at the hospital that showed most felt unprepared to diagnose and treat patients suffering from substance-use disorders. In response, MGH boosted the number of lectures on addiction from one a year to 12. Progress was limited. When Wakeman repeated the survey with the new curriculum, the results showed that while residents were significantly more prepared, their knowledge hadn’t increased.“That really gets to the fact that we learn medicine through doing and seeing,” she said.For more hands-on training, internal-medicine residents are beginning to round with MGH’s Addiction Consult Team, and there is a push to have the intensive two-week outpatient rotation in addiction required for primary-care residents extended to all internal-medicine residents.“We are in the middle of a public health crisis,” said Wakeman. “We have treatment that works and yet doctors aren’t providing that treatment, and I think the only way to really change that, change that culture, is to better train the next generation of doctors to feel like this is something that they own, that it’s a part of our skill set and that they have the tools they need.”The other sideIn contrast to those difficult nights in the ER, Ward these days can see further along her patients’ journeys, and can feel the hope they keep close. After years of working with people struggling to get clean, she understands just how incredibly complicated treatment is. She knows addiction is a disease that takes a vise-like hold on users with certain genetic susceptibilities, and that over time it can actually alter the way the brain functions, making “drug-free” seem excruciatingly distant. She also understands the treatment map and the range of effective therapies that can bring addicts back from the edge.Still, even within the medical community, she acknowledges, there are doubters, those who wonder why she spends so much effort on patients who, to many, seem beyond help. They don’t bother her.“It’s an opportunity to educate,” Ward said, “to say, ‘Look, there’s a whole different side to this disease and treatment is not that straightforward, but individuals who suffer from substance-use disorders can be treated.“There is hope in this field,” she emphasized. “Addiction’s not a death sentence. It’s not your destiny. I think the more I work with those who suffer, the more I am encouraged by how people change, their ability to change, and the ways we can help. Every day, I am more and more impressed.”Harvard staff writer Alvin Powell contributed to this report.
Burton’s Broadway credits include The 39 Steps, Machinal, A Free Man of Color and Amadeus. Elrod has appeared in Reckless and Noises Off on Broadway. Holmes’ Great White Way credits include Spamalot, The Pillowman, Cabaret and Major Barbara. Additionally, Burton, Elrod and Holmes all appeared together in Peter and the Starcatcher on Broadway. Hutchinson’s credits include Desire Under the Elms, Major Barbara and Macbeth. This marks Rooth’s third play by Ives; she appeared in Venus in Fur on Broadway and regionally and All in the Timing off-Broadway. Lives of the Saints View Comments The Primary Stages mounting will feature scenic design by Beowulf Boritt, costumes by Anita Yavich, lighting design by Jason Lyons and sound design and original music by John Gromada. Related Shows Casting is now set for Lives of the Saints, a collection of short plays, including three new pieces, by David Ives. The comedy will star Arnie Burton, Carson Elrod, Rick Holmes, Kelly Hutchinson and Liv Rooth. Tony winner John Rando directs the off-Broadway production. Performances will begin on February 3, 2015 at The Duke on 42nd Street, where it will run through March 27. Opening night is set for February 24. Show Closed This production ended its run on March 27, 2015