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Unknown | 1992-06-06 | 207.1 KB |
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Confidence | Program | Detection | Match Type | Support
|
---|
66%
| dexvert
| OS/2 Installation Package (archive/os2InstallPackage)
| ext
| Supported |
1%
| dexvert
| BeOS Installation Package (archive/beOSInstallPackage)
| ext
| Unsupported |
1%
| dexvert
| Newton Package (archive/newtonPackage)
| ext
| Unsupported |
1%
| dexvert
| Independence War 2 mod Package (other/independenceWar2ModPackage)
| ext
| Unsupported |
100%
| file
| data
| default
|
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hex view+--------+-------------------------+-------------------------+--------+--------+
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|00003360| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
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|000043c0| 20 63 61 72 65 0d 0a 73 | 79 73 74 65 6d 20 6e 65 | care..s|ystem ne|
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|000043e0| 2e 0d 0a 0d 0a 50 6f 73 | 74 2d 43 6f 6d 6d 65 6e |.....Pos|t-Commen|
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|00004500| 20 48 4d 4f 73 2c 20 74 | 68 65 73 65 20 70 72 6f | HMOs, t|hese pro|
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|00004560| 2d 6e 65 65 64 69 6e 67 | 20 70 61 74 69 65 6e 74 |-needing| patient|
|00004570| 73 2e 20 20 41 73 0d 0a | 44 6f 72 77 61 72 74 20 |s. As..|Dorwart |
|00004580| 61 6e 64 20 53 63 68 6c | 65 73 69 6e 67 65 72 20 |and Schl|esinger |
|00004590| 70 6f 69 6e 74 20 6f 75 | 74 2c 20 69 74 27 73 20 |point ou|t, it's |
|000045a0| 73 75 72 70 72 69 73 69 | 6e 67 20 74 68 61 74 20 |surprisi|ng that |
|000045b0| 70 6f 6c 69 63 79 6d 61 | 6b 65 72 73 20 64 6f 6e |policyma|kers don|
|000045c0| 27 74 0d 0a 77 6f 72 72 | 79 20 6d 6f 72 65 20 61 |'t..worr|y more a|
|000045d0| 62 6f 75 74 20 74 68 69 | 73 20 67 72 6f 77 74 68 |bout thi|s growth|
|000045e0| 27 73 20 69 6d 70 61 63 | 74 20 6f 6e 20 70 75 62 |'s impac|t on pub|
|000045f0| 6c 69 63 20 66 61 63 69 | 6c 69 74 69 65 73 2e 2d |lic faci|lities.-|
|00004600| 2d 4a 2e 41 2e 20 54 61 | 6c 62 6f 74 74 2c 0d 0a |-J.A. Ta|lbott,..|
|00004610| 4d 2e 44 2e 0d 0a 24 55 | 6e 69 71 75 65 5f 49 44 |M.D...$U|nique_ID|
|00004620| 7b 59 52 42 31 32 35 30 | 36 7d 0d 0a 24 54 69 74 |{YRB1250|6}..$Tit|
|00004630| 6c 65 7b 50 72 65 64 69 | 63 74 6f 72 73 20 6f 66 |le{Predi|ctors of|
|00004640| 20 42 65 72 65 61 76 65 | 6d 65 6e 74 20 44 65 70 | Bereave|ment Dep|
|00004650| 72 65 73 73 69 6f 6e 20 | 61 6e 64 20 49 74 73 20 |ression |and Its |
|00004660| 48 65 61 6c 74 68 20 53 | 65 72 76 69 63 65 73 20 |Health S|ervices |
|00004670| 43 6f 6e 73 65 71 75 65 | 6e 63 65 73 7d 0d 0a 24 |Conseque|nces}..$|
|00004680| 41 75 74 68 6f 72 7b 0d | 0a 4d 63 48 6f 72 6e 65 |Author{.|.McHorne|
|00004690| 79 2c 20 43 41 0d 0a 4d | 6f 72 2c 20 56 7d 0d 0a |y, CA..M|or, V}..|
|000046a0| 24 41 66 66 69 6c 69 61 | 74 69 6f 6e 7b 42 72 6f |$Affilia|tion{Bro|
|000046b0| 77 6e 20 55 6e 69 76 7d | 0d 0a 24 4a 6f 75 72 6e |wn Univ}|..$Journ|
|000046c0| 61 6c 7b 4d 65 64 20 43 | 61 72 65 7d 0d 0a 24 56 |al{Med C|are}..$V|
|000046d0| 6f 6c 75 6d 65 7b 32 36 | 7d 0d 0a 24 50 61 67 65 |olume{26|}..$Page|
|000046e0| 7b 38 38 32 2d 38 39 33 | 7d 0d 0a 24 44 61 74 65 |{882-893|}..$Date|
|000046f0| 7b 53 65 70 74 65 6d 62 | 65 72 20 31 39 38 38 7d |{Septemb|er 1988}|
|00004700| 0d 0a 24 59 42 56 6f 6c | 7b 31 39 39 30 20 59 65 |..$YBVol|{1990 Ye|
|00004710| 61 72 20 42 6f 6f 6b 20 | 6f 66 20 50 73 79 63 68 |ar Book |of Psych|
|00004720| 69 61 74 72 79 20 61 6e | 64 20 41 70 70 6c 69 65 |iatry an|d Applie|
|00004730| 64 20 4d 65 6e 74 61 6c | 20 48 65 61 6c 74 68 7d |d Mental| Health}|
|00004740| 0d 0a 24 43 68 61 70 74 | 65 72 7b 31 30 2d 31 37 |..$Chapt|er{10-17|
|00004750| 7d 0d 0a 24 59 42 45 64 | 69 74 6f 72 7b 44 72 73 |}..$YBEd|itor{Drs|
|00004760| 2e 20 54 61 6c 62 6f 74 | 74 2c 20 46 72 61 6e 63 |. Talbot|t, Franc|
|00004770| 65 73 2c 20 46 72 61 6e | 63 65 73 2c 20 46 72 65 |es, Fran|ces, Fre|
|00004780| 65 64 6d 61 6e 2c 20 4d | 65 6c 74 7a 65 72 2c 20 |edman, M|eltzer, |
|00004790| 53 63 68 6f 77 61 6c 74 | 65 72 2c 20 61 6e 64 20 |Schowalt|er, and |
|000047a0| 59 75 64 6f 66 73 6b 79 | 7d 0d 0a 24 54 61 62 6c |Yudofsky|}..$Tabl|
|000047b0| 65 7b 7d 0d 0a 24 43 6f | 6d 6d 65 6e 74 61 74 6f |e{}..$Co|mmentato|
|000047c0| 72 7b 4a 2e 41 2e 20 54 | 61 6c 62 6f 74 74 2c 20 |r{J.A. T|albott, |
|000047d0| 4d 2e 44 2e 7d 0d 0a 0d | 0a 43 6f 70 79 72 69 67 |M.D.}...|.Copyrig|
|000047e0| 68 74 20 28 63 29 20 59 | 65 61 72 62 6f 6f 6b 20 |ht (c) Y|earbook |
|000047f0| 4d 65 64 69 63 61 6c 20 | 50 75 62 6c 69 73 68 65 |Medical |Publishe|
|00004800| 72 73 2c 20 49 6e 63 2e | 2c 20 31 39 39 30 0d 0a |rs, Inc.|, 1990..|
|00004810| 0d 0a 31 39 39 30 20 59 | 65 61 72 20 42 6f 6f 6b |..1990 Y|ear Book|
|00004820| 20 6f 66 20 50 73 79 63 | 68 69 61 74 72 79 20 61 | of Psyc|hiatry a|
|00004830| 6e 64 20 41 70 70 6c 69 | 65 64 20 4d 65 6e 74 61 |nd Appli|ed Menta|
|00004840| 6c 20 48 65 61 6c 74 68 | 20 28 52 29 0d 0a 0d 0a |l Health| (R)....|
|00004850| 43 68 61 70 74 65 72 20 | 31 30 2d 2d 43 6f 6d 6d |Chapter |10--Comm|
|00004860| 75 6e 69 74 79 20 50 73 | 79 63 68 69 61 74 72 79 |unity Ps|ychiatry|
|00004870| 0d 0a 0d 0a 4d 65 6e 74 | 61 6c 20 48 65 61 6c 74 |....Ment|al Healt|
|00004880| 68 20 53 65 72 76 69 63 | 65 73 20 52 65 73 65 61 |h Servic|es Resea|
|00004890| 72 63 68 0d 0a 0d 0a 2d | 2d 2d 2d 2d 2d 2d 2d 2d |rch....-|--------|
|000048a0| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|000048b0| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|000048c0| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|000048d0| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|000048e0| 2d 2d 2d 2d 2d 0d 0a 50 | 72 65 64 69 63 74 6f 72 |-----..P|redictor|
|000048f0| 73 20 6f 66 20 42 65 72 | 65 61 76 65 6d 65 6e 74 |s of Ber|eavement|
|00004900| 20 44 65 70 72 65 73 73 | 69 6f 6e 20 61 6e 64 20 | Depress|ion and |
|00004910| 49 74 73 20 48 65 61 6c | 74 68 20 53 65 72 76 69 |Its Heal|th Servi|
|00004920| 63 65 73 20 43 6f 6e 73 | 65 71 75 65 6e 63 65 73 |ces Cons|equences|
|00004930| 0d 0a 0d 0a 4d 63 48 6f | 72 6e 65 79 20 43 41 2c |....McHo|rney CA,|
|00004940| 20 4d 6f 72 20 56 0d 0a | 28 42 72 6f 77 6e 20 55 | Mor V..|(Brown U|
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|00004960| 36 3a 38 38 32 2d 38 39 | 33 2c 20 53 65 70 74 65 |6:882-89|3, Septe|
|00004970| 6d 62 65 72 20 31 39 38 | 38 0d 0a 2d 2d 2d 2d 2d |mber 198|8..-----|
|00004980| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00004990| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|000049a0| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|000049b0| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|000049c0| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 0d 0a 0d 0a 41 62 73 |--------|-....Abs|
|000049d0| 74 72 61 63 74 0d 0a 0d | 0a 20 20 20 20 20 42 65 |tract...|. Be|
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|00004d20| 20 6d 65 6e 74 61 6c 20 | 68 65 61 6c 74 68 0d 0a | mental |health..|
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|00004e90| 6d 70 6f 72 74 61 6e 74 | 20 74 6f 20 61 76 65 72 |mportant| to aver|
|00004ea0| 74 20 74 68 65 20 63 6f | 73 74 73 20 74 6f 20 74 |t the co|sts to t|
|00004eb0| 68 65 20 68 65 61 6c 74 | 68 20 63 61 72 65 20 73 |he healt|h care s|
|00004ec0| 79 73 74 65 6d 20 6f 66 | 20 64 65 70 72 65 73 73 |ystem of| depress|
|00004ed0| 69 6f 6e 2d 72 65 6c 61 | 74 65 64 0d 0a 73 6f 6d |ion-rela|ted..som|
|00004ee0| 61 74 69 7a 61 74 69 6f | 6e 20 61 66 74 65 72 20 |atizatio|n after |
|00004ef0| 62 65 72 65 61 76 65 6d | 65 6e 74 2e 0d 0a 0d 0a |bereavem|ent.....|
|00004f00| 50 6f 73 74 2d 43 6f 6d | 6d 65 6e 74 0d 0a 0d 0a |Post-Com|ment....|
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|00004f20| 20 68 65 79 64 61 79 20 | 6f 66 20 63 6f 6d 6d 75 | heyday |of commu|
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|00004f40| 20 6d 75 63 68 20 77 61 | 73 20 6d 61 64 65 20 6f | much wa|s made o|
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|00004f60| 73 75 6c 74 61 74 69 6f | 6e 20 61 6e 64 20 70 72 |sultatio|n and pr|
|00004f70| 69 6d 61 72 79 20 70 72 | 65 76 65 6e 74 69 6f 6e |imary pr|evention|
|00004f80| 2c 20 65 73 70 65 63 69 | 61 6c 6c 79 20 62 79 20 |, especi|ally by |
|00004f90| 65 78 70 65 72 74 73 20 | 73 75 63 68 20 61 73 20 |experts |such as |
|00004fa0| 47 65 72 61 6c 64 0d 0a | 43 61 70 6c 61 6e 2e 20 |Gerald..|Caplan. |
|00004fb0| 20 54 68 65 20 61 72 67 | 75 6d 65 6e 74 20 66 6f | The arg|ument fo|
|00004fc0| 72 20 69 6e 74 65 72 76 | 65 6e 69 6e 67 20 77 69 |r interv|ening wi|
|00004fd0| 74 68 20 70 6f 70 75 6c | 61 74 69 6f 6e 73 20 61 |th popul|ations a|
|00004fe0| 74 20 72 69 73 6b 2c 20 | 73 75 63 68 20 61 73 20 |t risk, |such as |
|00004ff0| 77 69 64 6f 77 73 0d 0a | 61 6e 64 20 77 69 64 6f |widows..|and wido|
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|00005040| 72 74 69 63 6c 65 0d 0a | 70 75 62 6c 69 73 68 65 |rticle..|publishe|
|00005050| 64 20 69 6e 20 61 6e 20 | 61 6c 6d 6f 73 74 20 73 |d in an |almost s|
|00005060| 74 72 69 63 74 6c 79 20 | 65 63 6f 6e 6f 6d 69 63 |trictly |economic|
|00005070| 2d 66 6f 63 75 73 65 64 | 20 6a 6f 75 72 6e 61 6c |-focused| journal|
|00005080| 2e 20 20 49 74 20 77 69 | 6c 6c 20 62 65 0d 0a 69 |. It wi|ll be..i|
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|000050a0| 65 20 69 66 20 69 74 20 | 6d 61 6b 65 73 20 61 6e |e if it |makes an|
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|00005e30| 39 2d 33 37 32 7d 0d 0a | 24 44 61 74 65 7b 4d 61 |9-372}..|$Date{Ma|
|00005e40| 72 63 68 20 31 39 38 39 | 7d 0d 0a 24 59 42 56 6f |rch 1989|}..$YBVo|
|00005e50| 6c 7b 31 39 39 30 20 59 | 65 61 72 20 42 6f 6f 6b |l{1990 Y|ear Book|
|00005e60| 20 6f 66 20 50 73 79 63 | 68 69 61 74 72 79 20 61 | of Psyc|hiatry a|
|00005e70| 6e 64 20 41 70 70 6c 69 | 65 64 20 4d 65 6e 74 61 |nd Appli|ed Menta|
|00005e80| 6c 20 48 65 61 6c 74 68 | 7d 0d 0a 24 43 68 61 70 |l Health|}..$Chap|
|00005e90| 74 65 72 7b 31 30 2d 31 | 39 7d 0d 0a 24 59 42 45 |ter{10-1|9}..$YBE|
|00005ea0| 64 69 74 6f 72 7b 44 72 | 73 2e 20 54 61 6c 62 6f |ditor{Dr|s. Talbo|
|00005eb0| 74 74 2c 20 46 72 61 6e | 63 65 73 2c 20 46 72 61 |tt, Fran|ces, Fra|
|00005ec0| 6e 63 65 73 2c 20 46 72 | 65 65 64 6d 61 6e 2c 20 |nces, Fr|eedman, |
|00005ed0| 4d 65 6c 74 7a 65 72 2c | 20 53 63 68 6f 77 61 6c |Meltzer,| Schowal|
|00005ee0| 74 65 72 2c 20 61 6e 64 | 20 59 75 64 6f 66 73 6b |ter, and| Yudofsk|
|00005ef0| 79 7d 0d 0a 24 54 61 62 | 6c 65 7b 7d 0d 0a 24 43 |y}..$Tab|le{}..$C|
|00005f00| 6f 6d 6d 65 6e 74 61 74 | 6f 72 7b 4a 2e 41 2e 20 |ommentat|or{J.A. |
|00005f10| 54 61 6c 62 6f 74 74 2c | 20 4d 2e 44 2e 7d 0d 0a |Talbott,| M.D.}..|
|00005f20| 0d 0a 43 6f 70 79 72 69 | 67 68 74 20 28 63 29 20 |..Copyri|ght (c) |
|00005f30| 59 65 61 72 62 6f 6f 6b | 20 4d 65 64 69 63 61 6c |Yearbook| Medical|
|00005f40| 20 50 75 62 6c 69 73 68 | 65 72 73 2c 20 49 6e 63 | Publish|ers, Inc|
|00005f50| 2e 2c 20 31 39 39 30 0d | 0a 0d 0a 31 39 39 30 20 |., 1990.|...1990 |
|00005f60| 59 65 61 72 20 42 6f 6f | 6b 20 6f 66 20 50 73 79 |Year Boo|k of Psy|
|00005f70| 63 68 69 61 74 72 79 20 | 61 6e 64 20 41 70 70 6c |chiatry |and Appl|
|00005f80| 69 65 64 20 4d 65 6e 74 | 61 6c 20 48 65 61 6c 74 |ied Ment|al Healt|
|00005f90| 68 20 28 52 29 0d 0a 0d | 0a 43 68 61 70 74 65 72 |h (R)...|.Chapter|
|00005fa0| 20 31 30 2d 2d 43 6f 6d | 6d 75 6e 69 74 79 20 50 | 10--Com|munity P|
|00005fb0| 73 79 63 68 69 61 74 72 | 79 0d 0a 0d 0a 4d 65 6e |sychiatr|y....Men|
|00005fc0| 74 61 6c 20 48 65 61 6c | 74 68 20 53 65 72 76 69 |tal Heal|th Servi|
|00005fd0| 63 65 73 20 52 65 73 65 | 61 72 63 68 0d 0a 0d 0a |ces Rese|arch....|
|00005fe0| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00005ff0| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00006000| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00006010| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00006020| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 0d 0a |--------|------..|
|00006030| 54 68 65 20 50 73 79 63 | 68 69 61 74 72 69 63 20 |The Psyc|hiatric |
|00006040| 45 6d 65 72 67 65 6e 63 | 79 20 53 65 72 76 69 63 |Emergenc|y Servic|
|00006050| 65 20 48 6f 6c 64 69 6e | 67 20 41 72 65 61 3a 20 |e Holdin|g Area: |
|00006060| 20 45 66 66 65 63 74 20 | 6f 6e 20 55 74 69 6c 69 | Effect |on Utili|
|00006070| 7a 61 74 69 6f 6e 20 6f | 66 0d 0a 49 6e 70 61 74 |zation o|f..Inpat|
|00006080| 69 65 6e 74 20 52 65 73 | 6f 75 72 63 65 73 0d 0a |ient Res|ources..|
|00006090| 0d 0a 47 69 6c 6c 69 67 | 20 50 4d 2c 20 48 69 6c |..Gillig| PM, Hil|
|000060a0| 6c 61 72 64 20 4a 52 2c | 20 42 65 6c 6c 20 4a 2c |lard JR,| Bell J,|
|000060b0| 20 43 6f 6d 62 73 20 48 | 45 2c 20 4d 61 72 74 69 | Combs H|E, Marti|
|000060c0| 6e 20 43 2c 20 44 65 64 | 64 65 6e 73 20 4a 41 0d |n C, Ded|dens JA.|
|000060d0| 0a 28 55 6e 69 76 20 6f | 66 20 43 69 6e 63 69 6e |.(Univ o|f Cincin|
|000060e0| 6e 61 74 69 3b 20 48 75 | 6d 61 6e 61 20 48 6f 73 |nati; Hu|mana Hos|
|000060f0| 70 2d 55 6e 69 76 20 6f | 66 20 4c 6f 75 69 73 76 |p-Univ o|f Louisv|
|00006100| 69 6c 6c 65 3b 20 43 65 | 6e 74 72 61 6c 20 53 74 |ille; Ce|ntral St|
|00006110| 61 74 65 20 48 6f 73 70 | 2c 0d 0a 4c 6f 75 69 73 |ate Hosp|,..Louis|
|00006120| 76 69 6c 6c 65 29 0d 0a | 41 6d 20 4a 20 50 73 79 |ville)..|Am J Psy|
|00006130| 63 68 69 61 74 72 79 20 | 31 34 36 3a 33 36 39 2d |chiatry |146:369-|
|00006140| 33 37 32 2c 20 4d 61 72 | 63 68 20 31 39 38 39 0d |372, Mar|ch 1989.|
|00006150| 0a 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |.-------|--------|
|00006160| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00006170| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00006180| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00006190| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 0d |--------|-------.|
|000061a0| 0a 0d 0a 41 62 73 74 72 | 61 63 74 0d 0a 0d 0a 20 |...Abstr|act.... |
|000061b0| 20 20 20 20 50 73 79 63 | 68 69 61 74 72 69 63 20 | Psyc|hiatric |
|000061c0| 65 6d 65 72 67 65 6e 63 | 79 20 73 65 72 76 69 63 |emergenc|y servic|
|000061d0| 65 73 20 6d 75 73 74 20 | 64 65 63 69 64 65 20 77 |es must |decide w|
|000061e0| 68 65 74 68 65 72 20 70 | 61 74 69 65 6e 74 73 20 |hether p|atients |
|000061f0| 61 72 65 20 74 6f 20 62 | 65 0d 0a 74 72 65 61 74 |are to b|e..treat|
|00006200| 65 64 20 61 73 20 69 6e | 70 61 74 69 65 6e 74 73 |ed as in|patients|
|00006210| 20 6f 72 20 6f 75 74 70 | 61 74 69 65 6e 74 73 2e | or outp|atients.|
|00006220| 20 20 53 6f 6d 65 20 73 | 65 72 76 69 63 65 73 20 | Some s|ervices |
|00006230| 6d 75 73 74 20 6d 61 6b | 65 20 74 68 69 73 20 64 |must mak|e this d|
|00006240| 65 63 69 73 69 6f 6e 0d | 0a 69 6d 6d 65 64 69 61 |ecision.|.immedia|
|00006250| 74 65 6c 79 20 6f 72 20 | 77 69 74 68 69 6e 20 61 |tely or |within a|
|00006260| 20 66 65 77 20 68 6f 75 | 72 73 2c 20 77 68 65 72 | few hou|rs, wher|
|00006270| 65 61 73 20 6f 74 68 65 | 72 73 20 6d 61 79 20 22 |eas othe|rs may "|
|00006280| 68 6f 6c 64 22 20 61 20 | 70 61 74 69 65 6e 74 20 |hold" a |patient |
|00006290| 66 6f 72 0d 0a 65 78 74 | 65 6e 64 65 64 20 61 73 |for..ext|ended as|
|000062a0| 73 65 73 73 6d 65 6e 74 | 2e 20 20 54 77 6f 20 73 |sessment|. Two s|
|000062b0| 69 6d 69 6c 61 72 20 65 | 6d 65 72 67 65 6e 63 79 |imilar e|mergency|
|000062c0| 20 73 65 72 76 69 63 65 | 73 20 77 65 72 65 20 63 | service|s were c|
|000062d0| 6f 6d 70 61 72 65 64 3a | 20 31 2c 20 69 6e 0d 0a |ompared:| 1, in..|
|000062e0| 43 69 6e 63 69 6e 6e 61 | 74 69 2c 20 77 69 74 68 |Cincinna|ti, with|
|000062f0| 20 74 68 65 20 63 61 70 | 61 63 69 74 79 20 66 6f | the cap|acity fo|
|00006300| 72 20 6f 62 73 65 72 76 | 69 6e 67 20 61 6e 64 20 |r observ|ing and |
|00006310| 61 73 73 65 73 73 69 6e | 67 20 70 61 74 69 65 6e |assessin|g patien|
|00006320| 74 73 20 66 6f 72 20 75 | 70 20 74 6f 0d 0a 32 34 |ts for u|p to..24|
|00006330| 20 68 6f 75 72 73 2c 20 | 61 6e 64 20 31 2c 20 69 | hours, |and 1, i|
|00006340| 6e 20 4c 6f 75 69 73 76 | 69 6c 6c 65 2c 20 77 69 |n Louisv|ille, wi|
|00006350| 74 68 6f 75 74 20 69 74 | 2e 0d 0a 20 20 20 20 20 |thout it|... |
|00006360| 45 61 63 68 20 73 65 72 | 76 69 63 65 20 77 61 73 |Each ser|vice was|
|00006370| 20 74 68 65 20 70 72 69 | 6d 61 72 79 20 65 6d 65 | the pri|mary eme|
|00006380| 72 67 65 6e 63 79 20 65 | 76 61 6c 75 61 74 69 6f |rgency e|valuatio|
|00006390| 6e 20 63 65 6e 74 65 72 | 20 66 6f 72 20 70 73 79 |n center| for psy|
|000063a0| 63 68 69 61 74 72 69 63 | 0d 0a 70 61 74 69 65 6e |chiatric|..patien|
|000063b0| 74 73 20 72 65 66 65 72 | 72 65 64 20 66 72 6f 6d |ts refer|red from|
|000063c0| 20 61 20 63 61 74 63 68 | 6d 65 6e 74 20 61 72 65 | a catch|ment are|
|000063d0| 61 20 6f 66 20 6d 6f 72 | 65 20 74 68 61 6e 20 31 |a of mor|e than 1|
|000063e0| 20 6d 69 6c 6c 69 6f 6e | 20 72 65 73 69 64 65 6e | million| residen|
|000063f0| 74 73 20 6f 66 20 61 6e | 0d 0a 4f 68 69 6f 20 56 |ts of an|..Ohio V|
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