Healthcare ↔ relates to ↔ Substance Use Recovery

gton and Oregon to the west; the state shares a small portion of the Canada–United States border to the north with the Canadian province of British Columbia. Idaho's state capital and largest city is Boise. With an area of 83,569 square miles (216,440 km2), Idaho is the 14th-largest state by land area. The state has a population of approximately two million people; it ranks as the 13th-least populous and the seventh-least densely populated of the 50 U.S. states. For thousands of years, and prior to European colonization, Idaho had been inhabited by natives. In the early 19th century, Idaho was considered part of the Oregon Country, an area which was disputed between the U.S. and the British Empire. Idaho officially became a U.S. territory with the signing of the Oregon Treaty of 1846, but a separate Idaho Territory was not organized until 1863, instead being included for periods in Oregon Territory and Washington Territory. The state was eventually admitted to the Union on July 3, 1890, becoming the 43rd state. Forming part of the Pacific Northwest (and the associated Cascadia bioregion), Idaho is divided into several distinct geographic and climatic regions. The state's north, the relatively isolated Idaho Panhandle, is closely linked with Eastern Washington, with which it shares the Pacific Time Zone—the rest of the state uses the Mountain Time Zone. The state's south includes the Snake River Plain (which has most of the population and agricultural land), and the southeast incorporates part of the Great Basin. Idaho is quite mountainous and contains several stretches of the Rocky Mountains. The United States Forest Service holds about 38% of Idaho's land, the highest proportion of any state. Industries significant for the state economy include manufacturing, agriculture, mining, forestry, science and technology, and tourism. Idaho has been a predominantly Republican state since statehood, with the Republican Party dominating in both state and national elections; abortion is severely restricted and the state retains the death penalty, including methods like the firing squad. The state contains the Idaho National Laboratory. Idaho's agricultural sector supplies many products, but the state is best known for its potato crop, which comprises around one-third of the nationwide yield.

The most parsimonious explanation we think is that people came down the Pacific Coast, and as they encountered the mouth of the Columbia River, they essentially found an off-ramp from this coastal migration and also found their first viable interior route to the areas that are south of the ice sheet. An early presence of French-Canadian trappers is visible in names and toponyms: Nez Percé, Cœur d'Alène, Boisé, Payette. Some of these names appeared prior to the Lewis and Clark and Astorian expeditions, which included significant numbers of French and Métis guides recruited for their familiarity with the terrain. Idaho, as part of the Oregon Country, was claimed by both the United States and Great Britain until the United States gained undisputed jurisdiction in 1846. From 1843 to 1859, present-day Idaho was under the de facto jurisdiction of the Provisional Government of Oregon. When Oregon became a state in 1859, what is now Idaho was situated in what remained of the original Oregon Territory, designated as the Washington Territory. Between 1849 and the creation of the Idaho Territory in 1863, parts of present-day Idaho were included in the Oregon, Washington, and Dakota Territories. The new Idaho territory included present-day Idaho, Montana, and most of Wyoming. The Lewis and Clark expedition crossed Idaho in 1805 on the way to the Pacific, and in 1806, on the return trip, largely following the Clearwater River in both directions, making it one the last states settled by European Americans. The first non-indigenous settlement was Kullyspell House, established on the shore of Lake Pend Oreille in 1809 by David Thompson of the North West Company for fur trading. In 1812 Donald Mackenzie, working for the Pacific Fur Company at the time, established a post on the lower Clearwater River near present-day Lewiston. This post, known as "MacKenzie's Post" or "Clearwater", operated until the Pacific Fur Company was bought out by the North West Company in 1813, after which the post was abandoned. The first organized non-indigenous communities within the present borders of Idaho were established by Mormon pioneers in 1860. The first permanent, substantial incorporated community was Lewiston, in 1861. Early in its history, Idaho saw a large influx of Chinese immigrants, who by 1870 made up about 28.5% of the territory's population. Idaho achieved statehood in 1890, following a difficult start as a territory, including the transfer of the territorial capital from Lewiston to Boise, disenfranchisement of Mormon polygamists upheld by the U.S. Supreme Court in 1890, and a federal attempt to split the territory between Washington Territory, which gained statehood in 1889, a year before Idaho, and the state of Nevada which had been a state since 1864. Idaho was one of the hardest hit of the Pacific Northwest states during the Great Depression. Prices plummeted for Idaho's major crops: in 1932 a bushel of potatoes brought only ten cents compared to 1919 for $1.51, while Idaho farmers saw their annual income of $685 in 1929 drop to $250 by 1932. Between 1991 and 2002, Idaho expanded its commercial base to include the science and technology sector which accounted for over 25% of its gross state product in 2001. During the COVID-19 pandemic, Idaho enacted statewide crisis standards of care as COVID-19 patients overwhelmed hospitals.

The landscape is rugged, with some of the largest unspoiled natural areas in the United States. For example, at 2.3 million acres (930,000 ha), the Frank Church-River of No Return Wilderness Area is the largest contiguous area of protected wilderness in the continental United States. Idaho is a Rocky Mountain state with abundant natural resources and scenic areas. The state has snow-capped mountain ranges, rapids, vast lakes and steep canyons. The waters of the Snake River run through Hells Canyon, the deepest gorge in the United States. Shoshone Falls falls down cliffs from a height greater than Niagara Falls. By far, the most important river in Idaho is the Snake River, a major tributary of the Columbia River. The Snake River flows from Yellowstone in northwestern Wyoming through the Snake River Plain in southern Idaho before turning north, leaving the state at Lewiston before joining the Columbia in Kennewick. Other major rivers are the Clark Fork/Pend Oreille River, the Spokane River, and, many major tributaries of the Snake River, including the Clearwater River, the Salmon River, the Boise River, and the Payette River. The Salmon River empties into the Snake in Hells Canyon and forms the southern boundary of Nez Perce County on its north shore, of which Lewiston is the county seat. The Port of Lewiston, at the confluence of the Clearwater and the Snake Rivers is the farthest inland seaport on the West Coast at 465 river miles from the Pacific at Astoria, Oregon. The vast majority of Idaho's population lives in the Snake River Plain, a valley running from across the entirety of southern Idaho from east to west. The valley contains the major cities of Boise, Meridian, Nampa, Caldwell, Twin Falls, Idaho Falls, and Pocatello. The plain served as an easy pass through the Rocky Mountains for westward-bound settlers on the Oregon Trail, and many settlers chose to settle the area rather than risking the treacherous route through the Blue Mountains and the Cascade Range to the west. The western region of the plain is known as the Treasure Valley, bound between the Owyhee Mountains to the southwest and the Boise Mountains to the northeast.

24 hours. Buprenorphine affects different types of opioid receptors in different ways. Depending on the type of opioid receptor, it may be an agonist, partial agonist, or antagonist. Buprenorphine's activity as an agonist/antagonist is important in the treatment of opioid use disorder: it relieves withdrawal symptoms from other opioids and induces some euphoria (primarily when first starting treatment if one is not already opioid tolerant/dependent), but also blocks the ability for many other opioids, including heroin, to cause an effect. Unlike full agonists like heroin or methadone, buprenorphine has a ceiling effect, such that taking more medicine past a certain point will not increase the effects of the drug. Being a partial MOR agonist, buprenorphine offers flexibility to prescribers treating opioid use disorder as the dosage can be easily adjusted. Side effects may include respiratory depression (decreased breathing), sleepiness, adrenal insufficiency, changes in heart electrophysiology (QT prolongation), low blood pressure, allergic reactions, constipation, and opioid addiction. Among those with a history of seizures, a risk exists of further seizures. Opioid withdrawal following stopping buprenorphine is generally less severe than with other opioids. Whether use during pregnancy is safe is unclear, but use while breastfeeding is probably safe, since the dose the infant receives is 1–2% that of the maternal dose, on a weight basis. Buprenorphine was patented in 1965, FDA approved for medical use as an analgesic in 1981, and FDA approved for treating opioid use disorder in 2002. It is on the World Health Organization's List of Essential Medicines. Despite originally being marketed as an analgesic it is far more commonly prescribed and used to treat opioid use disorders, such as addiction to heroin. In 2020, it was the 186th most commonly prescribed medication in the United States, with more than 2.8 million prescriptions. Buprenorphine is generally used as a medication for treating opioid use disorder. In the United States, buprenorphine hydrochloride (and a combination formula, buprenorphine hydrochloride/naloxone,) are schedule III controlled substances. Buprenorphine does not produce the same sense of euphoria and/or "sense of well-being" as reported in use of full-agonist opioids. A "ceiling effect" is observed in regards to the potentially fatal side effects of other opioids, such as respiratory depression. While the medication may produce comparably mild side effects to that of other drugs in its classification, it still carries some abuse potential.

Respiratory effects The most severe side effect associated with buprenorphine is respiratory depression (insufficient breathing). It occurs more often in those who are also taking benzodiazepines or alcohol, or have underlying lung disease. The usual reversal agents for opioids, such as naloxone, may be only partially effective, and additional efforts to support breathing may be required. Respiratory depression may be less than with other opioids, particularly with chronic use. In the setting of acute pain management, though, buprenorphine appears to cause the same rate of respiratory depression as other opioids such as morphine. Central sleep apnea is possible with long-term use, possibly resolving with dose reduction. Buprenorphine dependence Buprenorphine treatment carries the risk of causing psychological or physiological (physical) dependencies. It has a slow onset of activity, with a long duration of action, and a long half-life of 24 to 60 hours.

μ-Opioid receptor (MOR): Very high affinity partial agonist: at low doses, the MOR-mediated effects of buprenorphine are comparable to those of other narcotics, but these effects reach a "ceiling" as the receptor population is saturated. This behavior is responsible for several unique properties: buprenorphine greatly reduces the effect of most other MOR agonists, can cause precipitated withdrawal when used in actively opioid dependent persons, and has a lower incidence of respiratory depression relative to full MOR agonists. κ-Opioid receptor (KOR): High affinity antagonist/weak partial agonist —this activity is hypothesized to underlie some of the effects of buprenorphine on mood disorders and addiction. δ-Opioid receptor (DOR): High affinity antagonist Nociceptin receptor (NOP, ORL-1): Weak affinity, very weak partial agonist In simplified terms, buprenorphine can essentially be thought of as a nonselective, mixed agonist–antagonist opioid receptor modulator, acting as an unusually high affinity, weak partial agonist of the MOR, a high affinity antagonist of the KOR and DOR, and a relatively low affinity, very weak partial agonist of the ORL-1/NOP. Although buprenorphine is a partial agonist of the MOR, human studies have found that it acts like a full agonist with respect to analgesia in opioid-intolerant individuals.

ther information networks and exchanges. EHRs may include a range of data, including demographics, medical history, medication and allergies, immunization status, laboratory test results, radiology images, vital signs, personal statistics like age and weight, and billing information. For several decades, EHRs have been touted as key to increasing quality of care. EHR combines all patients' demographics into a large pool, which assists providers in the creation of "new treatments or innovation in healthcare delivery" to improve quality outcomes in healthcare. Combining multiple types of clinical data within electronic health records has enabled clinicians to identify and stratify patients with chronic conditions. EHR systems may also support improvements in quality of care through the use of data and analytics to help prevent hospitalizations among high-risk patients. EHR systems are designed to store data accurately and to capture a patient's state across time. It eliminates the need to track down a patient's previous paper medical records and assists in ensuring data is up-to-date, accurate, and legible. It also allows open communication between the patient and the provider while providing "privacy and security." EHR is cost-efficient, decreases the risk of lost paperwork, and can reduce risk of data replication as there is only one modifiable file, which means the file is more likely up to date. Due to the digital information being searchable and in a single file, EMRs (electronic medical records) are more effective when extracting medical data to examine possible trends and long-term changes in a patient.

Terminology The terms electronic health record (EHR), electronic patient record (EPR), and electronic medical record (EMR) have often been used interchangeably, but "subtle" differences exist. The EHR is a more longitudinal collection of the electronic health information of individual patients or populations. The EMR, in contrast, is the patient record created by providers for specific encounters in hospitals and ambulatory environments and can serve as a data source for an EHR. EMRs are essentially digital versions of the paper documents used in a clinician's office, typically functioning as an internal system within a practice. An EMR includes the medical and treatment history of patients treated by that specific practice. In contrast, a personal health record (PHR) is an electronic application for recording individual medical data that the individual patient controls and may make available to health providers. Comparison with paper-based records While there is ongoing debate regarding the advantages of electronic health records compared with paper records, the research literature presents a more nuanced view of their benefits and limitations. Increasing discontent and burnout among healthcare professionals is well documented as of 2023, with several studies finding that a leading cause of job frustration and increasing stress for most doctors and nurses is the increasing burden of increasingly complex record-keeping, paperwork, and administrative workloads.. Proponents of EHR note that these systems can substantially reduce such burdens, for example cutting time spent on insurance eligibility tasks by more than 80%. But along with increased convenience, transparency, portability, and accessibility, there is also an increased risk that sensitive information may be accessed by unauthorized persons or unscrupulous users (versus paper medical records). This is acknowledged by the increased security requirements for electronic medical records included in the Health Insurance Portability and Accountability Act (HIPAA) and by large-scale breaches in confidential records reported by EMR users. Meanwhile, handwritten paper medical records may be poorly legible, which can contribute to medical errors. Pre-printed forms, standardization of abbreviations, and standards for penmanship were encouraged to improve the reliability of paper medical records. An example of possible medical errors is the administration of medication. Medication is an intervention that can turn a person's status from stable to unstable very quickly. With paper documentation it is very easy to not properly document the administration of medication, the time given, or errors such as giving the "wrong drug, dose, form, or not checking for allergies," and could affect the patient negatively. It has been reported that these errors have been reduced by "55-83%" because records are now online and require specific steps to avoid these errors. Electronic records may help with the standardization of forms, terminology, and data input. Digitization of forms facilitates the collection of data for epidemiology and clinical studies. However, standardization may create challenges for local practice. Overall, those with EMRs that have automated notes and records, order entry, and clinical decision support had fewer complications, lower mortality rates, and lower costs. EMRs can be continuously updated (within certain legal limitations: see below). If the ability to exchange records between different EMR systems were perfected ("interoperability"), it would facilitate the coordination of health care delivery in non-affiliated health care facilities. In addition, data from an electronic system can be used anonymously for statistical reporting in matters such as quality improvement, resource management, and public health communicable disease surveillance.

Comparison with paper-based records While there is ongoing debate regarding the advantages of electronic health records compared with paper records, the research literature presents a more nuanced view of their benefits and limitations. Increasing discontent and burnout among healthcare professionals is well documented as of 2023, with several studies finding that a leading cause of job frustration and increasing stress for most doctors and nurses is the increasing burden of increasingly complex record-keeping, paperwork, and administrative workloads.. Proponents of EHR note that these systems can substantially reduce such burdens, for example cutting time spent on insurance eligibility tasks by more than 80%. But along with increased convenience, transparency, portability, and accessibility, there is also an increased risk that sensitive information may be accessed by unauthorized persons or unscrupulous users (versus paper medical records). This is acknowledged by the increased security requirements for electronic medical records included in the Health Insurance Portability and Accountability Act (HIPAA) and by large-scale breaches in confidential records reported by EMR users. Meanwhile, handwritten paper medical records may be poorly legible, which can contribute to medical errors. Pre-printed forms, standardization of abbreviations, and standards for penmanship were encouraged to improve the reliability of paper medical records. An example of possible medical errors is the administration of medication. Medication is an intervention that can turn a person's status from stable to unstable very quickly. With paper documentation it is very easy to not properly document the administration of medication, the time given, or errors such as giving the "wrong drug, dose, form, or not checking for allergies," and could affect the patient negatively. It has been reported that these errors have been reduced by "55-83%" because records are now online and require specific steps to avoid these errors. Electronic records may help with the standardization of forms, terminology, and data input. Digitization of forms facilitates the collection of data for epidemiology and clinical studies. However, standardization may create challenges for local practice. Overall, those with EMRs that have automated notes and records, order entry, and clinical decision support had fewer complications, lower mortality rates, and lower costs. EMRs can be continuously updated (within certain legal limitations: see below). If the ability to exchange records between different EMR systems were perfected ("interoperability"), it would facilitate the coordination of health care delivery in non-affiliated health care facilities. In addition, data from an electronic system can be used anonymously for statistical reporting in matters such as quality improvement, resource management, and public health communicable disease surveillance.

s. Methadone was developed in Germany in the late 1930s by Gustav Ehrhart and Max Bockmühl. It was approved for use as an analgesic in the United States in 1947, and has been used in the treatment of addiction since the 1960s. It is on the World Health Organization's List of Essential Medicines. Medical uses Opioid addiction Methadone is used for the treatment of opioid use disorder. It may be used as maintenance therapy or in shorter periods to manage opioid withdrawal symptoms. Its use for the treatment of addiction is usually strictly regulated. In the US, outpatient treatment programs must be certified by the federal Substance Abuse and Mental Health Services Administration (SAMHSA) and registered by the Drug Enforcement Administration (DEA) to prescribe methadone for opioid addiction. A 2009 Cochrane review found methadone was effective in retaining people in treatment and the reduction or cessation of heroin use as measured by self-report and urine/hair analysis and did not affect criminal activity or risk of death. Treatment of opioid-dependent persons with methadone follows one of two routes: maintenance or withdrawal management. Methadone maintenance therapy (MMT) usually takes place in outpatient settings. It is usually prescribed as a single daily dose medication for those who wish to abstain from illicit opioid use. Treatment models for MMT differ. It is not uncommon for treatment recipients to be administered methadone in a specialized clinic, where they are observed for around 15–20 minutes post-dosing, to reduce the risk of diversion of medication. The duration of methadone treatment programs ranges from a few months to years. Given opioid dependence is characteristically a chronic relapsing/remitting disorder, MMT may be lifelong. The length of time a person remains in treatment depends on a number of factors. While starting doses may be adjusted based on the amount of opioids reportedly used, most clinical guidelines suggest doses start low (e.g., at doses not exceeding 40 mg daily) and be titrated gradually. It has been found that doses of 40 mg per day were sufficient to help control the withdrawal symptoms but not enough to curb the cravings for the drug. Doses of 80 to 100 mg per day have shown higher rates of success in patients and less illicit heroin use during the maintenance therapy. However, higher doses do put a patient more at risk for overdose than a moderately low dose (e.g. 20 mg/day). Methadone maintenance has been shown to reduce the transmission of bloodborne viruses associated with opioid injection, such as hepatitis B and C, and/or HIV. The principal goals of methadone maintenance are to relieve opioid cravings, suppress the abstinence syndrome, and block the euphoric effects associated with opioids. Chronic methadone dosing will eventually lead to neuroadaptation, characterised by tolerance and dependence. However, when used correctly in treatment, maintenance therapy is medically safe, non-sedating, and can provide a slow recovery from opioid addiction.

analgesic in the United States in 1947, and has been used in the treatment of addiction since the 1960s. It is on the World Health Organization's List of Essential Medicines. Medical uses Opioid addiction Methadone is used for the treatment of opioid use disorder. It may be used as maintenance therapy or in shorter periods to manage opioid withdrawal symptoms. Its use for the treatment of addiction is usually strictly regulated. In the US, outpatient treatment programs must be certified by the federal Substance Abuse and Mental Health Services Administration (SAMHSA) and registered by the Drug Enforcement Administration (DEA) to prescribe methadone for opioid addiction. A 2009 Cochrane review found methadone was effective in retaining people in treatment and the reduction or cessation of heroin use as measured by self-report and urine/hair analysis and did not affect criminal activity or risk of death. Treatment of opioid-dependent persons with methadone follows one of two routes: maintenance or withdrawal management. Methadone maintenance therapy (MMT) usually takes place in outpatient settings. It is usually prescribed as a single daily dose medication for those who wish to abstain from illicit opioid use. Treatment models for MMT differ. It is not uncommon for treatment recipients to be administered methadone in a specialized clinic, where they are observed for around 15–20 minutes post-dosing, to reduce the risk of diversion of medication. The duration of methadone treatment programs ranges from a few months to years. Given opioid dependence is characteristically a chronic relapsing/remitting disorder, MMT may be lifelong. The length of time a person remains in treatment depends on a number of factors. While starting doses may be adjusted based on the amount of opioids reportedly used, most clinical guidelines suggest doses start low (e.g., at doses not exceeding 40 mg daily) and be titrated gradually. It has been found that doses of 40 mg per day were sufficient to help control the withdrawal symptoms but not enough to curb the cravings for the drug. Doses of 80 to 100 mg per day have shown higher rates of success in patients and less illicit heroin use during the maintenance therapy. However, higher doses do put a patient more at risk for overdose than a moderately low dose (e.g. 20 mg/day). Methadone maintenance has been shown to reduce the transmission of bloodborne viruses associated with opioid injection, such as hepatitis B and C, and/or HIV. The principal goals of methadone maintenance are to relieve opioid cravings, suppress the abstinence syndrome, and block the euphoric effects associated with opioids. Chronic methadone dosing will eventually lead to neuroadaptation, characterised by tolerance and dependence. However, when used correctly in treatment, maintenance therapy is medically safe, non-sedating, and can provide a slow recovery from opioid addiction.

Opioid addiction Methadone is used for the treatment of opioid use disorder. It may be used as maintenance therapy or in shorter periods to manage opioid withdrawal symptoms. Its use for the treatment of addiction is usually strictly regulated. In the US, outpatient treatment programs must be certified by the federal Substance Abuse and Mental Health Services Administration (SAMHSA) and registered by the Drug Enforcement Administration (DEA) to prescribe methadone for opioid addiction. A 2009 Cochrane review found methadone was effective in retaining people in treatment and the reduction or cessation of heroin use as measured by self-report and urine/hair analysis and did not affect criminal activity or risk of death. Treatment of opioid-dependent persons with methadone follows one of two routes: maintenance or withdrawal management. Methadone maintenance therapy (MMT) usually takes place in outpatient settings. It is usually prescribed as a single daily dose medication for those who wish to abstain from illicit opioid use. Treatment models for MMT differ. It is not uncommon for treatment recipients to be administered methadone in a specialized clinic, where they are observed for around 15–20 minutes post-dosing, to reduce the risk of diversion of medication. The duration of methadone treatment programs ranges from a few months to years. Given opioid dependence is characteristically a chronic relapsing/remitting disorder, MMT may be lifelong. The length of time a person remains in treatment depends on a number of factors. While starting doses may be adjusted based on the amount of opioids reportedly used, most clinical guidelines suggest doses start low (e.g., at doses not exceeding 40 mg daily) and be titrated gradually. It has been found that doses of 40 mg per day were sufficient to help control the withdrawal symptoms but not enough to curb the cravings for the drug. Doses of 80 to 100 mg per day have shown higher rates of success in patients and less illicit heroin use during the maintenance therapy. However, higher doses do put a patient more at risk for overdose than a moderately low dose (e.g. 20 mg/day). Methadone maintenance has been shown to reduce the transmission of bloodborne viruses associated with opioid injection, such as hepatitis B and C, and/or HIV. The principal goals of methadone maintenance are to relieve opioid cravings, suppress the abstinence syndrome, and block the euphoric effects associated with opioids. Chronic methadone dosing will eventually lead to neuroadaptation, characterised by tolerance and dependence. However, when used correctly in treatment, maintenance therapy is medically safe, non-sedating, and can provide a slow recovery from opioid addiction.

t an intervening health care provider." When rural settings, lack of transport, a lack of mobility, conditions due to outbreaks, epidemics or pandemics, decreased funding, or a lack of staff restrict access to care, telemedicine may bridge the gap and can even improve retention in treatment as well as provide distance-learning; meetings, supervision, and presentations between practitioners; online information and health data management and healthcare system integration.

gration. EHealth encompasses a wide range of applications, including but not limited to the following: Two clinicians discussing a case via video conference; Robotic surgery performed through remote access; Physical therapy conducted using digital monitoring instruments, live feed, and application combinations; Diagnostic tests transferred between facilities for interpretation by a higher specialist; Home monitoring through continuous transmission of patient health data; Online consultations between patients and practitioners; Video remote interpretation services for clinical visits.

Telehealth versus telemedicine Telehealth is sometimes discussed interchangeably with telemedicine, the latter being more common than the former. Telehealth has been described as a disruptive innovation in healthcare because it enables medical services to be delivered remotely using communication technologies. The Health Resources and Services Administration distinguishes telehealth from telemedicine in its scope, defining telemedicine only as describing remote clinical services, such as diagnosis and monitoring, while telehealth includes preventative, promotive, and curative care delivery. This includes the above-mentioned non-clinical applications, like administration and provider education. The United States Department of Health and Human Services states that the term telehealth includes "non-clinical services, such as provider training, administrative meetings, and continuing medical education", and that the term telemedicine means "remote clinical services". The World Health Organization uses telemedicine to describe all aspects of health care including preventive care. The American Telemedicine Association uses the terms telemedicine and telehealth interchangeably, although it acknowledges that telehealth is sometimes used more broadly for remote health not involving active clinical treatments. eHealth is another related term, used particularly in the U.K. and Europe, as an umbrella term that includes telehealth, electronic medical records, and other components of health information technology. Methods and modalities Telehealth requires good Internet access by participants, usually in the form of a strong, reliable broadband connection, and broadband mobile communication technology of at least the fourth generation (4G) or long-term evolution (LTE) standard to overcome issues with video stability and bandwidth restrictions. As broadband infrastructure has improved, telehealth usage has become more widely feasible. Healthcare providers often begin telehealth with a needs assessment which assesses hardships that can be improved by telehealth such as travel time, costs or time off work. Collaborators such as technology companies can ease the transition. Delivery can come within four distinct domains: live video (synchronous), store-and-forward (asynchronous), remote patient monitoring, and mobile health. Audio-based telemedicine, primarily through telephone consultations, has been studied as a tool for managing chronic conditions.

tection, promotion, and optimization of health and human functioning; prevention of illness and injury; facilitation of healing; and alleviation of suffering through compassionate presence". Nurses practice in many specialties with varying levels of certification and responsibility. Nurses comprise the largest component of most healthcare environments. There are imbalances between the supply and demand for qualified nurses in many countries. Nurses develop a plan of care, working collaboratively with physicians and physician assistants, therapists, patients, families of patients, and other team members that focuses on treating illness to improve quality of life. In the United Kingdom and the United States, clinical nurse specialists and nurse practitioners diagnose health problems and prescribe medications and other therapies, depending on regulations that vary by state. Nurses may help coordinate care performed by other providers or act independently as nursing professionals.

patients, families of patients, and other team members that focuses on treating illness to improve quality of life. In the United Kingdom and the United States, clinical nurse specialists and nurse practitioners diagnose health problems and prescribe medications and other therapies, depending on regulations that vary by state. Nurses may help coordinate care performed by other providers or act independently as nursing professionals.

urse practitioners diagnose health problems and prescribe medications and other therapies, depending on regulations that vary by state. Nurses may help coordinate care performed by other providers or act independently as nursing professionals. In addition to providing care and support, nurses educate the public and promote health and wellness. In the U.S., nurse practitioners are nurses with a graduate degree in advanced practice nursing, and are permitted to prescribe medications. They practice independently in a variety of settings in more than half of the United States.

ill then dispatch suitable resources for the call. Ambulances are the primary vehicles for delivering EMS, though squad cars, motorcycles, aircraft, boats, fire apparatus, and others may be used. EMS agencies may also operate a non-emergency patient transport service, and some have rescue squads to provide technical rescue or search and rescue services. When EMS is dispatched, they will initiate medical care upon arrival on scene. If it is deemed necessary or a patient requests transport, the unit is then tasked with transferring the patient to the next point of care, typically an emergency department of a hospital. Historically, ambulances only transported patients to care, and this remains the case in parts of the developing world. The term "emergency medical service" was popularised when these services began to emphasise emergency treatment at the scene. In some countries, a substantial portion of EMS calls do not result in a patient being taken to hospital. Training and qualification levels for members and employees of emergency medical services vary widely throughout the world. In some systems, members may be present who are qualified only to drive ambulances, with no medical training. In contrast, most systems have personnel who retain at least basic life support (BLS) certifications.

Advances in the 1960s, especially the development of CPR and defibrillation as the standard form of care for out-of-hospital cardiac arrest, along with new pharmaceuticals, led to changes in the tasks of the ambulances. In Belfast, Northern Ireland the first experimental mobile coronary care ambulance successfully resuscitated patients using these technologies. Freedom House Ambulance Service was the first civilian emergency medical service in the United States to be staffed by paramedics, all of whom were African-American. One well-known report in the US during that time was Accidental Death and Disability: The Neglected Disease of Modern Society, also known as The White Paper. The report concluded that ambulance services in the US varied widely in quality and were often unregulated and unsatisfactory. These studies placed pressure on governments to improve emergency care in general, including the care provided by ambulance services. The government reports resulted in the creation of standards in ambulance construction concerning the internal height of the patient care area (to allow for an attendant to continue to care for the patient during transport), and the equipment (and thus weight) that an ambulance had to carry, and several other factors. In 1971 a progress report was published at the annual meeting, by the then president of American Association of Trauma, Sawnie R. Gaston M.D. Dr. Gaston reported the study was a "superb white paper" that "jolted and wakened the entire structure of organized medicine." This report is created as a "prime mover" and made the "single greatest contribution of its kind to the improvement of emergency medical services". Since this time a concerted effort has been undertaken to improve emergency medical care in the pre-hospital setting. Such advancements included Dr. R Adams Cowley creating the country's first statewide EMS program, in Maryland. The developments were paralleled in other countries. In the United Kingdom, a 1973 law merged the municipal ambulance services into larger agencies and set national standards. In France, the first official SAMU agencies were founded in the 1970s. Organization Depending on country, area within country, or clinical need, emergency medical services may be provided by one or more different types of organization. This variation may lead to large differences in levels of care and expected scope of practice.

Operating separately from (although alongside) the fire and police services of the area, these ambulances are funded by local, provincial or national governments. In some countries, these only tend to be found in big cities, whereas in countries such as the United Kingdom, almost all emergency ambulances are part of a national health system. In the United States, ambulance services provided by a local government are often referred to as "third service" EMS (the fire department, police department, and EMS department forming an emergency services trio) by the members of said service, as well as other city officials and residents. The most notable examples of this model in the United States are Pittsburgh Bureau of Emergency Medical Services, Boston EMS, New Orleans Emergency Medical Services, and Cleveland EMS. Government ambulance services also have to take civil service exams just like government fire departments and police. In the United States, certain federal government agencies employ emergency medical technicians at the basic and advanced life support levels, such as the National Park Service and the Federal Bureau of Prisons. Fire- or police-linked service In countries such as the United States, Japan, France, South Korea and parts of India, ambulances can be operated by the local fire or police services. Fire-based EMS is the most common model in the United States, where nearly all urban fire departments provide EMS and a majority of emergency transport ambulance services in large cities are part of fire departments. Examples of this model are the New York City Fire Department (FDNY) and the Baltimore City Fire Department. It is rare for a police department in the United States to provide EMS or ambulance services, although many police officers have basic medical training (such as Nalaxone use and CPR).

t internationally. In countries following the Anglo-American model, emergency medicine initially consisted of surgeons, general practitioners, and other physicians. However, in recent decades, it has become recognized as a specialty in its own right with its training programs and academic posts, and the specialty is now a popular choice among medical students and newly qualified medical practitioners. By contrast, in countries following the Franco-German model, the specialty does not exist, and emergency medical care is instead provided directly by anesthesiologists (for critical resuscitation), surgeons, specialists in internal medicine, pediatricians, cardiologists, or neurologists as appropriate.

In Belgium there are three recognised ways to practice emergency medicine. Until 2005 there was no accredited emergency medicine program. Emergency medicine was performed by general practitioners (having followed a 240-hour course, Acute Medicine) or by specialists (surgeon, internal medicine, neurologist, anesthesiologist) with or without supra-specialty training in emergency medicine. Since 2005 residency training exists for acute medicine (3 years) or emergency medicine (6 years). At least 50% of the training is in the emergency department; the other part is a rotation between disciplines like pediatrics, surgery, orthopedic surgery, anesthesiology and critical care medicine. Alternative an attending physician with one of following specialties (anesthesiology, internal medicine, cardiology, gastro-enterology, pneumology, rheumatology, urology, general surgery, plastic & reconstructive surgery, orthopedic surgery, neurology, neurosurgery, pediatrics) can follow a supra-specialty program of two years to become an emergency medicine specialist. Brazil In Brazil, the first emergency medicine residency program was created at Hospital Pronto Socorro de Porto Alegre in 1996. In 2002, the emergency medical services were standardized nationally with the creation of SAMU (Serviço de atendimento móvel de urgência), inspired by French EMS, which also provides training to its employees. The nacional emergency medicina association (ABRAMEDE – Associação Brasileira de Medicina de Emergência) was created in 2007. In 2008 the second residency program was started at Messejana Hospital in Fortaleza. Then, in 2015, emergency medicine was formally recognized as a medical specialty by the Brazilian Medical Association. After formal recognition, multiple residency programs were created nationwide (e.g. Universidade Federal de Minas Gerais in 2016 and Universidade de São Paulo in 2017). The residency consists of a three-year program with training in all emergency department specialties (i.e.

A five-year residency leads to the designation of FRCP(EM) through the Royal College of Physicians and Surgeons of Canada (Emergency Medicine Board Certification – emergency medicine consultant). A one-year emergency medicine enhanced skills program following a two-year family medicine residency leading to the designation of CCFP(EM) through the College of Family Physicians of Canada (Advanced Competency Certification). The CFPC also allows those are having worked a minimum of four years at a minimum of 400 hours per year in emergency medicine to challenge the examination of special competence in emergency medicine and thus become specialized. CCFP(EM) emergency physicians outnumber FRCP(EM) physicians by a ratio of about 3 to 1, and they tend to work primarily as clinicians with a minor focus on academic activities such as teaching and research. FRCP(EM) Emergency Medicine Board specialists tend to congregate in academic centres and have more academically oriented careers, which emphasize administration, research, critical care, disaster medicine, and teaching. They also tend to sub-specialize in toxicology, critical care, pediatric emergency medicine, and sports medicine.

esses and injuries, some of which may be life-threatening and require immediate attention. In some countries, emergency departments have become important entry points for those without other means of access to medical care. The emergency departments of most hospitals operate 24 hours a day, although staffing levels may be varied in an attempt to reflect patient volume. History Accident services were provided by workmen's compensation plans, railway companies, and municipalities in Europe and the United States by the late mid-nineteenth century, but the world's first specialized trauma care center was opened in 1911 in the United States at the University of Louisville Hospital in Louisville, Kentucky. It was further developed in the 1930s by surgeon Arnold Griswold, who also equipped police and fire vehicles with medical supplies and trained officers to give emergency care while en route to the hospital. Today, a typical hospital has its emergency department in its own section of the ground floor of the grounds, with its own dedicated entrance. As patients can arrive at any time and with any complaint, a key part of the operation of an emergency department is the prioritization of cases based on clinical need. This process is called triage. Triage is normally the first stage the patient passes through, and consists of a brief assessment, including a set of vital signs, and the assignment of a "chief complaint" (e.g. chest pain, abdominal pain, difficulty breathing, etc.). Most emergency departments have a dedicated area for this process to take place and may have staff dedicated to performing nothing but a triage role. In most departments, this role is fulfilled by a triage nurse, although dependent on training levels in the country and area, other health care professionals may perform the triage sorting, including paramedics and physicians. Triage is typically conducted face-to-face when the patient presents, or a form of triage may be conducted via radio with an ambulance crew; in this method, the paramedics will call the hospital's triage center with a short update about an incoming patient, who will then be triaged to the appropriate level of care. Most patients will be initially assessed at triage and then passed to another area of the department, or another area of the hospital, with their waiting time determined by their clinical need. However, some patients may complete their treatment at the triage stage, for instance, if the condition is very minor and can be treated quickly, if only advice is required, or if the emergency department is not a suitable point of care for the patient. Conversely, patients with evidently serious conditions, such as cardiac arrest, will bypass triage altogether and move straight to the appropriate part of the department. The resuscitation area, commonly referred to as "Trauma" or "Resus", is a key area in most departments. The most seriously ill or injured patients will be dealt with in this area, as it contains the equipment and staff required for dealing with immediately life-threatening illnesses and injuries. In such situations, the time in which the patient is treated is crucial. Typical resuscitation staffing involves at least one attending physician, and at least one and usually two nurses with trauma and Advanced Cardiac Life Support training. These personnel may be assigned to the resuscitation area for the entirety of the shift or may be "on call" for resuscitation coverage (i.e. if a critical case presents via walk-in triage or ambulance, the team will be paged to the resuscitation area to deal with the case immediately). Resuscitation cases may also be attended by residents, radiographers, ambulance personnel, respiratory therapists, hospital pharmacists and students of any of these professions depending upon the skill mix needed for any given case and whether or not the hospital provides teaching services. Patients who exhibit signs of being seriously ill but are not in immediate danger of life or limb will be triaged to "acute care" or "majors", where they will be seen by a physician and receive a more thorough assessment and treatment. Examples of "majors" include chest pain, difficulty breathing, abdominal pain and neurological complaints. Advanced diagnostic testing may be conducted at this stage, including laboratory testing of blood and/or urine, ultrasonography, CT or MRI scanning. Medications appropriate to manage the patient's condition will also be given. Patients may be discharged home from this area or admitted to the hospital for further treatment depending on underlying causes of the patient's chief complaint. Patients whose condition is not immediately life-threatening will be sent to an area suitable to deal with them, and these areas might typically be termed a "prompt care" or "minors" area. Such patients may still have been found to have significant problems, including fractures, dislocations, and lacerations requiring suturing. Children can present particular challenges in treatment. Some departments have dedicated pediatrics areas, and some departments employ a play therapist whose job is to put children at ease to reduce the anxiety caused by visiting the emergency department, as well as provide distraction therapy for simple procedures. Many hospitals have a separate area for evaluation of psychiatric problems. These are often staffed by psychiatrists and mental health nurses and social workers. There is typically at least one room for people who are actively a risk to themselves or others (e.g. suicidal). Fast decisions on life-and-death cases are critical in hospital emergency departments. As a result, doctors face great pressures to overtest and overtreat.

Emergency departments in the military benefit from the added support of enlisted personnel who are capable of performing a wide variety of tasks they have been trained for through specialized military schooling. For example, in United States military hospitals, Air Force Aerospace Medical Technicians and Navy Hospital Corpsmen perform tasks that fall under the scope of practice of both doctors (i.e. sutures, staples and incision and drainages) and nurses (i.e. medication administration, foley catheter insertion, and obtaining intravenous access) and also perform splinting of injured extremities, nasogastric tube insertion, intubation, wound cauterizing, eye irrigation, and much more. Often, some civilian education and/or certification will be required, such as an EMT certification, in case of the need to provide care outside the base where the member is stationed.

Type 1 department – major A&E, providing a consultant-led 24 hour service with full resuscitation facilities Type 2 department – single specialty A&E service (e.g. ophthalmology, dentistry) Type 3 department – other A&E/minor injury unit/walk-in centre, treating minor injuries and illnesses Historically, waits for assessment in A&E were very long in some areas of the UK. In October 2002, the Department of Health introduced a four-hour target in emergency departments that required departments in England to assess and treat patients within four hours of arrival, with referral and assessment by other departments if deemed necessary. It was expected that the patients would have physically left the department within the four hours. Present policy is that 95% of all patient cases do not "breach" this four-hour wait. The busiest departments in the UK outside London include University Hospital of Wales in Cardiff, The North Wales Regional Hospital in Wrexham, the Royal Infirmary of Edinburgh and Queen Alexandra Hospital in Portsmouth. In July 2014, the QualityWatch research programme published in-depth analysis which tracked 41 million A&E attendances from 2010 to 2013. This showed that the number of patients in a department at any one time was closely linked to waiting times, and that crowding in A&E had increased as a result of a growing and ageing population, compounded by the freezing or reduction of A&E capacity. Between 2010/11 and 2012/13 crowding increased by 8%, despite a rise of just 3% in A&E visits, and this trend looks set to continue. Other influential factors identified by the report included temperature (with both hotter and colder weather pushing up A&E visits), staffing and inpatient bed numbers. A&E services in the UK are often the focus of a great deal of media and political interest, and data on A&E performance is published weekly. However, this is only one part of a complex urgent and emergency care system. Reducing A&E waiting times therefore requires a comprehensive, coordinated strategy across a range of related services. Many A&E departments are crowded and confusing. Many of those attending are understandably anxious, and some are mentally ill, and especially at night are under the influence of alcohol or other substances. Pearson Lloyd's redesign – 'A Better A&E' – is claimed to have reduced aggression against hospital staff in the departments by 50 per cent. A system of environmental signage provides location-specific information for patients. Screens provide live information about how many cases are being handled and the current status of the A&E department. Waiting times for patients to be seen at A&E were rising in the years leading up to 2020, and were hugely worsened during the COVID-19 pandemic that started in 2020. In response to the year-on-year increasing pressure on A&E units, followed by the unprecedented effects of the COVID-19 pandemic, the NHS in late 2020 proposed a radical change to handling of urgent and emergency care, separating "emergency" and "urgent". Emergencies are life-threatening illnesses or accidents which require immediate, intensive treatment. Services that should be accessed in an emergency include ambulance (via 999) and emergency departments. Urgent requirements are for an illness or injury that requires urgent attention but is not a life-threatening situation. Urgent care services include a phone consultation through the NHS111 Clinical Assessment Service, pharmacy advice, out-of-hours GP appointments, and/or referral to an urgent treatment centre (UTC). As part of the response, walk-in Urgent Treatment Centres (UTC) were created. People potentially needing A&E treatment are recommended to phone the NHS111 line, which will either book an arrival time for A&E, or recommend a more appropriate procedure.

the appropriateness of using a single category for a heterogeneous group of individuals with complex needs and a varied range of problems. The concept can be used broadly, for example depression and alcohol use disorder, or it can be restricted to specify severe mental illness (e.g. psychosis, schizophrenia) and substance use disorder (e.g. cannabis use), or a person who has a milder mental illness and a drug dependency, such as panic disorder or generalized anxiety disorder and is dependent on opioids. Diagnosing a primary psychiatric illness in people who use substances is challenging as substance use disorder itself often induces psychiatric symptoms, thus making it necessary to differentiate between substance induced and pre-existing mental illness. Those with co-occurring disorders face complex challenges.

Differentiating pre-existing and substance induced The identification of substance-induced versus independent psychiatric symptoms or disorders has important treatment implications and often constitutes a challenge in daily clinical practice. Similar patterns of comorbidity and risk factors in individuals with substance induced disorder and those with independent non-substance induced psychiatric symptoms suggest that the two conditions may share underlying etiologic factors. Substance use disorders, including those of alcohol and prescription medications, can induce a set of symptoms which resembles mental illness, which can make it difficult to differentiate between substance induced psychiatric syndromes and pre-existing mental health problems. More often than not psychiatric disorders among people who use alcohol or illicit substances disappear with prolonged abstinence. Substance induced psychiatric symptoms can occur both in the intoxicated state and also during the withdrawal state. In some cases, these substance induced psychiatric disorders can persist long after detoxification, such as prolonged psychosis or depression after amphetamine or cocaine use. Use of hallucinogens can trigger delusional and other psychotic phenomena long after cessation of use and cannabis may trigger panic attacks during intoxication and with use it may cause a state similar to dysthymia. Severe anxiety and depression are commonly induced by sustained alcohol use which in most cases abates with prolonged abstinence. Even moderate sustained use of alcohol may increase anxiety and depression levels in some individuals. In most cases these drug induced psychiatric disorders fade away with prolonged abstinence. A protracted withdrawal syndrome can also occur with psychiatric and other symptoms persisting for months after cessation of use. Among the currently prevalent medications, benzodiazepines are the most notable drug for inducing prolonged withdrawal effects with symptoms sometimes persisting for years after cessation of use. Prospective epidemiological studies do not support the hypotheses that comorbidity of substance use disorders with other psychiatric illnesses is primarily a consequence of substance use or dependence or that increasing comorbidity is largely attributable to increasing use of substances. Yet emphasis is often on the effects of substances on the brain creating the impression that dual disorders are a natural consequence of these substances. However, addictive drugs or exposure to gambling will not lead to addictive behaviors or drug dependence in most individuals but only in vulnerable ones, although, according to some researchers, neuroadaptation or regulation of neuronal plasticity, and molecular changes, may alter gene expression in some cases and subsequently lead to substance use disorders. Research instruments are also often insufficiently sensitive to discriminate between independent, true dual pathology, and substance-induced symptoms. Structured instruments, as Global Appraisal of Individual Needs - Short Screener-GAIN-SS and Psychiatric Research Interview for Substance and Mental Disorders for DSM-IV-PRISM, have been developed to increase the diagnostic validity.

Prevalence Comorbidity of addictive disorders and other psychiatric disorders, i.e., dual disorders, is very common and a large body of literature has accumulated demonstrating that mental disorders are strongly associated with substance use disorders. Adolescents and young adults are particularly at risk for dual diagnosis, as early substance use can interfere with brain development and exacerbate emerging mental health conditions. The 2011 USA National Survey on Drug Use and Health found that 17.5% of adults with a mental illness had a co-occurring substance use disorder; this works out to 7.98 million people. Estimates of co-occurring disorders in Canada are even higher, with an estimated 40-60% of adults with a severe and persistent mental illness experiencing a substance use disorder in their lifetime. A study by Kessler et al. in the United States attempting to assess the prevalence of dual diagnosis found that 47% of clients with schizophrenia had a substance misuse disorder at some time in their life, and the chances of developing a substance misuse disorder was significantly higher among patients with a psychotic illness than in those without a psychotic illness. Another study looked at the extent of substance misuse in a group of 187 chronically mentally ill patients living in the community. According to the clinician's ratings, around a third of the sample used alcohol, street drugs, or both during the six months before evaluation. Further UK studies have shown slightly more moderate rates of substance misuse among mentally ill individuals. One study found that individuals with schizophrenia showed just a 7% prevalence of problematic drug use in the year prior to being interviewed and 21% reported problematic use some time before that. Wright and colleagues identified individuals with psychotic illnesses who had been in contact with services in the London borough of Croydon over the previous 6 months. Cases of alcohol or substance misuse and dependence were identified through standardized interviews with clients and keyworkers. Results showed that prevalence rates of dual diagnosis were 33% for the use of any substance, 20% for alcohol misuse only and 5% for drug misuse only.

ensure the safe, effective, and affordable use of medicines. It is a miscellaneous science as it links health sciences with pharmaceutical sciences and natural sciences. The professional practice has become more clinically oriented as most drugs are now manufactured by pharmaceutical industries. Based on the setting, pharmacy practice is either classified as community or institutional pharmacy. Providing direct patient care in the community of institutional pharmacies is considered clinical pharmacy. The scope of pharmacy practice includes more traditional roles such as compounding and dispensing of medications. It also includes more modern services related to health care including clinical services, reviewing medications for safety and efficacy, and providing drug information with patient counselling. Pharmacists, therefore, are experts on drug therapy and are the primary health professionals who optimize the use of medication for the benefit of the patients. In some jurisdictions, such as Canada and Australia, Pharmacists may be able to prescribe or adapt/manage prescriptions, as well as give injections and immunizations. An establishment in which pharmacy (in the first sense) is practiced is called a pharmacy (this term is more common in the United States) or chemists (which is more common in Great Britain, though pharmacy is also used).

Pharmacists provide direct patient care services that optimize the use of medication and promotes health, wellness, and disease prevention. Clinical pharmacists care for patients in all health care settings, but the clinical pharmacy movement initially began inside hospitals and clinics. Clinical pharmacists often collaborate with physicians and other healthcare professionals to improve pharmaceutical care. Clinical pharmacists are now an integral part of the interdisciplinary approach to patient care. They often participate in patient care rounds for drug product selection. In the UK clinical pharmacists can also prescribe some medications for patients on the National Health Services (NHS) or privately, after completing a non-medical prescribers course to become an Independent Prescriber. The clinical pharmacist's role involves creating a comprehensive drug therapy plan for patient-specific problems, identifying goals of therapy, and reviewing all prescribed medications prior to dispensing and administration to the patient. The review process often involves an evaluation of the appropriateness of drug therapy (e.g., drug choice, dose, route, frequency, and duration of therapy) and its efficacy. Research shows that pharmacist led strategies reduce errors related to medication use.

Environmental impacts In 2022 the Organisation for Economic Co-operation and Development (OECD) proposed that pharmaceutical companies should be required to collect and destroy unused or expired medicines that they have put on the market in order to reduce public health risks around the misuse of medicines obtained from waste bins, the development of antimicrobial resistant bacteria from the discharge of antibiotics into environmental systems and "economic losses" from wasted healthcare resources. Potentially harmful concentrations of pharmaceutical waste has been detected in more than a quarter of water samples taken from 258 rivers around the world. OECD recommend that medicines should be collected separately from household waste and that "marketplaces and redistribution platforms for unused close-to-expiry-date medicines" should be set up. Such extended producer responsibility schemes are already running in France, Spain and Portugal. The future of pharmacy In the coming decades, pharmacists are expected to become more integral within the health care system. Rather than simply dispensing medication, pharmacists are increasingly expected to be compensated for their patient care skills. In particular, Medication Therapy Management (MTM) includes the clinical services that pharmacists can provide for their patients. Such services include a thorough analysis of all medication (prescription, non-prescription, and herbals) currently being taken by an individual. The result is a reconciliation of medication and patient education resulting in increased patient health outcomes and decreased costs to the health care system. This shift has already commenced in some countries; for instance, pharmacists in Australia receive remuneration from the Australian Government for conducting comprehensive Home Medicines Reviews. In Canada, pharmacists in certain provinces have limited prescribing rights (as in Alberta and British Columbia) or are remunerated by their provincial government for expanded services such as medications reviews (Medschecks in Ontario). In the United Kingdom, pharmacists who undertake additional training are obtaining prescribing rights and this is because of pharmacy education. They are also being paid for by the government for medicine use reviews. In Scotland, the pharmacist can write prescriptions for Scottish registered patients of their regular medications, for the majority of drugs, except for controlled drugs, when the patient is unable to see their doctor, as could happen if they are away from home or the doctor is unavailable. In the United States, pharmaceutical care or clinical pharmacy has had an evolving influence on the practice of pharmacy. Moreover, the Doctor of Pharmacy (Pharm. D.) degree is now required before entering practice and some pharmacists now complete one or two years of residency or fellowship training following graduation. In addition, consultant pharmacists, who traditionally operated primarily in nursing homes, are now expanding into direct consultation with patients, under the banner of "senior care pharmacy". In addition to patient care, pharmacies will be a focal point for medical adherence initiatives. There is enough evidence to show that integrated pharmacy based initiatives significantly impact adherence for chronic patients.

Medicaid is the largest source of funding for medical and health-related services for people with low income in the United States, providing taxpayer-funded health insurance to 85 million low-income and disabled people as of 2022; in 2019, the program paid for half of all U.S. births. In 2023, the total (federal and state) annual cost of Medicaid was $870 billion, with an average cost per enrollee of $7,600 for 2021. 37% of enrollees were children, but they only accounted for 15% of the spending, ($3,000 per person) while seniors and disabled persons accounted for 21% of enrollees and 52% of spending (more than $18,000 per person). In general, Medicaid recipients must be U.S. citizens or qualified non-citizens, and may include low-income adults, their children, and people with certain disabilities. Medicaid also covers long-term services and supports, including both nursing home care and home- and community-based services, for those with low incomes and minimal assets. Of the 7.7 million Americans who used long-term services and supports in 2020, about 5.6 million were covered by Medicaid. Along with Medicare, Tricare, ChampVA, and CHIP, Medicaid is one of the several Federal Government-sponsored medical insurance programs in the United States. Medicaid covers healthcare costs for people with low incomes; Medicare is a universal program providing health coverage for the elderly; and the CHIP program covers uninsured children in families with incomes that are too high to be covered by Medicaid. Medicaid offers elder care benefits not normally covered by Medicare, including nursing home care and personal care services. There are also dual health plans for people who have both Medicaid and Medicare. Research shows that existence of the Medicaid program improves health outcomes, health insurance coverage, access to health care, and recipients' financial security and provides economic benefits to states and health providers.

2025 Medicaid cuts in the second Trump administration In 2025, Republican Congressional leaders John Thune and Mike Johnson announced goals of cutting 1.5 to 2 trillion dollars of the US federal budget, with President Donald Trump stating that cuts to Medicaid would only include "abuse or waste". The 2025 budget resolution, which was passed by the House of Representatives with only Republicans votes, proposed cutting $880 billion from the Standing Committee for Energy and Commerce, which includes many areas, such as Medicaid and Medicare. On July 4, 2025, President Donald Trump signed the One Big Beautiful Bill Act, intended in part to implement this resolution. The act cut Medicaid in a number of ways: while it did not repeal the ACA's Medicaid expansion, it mandated work requirements for able-bodied Medicaid recipients. It also requires Medicaid recipients above the federal poverty line to pay more fees for coverage; adds new verification requirements; increases the number of times states need to check the eligibility of their Medicaid expansion recipients; prohibits Medicaid from funding nonprofits that provide abortion care; makes it harder for illegal immigrants to use Medicaid; bans pharmacy benefit managers from using spread pricing; and puts limits on so-called "provider taxes" that states impose on healthcare providers to fund their portion of Medicaid spending. The non-partisan Congressional Budget Office (CBO) estimated that it will reduce the number of people on Medicaid by several million.; the CBO estimates that the work requirements in particular will lead 11 million to lose their Medicaid coverage, many of whom already work or qualify for exemptions but will not be able to get through the red tape. The bill prompted claims that undocumented immigrants are on Medicaid. Undocumented immigrants are already ineligible for full Medicaid benefits, and many undocumented immigrants access state-funded health programs rather than federal Medicaid. According to a CBO analysis, the bill's provisions could lead some states to cut back those state-funded health programs, potentially causing an estimated 1.4 million people to lose state-level health coverage, including undocumented immigrants. When commenting on the Trump administration's One Big Beautiful Bill Act and the impact of the Medicaid provisions on the economy, USDA Secretary Brooke Rollins stated that 34 million able-bodied adults on Medicaid should be working.

Arizona: AHCCCS California: Medi-Cal Connecticut: HUSKY D Illinois: HealthChoice Illinois Iowa: Hawk-i Healthy and Well-Kids in Iowa Maine: MaineCare Massachusetts: MassHealth New Jersey: NJ FamilyCare Oregon: Oregon Health Plan Oklahoma: Soonercare Tennessee: TennCare Washington: Washington Apple Health Wisconsin: BadgerCare As of January 2012, Medicaid and/or CHIP funds could be obtained to help pay employer health care premiums in Alabama, Alaska, Arizona, Colorado, Florida, and Georgia. Differences by state While states have significant autonomy in implementing the Medicaid program, their flexibility is bounded by federal requirements designed to ensure a baseline of coverage and access. For example, federal law mandates that certain services, such as inpatient and outpatient hospital services, laboratory and X-ray services, and physician services, must be covered by all state Medicaid programs. Additionally, states must adhere to federal guidelines regarding beneficiary protections and quality standards.

n. While psychological knowledge is often applied to the assessment and treatment of mental health problems, it is also directed towards understanding and solving problems in several spheres of human activity. By many accounts, psychology ultimately aims to benefit society. Many psychologists are involved in some therapeutic role, practicing psychotherapy in clinical, counseling, or school settings. Other psychologists conduct scientific research on a wide range of topics related to mental processes and behavior. Typically, the latter group of psychologists works in academic settings (e.g., universities, medical schools, or hospitals). Another group of psychologists is employed in industrial and organizational settings.

The ancient civilizations of Egypt, Greece, China, India, and Persia all engaged in the philosophical study of psychology. In Ancient Egypt the Ebers Papyrus mentioned depression and thought disorders. Historians note that Greek philosophers, including Thales, Plato, and Aristotle (especially in his De Anima treatise), addressed the workings of the mind. As early as the 4th century BCE, the Greek physician Hippocrates theorized that mental disorders had physical rather than supernatural causes. In 387 BCE, Plato suggested that the brain is where mental processes take place, and in 335 BC, Aristotle suggested that it was the heart. In China, the foundations of psychological thought emerged from the philosophical works of ancient thinkers like Laozi and Confucius, as well as the teachings of Buddhism. This body of knowledge drew insights from introspection, observation, and techniques for focused thinking and behavior. It viewed the universe as comprising physical and mental realms and their interplay. Chinese philosophy also emphasized purifying the mind to increase virtue and power. An ancient text known as The Yellow Emperor's Classic of Internal Medicine identifies the brain as the nexus of wisdom and sensation, includes theories of personality based on yin–yang balance, and analyzes mental disorder in terms of physiological and social disequilibria. Chinese scholarship that focused on the brain advanced during the Qing dynasty with the work of Western-educated Fang Yizhi (1611–1671), Liu Zhi (1660–1730), and Wang Qingren (1768–1831). Wang Qingren emphasized the brain as the center of the nervous system, linked mental disorders to brain diseases, investigated the causes of dreams and insomnia, and advanced a theory of hemispheric lateralization in brain function. Influenced by Hinduism, Indian philosophy explored distinctions in types of awareness. A central idea of the Upanishads and other Vedic texts that formed the foundations of Hinduism was the distinction between a person's transient mundane self and their eternal, unchanging soul. Divergent Hindu doctrines and Buddhism have challenged this hierarchy of selves, but have all emphasized the importance of reaching higher awareness. Yoga encompasses a range of techniques for pursuing the goal of higher awareness. Theosophy, a religion established by Russian-American philosopher Helena Blavatsky, drew inspiration from these doctrines during her time in British India. Psychology was of interest to Enlightenment thinkers in Europe. In Germany, Gottfried Wilhelm Leibniz (1646–1716) applied his principles of calculus to the mind, arguing that mental activity took place on an indivisible continuum. He suggested that the difference between conscious and unconscious awareness is only a matter of degree. Christian Wolff identified psychology as its own science, writing Psychologia Empirica in 1732 and Psychologia Rationalis in 1734. Immanuel Kant advanced the idea of anthropology as a discipline, with psychology an important subdivision. Kant, however, explicitly rejected the idea of an experimental psychology, writing that "the empirical doctrine of the soul can also never approach chemistry even as a systematic art of analysis or experimental doctrine, for in it the manifold of inner observation can be separated only by mere division in thought, and cannot then be held separate and recombined at will (but still less does another thinking subject suffer himself to be experimented upon to suit our purpose), and even observation by itself already changes and displaces the state of the observed object." In 1783, Ferdinand Ueberwasser (1752–1812) designated himself Professor of Empirical Psychology and Logic and gave lectures on scientific psychology, though these developments were soon overshadowed by the Napoleonic Wars. At the end of the Napoleonic era, Prussian authorities discontinued the Old University of Münster. Having consulted philosophers Hegel and Herbart, however, in 1825 the Prussian state established psychology as a mandatory discipline in its rapidly expanding and highly influential educational system. However, this discipline did not yet embrace experimentation.

Surveys are used in psychology for the purpose of measuring attitudes and traits, monitoring changes in mood, and checking the validity of experimental manipulations (checking research participants' perception of the condition they were assigned to). Psychologists have commonly used paper-and-pencil surveys. However, surveys are also conducted by phone or via e-mail. Web-based surveys are increasingly used to conveniently reach a large number of subjects. Observational studies are commonly conducted in psychology. In cross-sectional observational studies, psychologists collect data at a single point in time. The goal of many cross-sectional studies is to assess the extent to which factors are correlated. By contrast, in longitudinal studies psychologists collect data on the same sample at two or more points in time. Sometimes the purpose of longitudinal research is to study trends across time, such as the stability of traits or age-related changes in behavior. Because some studies involve endpoints that psychologists cannot ethically study from an experimental standpoint, such as identifying the causes of depression, they conduct longitudinal studies of a large group of depression-free people, periodically assessing what is happening in the individuals' lives. In this way, psychologists have an opportunity to test causal hypotheses regarding conditions that commonly arise in people's lives that put them at risk for depression. Problems that affect longitudinal studies include selective attrition, a type of bias in which a particular type of research participant leaves a study disproportionately. Arthur Bandura ran an example of an observational study. This observational study focused on children exposed to an adult exhibiting aggressive behavior and their reactions to toys, compared with other children not exposed to these stimuli. The result shows that children who had seen the adult acting aggressively towards a toy, in turn, were aggressive towards their own toy when put in a situation that frustrated them. Exploratory data analysis includes a variety of practices that researchers use to reduce a large number of variables to a small number of overarching factors. In Peirce's three modes of inference, exploratory data analysis corresponds to abduction. Meta-analysis is the technique research psychologists use to integrate results from many studies of the same variables and arriving at a grand average of the findings. Direct brain observation/manipulation A classic and popular tool for relating mental and neural activity is the electroencephalogram (EEG). This technique uses electrodes with amplifiers on a person's scalp to measure voltage changes across different parts of the brain. Hans Berger, the first researcher to use EEG on an unopened skull, quickly found that brains exhibit signature "brain waves": electric oscillations which correspond to different states of consciousness. Researchers subsequently refined statistical methods for synthesizing the electrode data, and identified unique brain wave patterns such as the delta wave observed during non-REM sleep. Newer functional neuroimaging techniques include functional magnetic resonance imaging and positron emission tomography, both of which track blood flow in the brain. These technologies provide more localized information about brain activity and create brain representations with widespread appeal. They also provide insight that avoids the classic problems of subjective self-reporting. It remains challenging to draw hard conclusions about where in the brain specific thoughts originate—or even how usefully such localization corresponds with reality. However, neuroimaging has yielded unmistakable results demonstrating correlations between mind and brain. Some of these draw on a systemic neural network model rather than a localized function model. Interventions such as transcranial magnetic stimulation and drugs also provide information about brain–mind interactions.

, Arts & Sciences, and Education; MPA program in the School of Public Service; and the MPH program in the College of Health Sciences. It is classified among "R2: Doctoral Universities – High research activity".

Boise State University (BSU) is a public research university in Boise, Idaho, United States. Founded in 1932 by the Episcopal Church, it became an independent junior college in 1934 and has been awarding baccalaureate and master's degrees since 1965. It became a public institution in 1969. Boise State offers more than 100 graduate programs, including a variety of MBA programs and the MAcc program in the College of Business and Economics; master's and PhD programs in the Colleges of Engineering, Arts & Sciences, and Education; MPA program in the School of Public Service; and the MPH program in the College of Health Sciences. It is classified among "R2: Doctoral Universities – High research activity".

CAA Division I as a member of the Mountain West Conference. History The school became Idaho's third state university in 1974, after the University of Idaho (1889) and Idaho State University (1963). Boise State awards associate, bachelor's, master's, and doctoral degrees, and is accredited by the Northwest Commission on Colleges and Universities. As of 2010, it has over 75,000 living alumni. Campus The 285-acre (1.15 km2) campus is located near downtown Boise, on the south bank of the Boise River, opposite Julia Davis Park. With more than 170 buildings, the campus is at an elevation of 2,700 feet (825 m) above sea level, bounded by Capitol Boulevard on the west and Broadway Avenue to the east.

Alcoholism is the continued drinking of alcohol despite the problems it causes. Some definitions require evidence of dependence and withdrawal. Problematic alcohol use has been mentioned in the earliest historical records. The World Health Organization (WHO) estimated there were 283 million people with alcohol use disorders worldwide as of 2016. The term alcoholism was first coined in 1852, but alcoholism and alcoholic are considered stigmatizing and likely to discourage seeking treatment, so diagnostic terms such as alcohol use disorder and alcohol dependence are often used instead in a clinical context. Other terms, some slurs and some informal, have been used to refer to people affected by alcoholism such as tippler, sot, drunk, drunkard, dipsomaniac, and souse. Alcohol is addictive, and heavy long-term use results in many negative health and social consequences. It can damage all organ systems, but especially affects the brain, heart, liver, pancreas, and immune system. Heavy usage can result in trouble sleeping, and severe cognitive issues like dementia, brain damage, or Wernicke–Korsakoff syndrome. Physical effects include irregular heartbeat, impaired immune response, cirrhosis, increased cancer risk, and severe withdrawal symptoms if stopped suddenly. These effects can reduce life expectancy by 10 years. Drinking during pregnancy may harm the child's health, and drunk driving increases the risk of traffic accidents. Alcoholism is associated with violent and non-violent crime. While alcoholism directly resulted in 139,000 deaths worldwide in 2013, in 2012, 3.3 million deaths may have been attributable globally to alcohol. The development of alcoholism is attributed to environment and genetics equally. Someone with a parent or sibling with an alcohol use disorder is 3-4 times more likely to develop alcohol use disorder, but only a minority do. Environmental factors include social, cultural and behavioral influences. High stress levels and anxiety, as well as alcohol's low cost and easy accessibility, increase the risk. Medically, alcoholism is considered both a physical and mental illness. Questionnaires are usually used to detect possible alcoholism. Further information is then collected to confirm the diagnosis. Treatment takes several forms. Due to medical problems that can occur during withdrawal, alcohol cessation should often be controlled carefully. Benzodiazepine is used to mitigate withdrawal symptoms, and acamprosate, naltrexone, or disulfiram to reduce cravings and make consumption less rewarding or unpleasant. Mental illness or other addictions may complicate treatment. Individual, group therapy, or support groups are used to attempt to keep a person from returning to alcoholism. Among them is the abstinence-based mutual aid fellowship Alcoholics Anonymous (AA).

records. The World Health Organization (WHO) estimated there were 283 million people with alcohol use disorders worldwide as of 2016. The term alcoholism was first coined in 1852, but alcoholism and alcoholic are considered stigmatizing and likely to discourage seeking treatment, so diagnostic terms such as alcohol use disorder and alcohol dependence are often used instead in a clinical context. Other terms, some slurs and some informal, have been used to refer to people affected by alcoholism such as tippler, sot, drunk, drunkard, dipsomaniac, and souse. Alcohol is addictive, and heavy long-term use results in many negative health and social consequences. It can damage all organ systems, but especially affects the brain, heart, liver, pancreas, and immune system. Heavy usage can result in trouble sleeping, and severe cognitive issues like dementia, brain damage, or Wernicke–Korsakoff syndrome. Physical effects include irregular heartbeat, impaired immune response, cirrhosis, increased cancer risk, and severe withdrawal symptoms if stopped suddenly. These effects can reduce life expectancy by 10 years. Drinking during pregnancy may harm the child's health, and drunk driving increases the risk of traffic accidents. Alcoholism is associated with violent and non-violent crime. While alcoholism directly resulted in 139,000 deaths worldwide in 2013, in 2012, 3.3 million deaths may have been attributable globally to alcohol. The development of alcoholism is attributed to environment and genetics equally. Someone with a parent or sibling with an alcohol use disorder is 3-4 times more likely to develop alcohol use disorder, but only a minority do. Environmental factors include social, cultural and behavioral influences. High stress levels and anxiety, as well as alcohol's low cost and easy accessibility, increase the risk. Medically, alcoholism is considered both a physical and mental illness. Questionnaires are usually used to detect possible alcoholism. Further information is then collected to confirm the diagnosis. Treatment takes several forms. Due to medical problems that can occur during withdrawal, alcohol cessation should often be controlled carefully. Benzodiazepine is used to mitigate withdrawal symptoms, and acamprosate, naltrexone, or disulfiram to reduce cravings and make consumption less rewarding or unpleasant. Mental illness or other addictions may complicate treatment. Individual, group therapy, or support groups are used to attempt to keep a person from returning to alcoholism. Among them is the abstinence-based mutual aid fellowship Alcoholics Anonymous (AA).

nostic terms such as alcohol use disorder and alcohol dependence are often used instead in a clinical context. Other terms, some slurs and some informal, have been used to refer to people affected by alcoholism such as tippler, sot, drunk, drunkard, dipsomaniac, and souse. Alcohol is addictive, and heavy long-term use results in many negative health and social consequences. It can damage all organ systems, but especially affects the brain, heart, liver, pancreas, and immune system. Heavy usage can result in trouble sleeping, and severe cognitive issues like dementia, brain damage, or Wernicke–Korsakoff syndrome. Physical effects include irregular heartbeat, impaired immune response, cirrhosis, increased cancer risk, and severe withdrawal symptoms if stopped suddenly. These effects can reduce life expectancy by 10 years. Drinking during pregnancy may harm the child's health, and drunk driving increases the risk of traffic accidents. Alcoholism is associated with violent and non-violent crime. While alcoholism directly resulted in 139,000 deaths worldwide in 2013, in 2012, 3.3 million deaths may have been attributable globally to alcohol. The development of alcoholism is attributed to environment and genetics equally. Someone with a parent or sibling with an alcohol use disorder is 3-4 times more likely to develop alcohol use disorder, but only a minority do. Environmental factors include social, cultural and behavioral influences. High stress levels and anxiety, as well as alcohol's low cost and easy accessibility, increase the risk. Medically, alcoholism is considered both a physical and mental illness. Questionnaires are usually used to detect possible alcoholism. Further information is then collected to confirm the diagnosis. Treatment takes several forms. Due to medical problems that can occur during withdrawal, alcohol cessation should often be controlled carefully. Benzodiazepine is used to mitigate withdrawal symptoms, and acamprosate, naltrexone, or disulfiram to reduce cravings and make consumption less rewarding or unpleasant. Mental illness or other addictions may complicate treatment. Individual, group therapy, or support groups are used to attempt to keep a person from returning to alcoholism. Among them is the abstinence-based mutual aid fellowship Alcoholics Anonymous (AA).

tic criteria are met. The ICD-11 divides substance use disorders into two categories: (1) harmful pattern of substance use; and (2) substance dependence. In 2017, globally 271 million people (5.5% of adults) were estimated to have used one or more illicit drugs. Of these, 35 million had a substance use disorder. An additional 237 million men and 46 million women have alcohol use disorder as of 2016. In 2017, substance use disorders from illicit substances directly resulted in 585,000 deaths. Direct deaths from drug use, other than alcohol, have increased over 60 percent from 2000 to 2015.

Substance use disorders (SUDs) are highly prevalent and exact a large toll on individuals' health, well-being, and social functioning. Long-lasting changes in brain networks involved in reward, executive function, stress reactivity, mood, and self-awareness underlie the intense drive to consume substances and the inability to control this urge in a person who suffers from addiction (moderate or severe SUD). Biological (including genetics and developmental life stages) and social (including adverse childhood experiences) determinants of health are recognized factors that contribute to vulnerability to or resilience against developing a SUD. Consequently, prevention strategies that target social risk factors can improve outcomes and, when deployed in childhood and adolescence, can decrease the risk for these disorders. This section divides substance use disorder causes into categories consistent with the biopsychosocial model.

Psychological causal factors include cognitive, affective, and developmental determinants, among others. For example, individuals who begin using alcohol or other drugs in their teens are more likely to have a substance use disorder as adults. Other common risk factors are being male, being under 25, having other mental health problems (with the latter two being related to symptomatic relapse, impaired clinical and psychosocial adjustment, reduced medication adherence, and lower response to treatment), and lack of familial support and supervision. (As mentioned above, some of these causal factors can also be categorized as social or biological).

gs, and workshops are scheduled throughout the day, and patients are expected to adhere to the program's structure. Online IOP has also been shown to be effective. Typical IOP programs also encourage active participation in 12-step programs.

es typically offered by larger, more comprehensive treatment facilities. A typical IOP program offers group therapy and generally facilitates 9 to 19 hours a week of programming for mental health and addiction treatment. IOP allows patients to participate in their daily affairs, such as work, and in treatment at an appropriate facility in the morning or the end of the day. With an IOP, classes, sessions, meetings, and workshops are scheduled throughout the day, and patients are expected to adhere to the program's structure. Online IOP has also been shown to be effective. Typical IOP programs also encourage active participation in 12-step programs.

rategies for encouraging motivation and engagement in treatment. IOP operates on a small scale and does not require the intensive residential or partial day services typically offered by larger, more comprehensive treatment facilities. A typical IOP program offers group therapy and generally facilitates 9 to 19 hours a week of programming for mental health and addiction treatment. IOP allows patients to participate in their daily affairs, such as work, and in treatment at an appropriate facility in the morning or the end of the day. With an IOP, classes, sessions, meetings, and workshops are scheduled throughout the day, and patients are expected to adhere to the program's structure. Online IOP has also been shown to be effective. Typical IOP programs also encourage active participation in 12-step programs.

Detoxification or detoxication (detox for short) is the physiological or medicinal removal of toxic substances from a living organism, including the human body, which is mainly carried out by the liver. Additionally, it can refer to the period of drug withdrawal during which an organism returns to homeostasis after long-term use of an addictive substance. In medicine, detoxification can be achieved by decontamination of poison ingestion and the use of antidotes as well as techniques such as dialysis and (in a limited number of cases) chelation therapy. Many alternative medicine practitioners promote various types of detoxification such as detoxification diets. Sense about Science, a UK-based charitable trust, determined that most such dietary "detox" claims lack any supporting evidence. The liver and kidney are naturally capable of detox, as are intracellular (specifically, inner membrane of mitochondria or in the endoplasmic reticulum of cells) proteins such as CYP enzymes.

Types Metal detoxification Alcohol detoxification Alcohol detoxification is a process by which a heavy drinker's system is brought back to normal after being habituated to having alcohol in the body continuously for an extended period of substance abuse. Serious alcohol addiction results in a downregulation of GABA neurotransmitter receptors. Precipitous withdrawal from long-term alcohol addiction without medical management can cause severe health problems and can be fatal. Alcohol detox is not a treatment for alcoholism.

Metabolic detoxification An animal's metabolism can produce harmful substances which it can then make less toxic through reduction, oxidation (collectively known as redox reactions), conjugation and excretion of molecules from cells or tissues. This is called xenobiotic metabolism. Enzymes that are important in detoxification metabolism include cytochrome P450 oxidases, UDP-glucuronosyltransferases, and glutathione S-transferases. These processes are particularly well-studied as part of drug metabolism, as they influence the pharmacokinetics of a drug in the body. Alternative medicine Certain approaches in alternative medicine claim to remove alleged "toxins" from the body through herbal, electrical, electromagnetic or other treatments. These toxins may not be linked to symptoms and treatments have no scientific evidence, making the validity of such techniques questionable. There is little evidence for toxic accumulation in these cases, as the liver and kidneys automatically detoxify and excrete many toxic materials including metabolic wastes. Under this theory, if toxins are too rapidly released without being safely eliminated (such as when metabolizing fat that stores toxins), they can damage the body and cause malaise.

ern Oregon to Boise, and is the most populated area in Idaho. Historically, the valley had been known as the Lower Snake River Valley or the Boise River Valley. Pete Olesen, president of the valley's association of local Chambers of Commerce, coined the name "Treasure Valley" in 1959 to reflect the treasure chest of resources and opportunities that the region offered. The valley has a very diverse terrain, from sage flatlands, to mesas, agricultural areas, and urbanized areas.

The Treasure Valley is a valley in the western United States, primarily in southwestern Idaho, where the Payette, Boise, Weiser, Malheur, and Owyhee rivers drain into the Snake River. It includes all the lowland areas from Vale in rural eastern Oregon to Boise, and is the most populated area in Idaho. Historically, the valley had been known as the Lower Snake River Valley or the Boise River Valley. Pete Olesen, president of the valley's association of local Chambers of Commerce, coined the name "Treasure Valley" in 1959 to reflect the treasure chest of resources and opportunities that the region offered. The valley has a very diverse terrain, from sage flatlands, to mesas, agricultural areas, and urbanized areas.

eflect the treasure chest of resources and opportunities that the region offered. The valley has a very diverse terrain, from sage flatlands, to mesas, agricultural areas, and urbanized areas. As the Boise Metropolitan Area grows, more and more undeveloped and agricultural land is being urbanized. History Settling the region The tribes that roamed the area, specifically, were the Northern Paiute and Shoshone. In 1834, Thomas McKay built the original Fort Boise, in the area near present-day Parma, which was run for a time by Francois Payette. It later was moved because of flooding troubles and was abandoned in 1854. The Oregon Trail runs through the Treasure Valley. The valley was settled for the most part by ranchers and farmers, initially to supply the gold and silver mining communities in the higher elevations nearby: Idaho City in the Boise Basin and Silver City in the Owyhees. A new Fort Boise was constructed by the U.S. Army in 1863 in present-day Boise, from which the city grew.

atient needs, order and interpret diagnostic and laboratory tests, diagnose disease, prescribe medications, and formulate treatment plans. NP training covers basic disease prevention, coordination of care, and health promotion. History United States The present-day concept of advanced practice nursing as a primary care provider was created in the mid-1960s, spurred on by a national shortage of physicians. The first formal graduate certificate program for NPs was created by Henry Silver, a physician, and Loretta Ford, a nurse, in 1965. In 1971, the US Secretary of Health, Education and Welfare, Elliot Richardson, made a formal recommendation for expanding the scope of nursing practice to be able to serve as primary care providers.

e treatment plans. NP training covers basic disease prevention, coordination of care, and health promotion. History United States The present-day concept of advanced practice nursing as a primary care provider was created in the mid-1960s, spurred on by a national shortage of physicians. The first formal graduate certificate program for NPs was created by Henry Silver, a physician, and Loretta Ford, a nurse, in 1965. In 1971, the US Secretary of Health, Education and Welfare, Elliot Richardson, made a formal recommendation for expanding the scope of nursing practice to be able to serve as primary care providers.

Training pathways There are many types of nurse practitioner programs in the United States, with the vast majority being in the specialty of a family nurse practitioner (FNP). There are also psychiatric, adult–geriatric acute care, adult–geriatric primary care, pediatric, women's health, and neonatal nurse practitioner programs. Many of these programs have their pre-clinical or didactic courses taught online with proctored examinations. Once the students start their clinical courses, they have online material but are required to perform clinical hours at an approved facility under the guidance of an NP or physician. Each clinical course has specific requirements that vary depending on the program's degree or eligibility for certification. For instance, FNPs are required to see patients across the lifespan during their training, whereas adult geriatric NPs do not see anyone below the age of 13. Nurse practitioners may pursue dual or multiple certifications by completing additional graduate-level training, such as post-master's certificates or Doctor of Nursing Practice (DNP) programs. Upon satisfying the educational and clinical requirements for these secondary specialties, they become eligible for further board certification and expanded clinical practice.

Opioid agonist therapy (OAT) is a treatment in which prescribed opioid agonists are given to patients who live with opioid use disorder (OUD). In the case of methadone maintenance treatment (MMT), methadone is used to treat dependence on heroin or other opioids, and is administered on an ongoing basis. The benefits of this treatment include a roughly 50% reduction in mortality among people with opioid use disorder, decreased substance use, improvements in social functioning, increased rates of retention in rehabilitative programs, more manageable withdrawal experience, cognitive improvement, and lower HIV transmission.

used to treat dependence on heroin or other opioids, and is administered on an ongoing basis. The benefits of this treatment include a roughly 50% reduction in mortality among people with opioid use disorder, decreased substance use, improvements in social functioning, increased rates of retention in rehabilitative programs, more manageable withdrawal experience, cognitive improvement, and lower HIV transmission.

ent, and lower HIV transmission. The length of OAT varies from one individual to another based on their physiology, environmental surroundings, and quality of life. The term medication for Opioid Use Disorder (MOUD) is used to describe medication including methadone and buprenorphine, which are used to treat patients with OUD. Terminology Other terms that appear in the professional and popular literature include opioid replacement therapy, medication-assisted treatment (MAT) and medications for opioid use disorder (MOUD).

, the use of PAs has spread to at least 16 countries around the world. In the US, PAs may diagnose illnesses, develop and manage treatment plans, prescribe medications, and serve as a principal healthcare provider. In many states PAs are required to have a direct agreement with a physician. In the UK, PAs were introduced in 2003. They support the work of the healthcare team, but are dependent clinicians requiring supervision from a physician. They cannot prescribe medications nor request ionising radiation investigations (e.g., x-ray) in the UK. PAs are widely used in Canada. The model began during the Korean War and transitioned to the present concept in 2002.

and serve as a principal healthcare provider. In many states PAs are required to have a direct agreement with a physician. In the UK, PAs were introduced in 2003. They support the work of the healthcare team, but are dependent clinicians requiring supervision from a physician. They cannot prescribe medications nor request ionising radiation investigations (e.g., x-ray) in the UK. PAs are widely used in Canada. The model began during the Korean War and transitioned to the present concept in 2002.

conduct patient interviews and take medical histories conduct physical examinations, including the interpretation of clinical signs order and interpret diagnostic tests and exams (As per International labour Organisation code) diagnose illnesses formulate treatment plans coordinate and manage care perform medical procedures prescribe medications (As per International labour organisation norms if any) conduct clinical research provide patient counselling offer advice on preventative health care first assist in surgery Can serve as a clinical tutor/Demonstrator, assistant professor, associate professor, or professor (depending on academic qualifications along with experience). In Administrative sector, can serve as principal/Director, Dean etc.

oftware engineering, information engineering, bioinformatics, bio-inspired computing, theoretical computer science, information systems, data science, information technology, autonomic computing, and behavior informatics. In academic institutions, health informatics includes research focuses on applications of artificial intelligence in healthcare and designing medical devices based on embedded systems.

kled using computational techniques. Health informatics is a multidisciplinary field that includes the study of the design, development, and application of computational innovations to improve health care. The disciplines involved combine healthcare fields with computing fields, in particular computer engineering, software engineering, information engineering, bioinformatics, bio-inspired computing, theoretical computer science, information systems, data science, information technology, autonomic computing, and behavior informatics. In academic institutions, health informatics includes research focuses on applications of artificial intelligence in healthcare and designing medical devices based on embedded systems.

Subject areas Dutch former professor of medical informatics Jan van Bemmel has described medical informatics as the theoretical and practical aspects of information processing and communication based on knowledge and experience derived from processes in medicine and health care. The Faculty of Clinical Informatics has identified six high level domains of core competency for clinical informaticians: Health and Wellbeing in Practice Information Technologies and Systems Working with Data and Analytical Methods Enabling Human and Organizational Change Decision Making Leading Informatics Teams and projects.

r mitigate troublesome behaviors, beliefs, compulsions, thoughts, or emotions, and to improve relationships and social skills. Numerous types of psychotherapy have been designed either for individual adults, families, or children and adolescents. Some types of psychotherapy are considered evidence-based for treating diagnosed mental disorders; other types have been criticized as pseudoscience. However, at least to some extent, psychotherapies are supported by neuroscience, tend to have longer-lasting effects than pharmacotherapies, and can improve the effects of pharmacotherapies, including those involving psychedelics. There are hundreds of psychotherapy techniques, some being minor variations; others are based on very different conceptions of psychology. Most approaches involve one-to-one sessions, between the client and therapist, but some are conducted with groups, including couples and families. Psychotherapists may be mental health professionals such as psychiatrists, psychologists, mental health nurses, clinical social workers, marriage and family therapists, or licensed professional counselors. Psychotherapists may also come from a variety of other backgrounds, and depending on the jurisdiction may be legally regulated, voluntarily regulated or unregulated (and the term itself may be protected or not). It has shown general efficacy across a range of conditions, although its efficacy varies by individual and condition. While large-scale reviews support its benefits, debates continue over the best methods for evaluating outcomes, including the use of randomized controlled trials versus individualized approaches. A 2022 umbrella review of 102 meta-analyses found that effect sizes for both psychotherapies and medications were generally small, leading researchers to recommend a paradigm shift in mental health research. Although many forms of therapy differ in technique, they often produce similar outcomes, leading to theories that common factors—such as the therapeutic relationship—are key drivers of efficacy. Challenges include high dropout rates, limited understanding of mechanisms of change, potential adverse effects, and concerns about therapist adherence to treatment fidelity.

Definitions The term psychotherapy is derived from Ancient Greek psyche (ψυχή meaning "breath; spirit; soul") and therapeia (θεραπεία "healing; medical treatment"). The Oxford English Dictionary defines it as "The treatment of disorders of the mind or personality by psychological means...", however, in earlier use, it denoted the treatment of disease through hypnotic suggestion. Psychotherapy is often dubbed as a "talking therapy" or "talk therapy", particularly for a general audience, though not all forms of psychotherapy rely on verbal communication. Children or adults who do not engage in verbal communication (or not in the usual way) are not excluded from psychotherapy; indeed some types are designed for such cases. The American Psychological Association adopted a resolution on the effectiveness of psychotherapy in 2012 based on a definition developed by American psychologist John C. Norcross: "Psychotherapy is the informed and intentional application of clinical methods and interpersonal stances derived from established psychological principles for the purpose of assisting people to modify their behaviors, cognitions, emotions, and/or other personal characteristics in directions that the participants deem desirable". Influential editions of a work by psychiatrist Jerome Frank defined psychotherapy as a healing relationship using socially authorized methods in a series of contacts primarily involving words, acts and rituals—which Frank regarded as forms of persuasion and rhetoric. Historically, psychotherapy has sometimes meant "interpretative" (i.e. Freudian) methods, namely psychoanalysis, in contrast with other methods to treat psychiatric disorders such as behavior modification. Some definitions of counseling overlap with psychotherapy (particularly in non-directive client-centered approaches), or counseling may refer to guidance for everyday problems in specific areas, typically for shorter durations with a less medical or "professional" focus. Somatotherapy refers to the use of physical changes as injuries and illnesses, and sociotherapy to the use of a person's social environment to effect therapeutic change.

Europe As of 2015, there are still a lot of variations between different European countries about the regulation and delivery of psychotherapy. Several countries have no regulation of the practice or no protection of the title. Some have a system of voluntary registration, with independent professional organizations, while other countries attempt to restrict the practice of psychotherapy to 'mental health professionals' (psychologists and psychiatrists) with state-certified training. The titles that are protected also vary. The European Association for Psychotherapy (EAP) established the 1990 Strasbourg Declaration on Psychotherapy, which is dedicated to establishing an independent profession of psychotherapy in Europe, with pan-European standards. The EAP has already made significant contacts with the European Union & European Commission towards this end. Given that the European Union has a primary policy about the free movement of labor within Europe, European legislation can overrule national regulations that are, in essence, forms of restrictive practices. In Germany, the practice of psychotherapy for adults is restricted to qualified psychologists and physicians (including psychiatrists) who have completed several years of specialist practical training and certification in psychotherapy. As psychoanalysis, psychodynamic therapy, cognitive behavioral therapy, and systemic therapy meet the requirements of German health insurance companies, mental health professionals regularly opt for one of these four specializations in their postgraduate training. For psychologists, this includes three years of full-time practical training (4,200 hours), encompassing a year-long internship at an accredited psychiatric institution, six months of clinical work at an outpatient facility, 600 hours of supervised psychotherapy in an outpatient setting, and at least 600 hours of theoretical seminars. Social workers may complete the specialist training for child and teenage clients. Similarly in Italy, the practice of psychotherapy is restricted to graduates in psychology or medicine who have completed four years of recognised specialist training. Sweden has a similar restriction on the title "psychotherapist", which may only be used by professionals who have gone through a post-graduate training in psychotherapy and then applied for a licence, issued by the National Board of Health and Welfare. Legislation in France restricts the use of the title "psychotherapist" to professionals on the National Register of Psychotherapists, which requires a training in clinical psychopathology and a period of internship which is only open to physicians or titulars of a master's degree in psychology or psychoanalysis. Austria and Switzerland (2011) have laws that recognize multi-disciplinary functional approaches. In the United Kingdom, the government and Health and Care Professions Council considered mandatory legal registration but decided that it was best left to professional bodies to regulate themselves, so the Professional Standards Authority for Health and Social Care (PSA) launched an Accredited Voluntary Registers scheme. Counseling and psychotherapy are not protected titles in the United Kingdom.

The Affordable Care Act (ACA), formally the Patient Protection and Affordable Care Act (PPACA) and informally known as Obamacare, is a landmark U.S. federal statute enacted by the 111th United States Congress and signed into law by President Barack Obama on March 23, 2010. Together with amendments made to it by the Health Care and Education Reconciliation Act of 2010, it represents the U.S. healthcare system's most significant regulatory overhaul and expansion of coverage since the enactment of Medicare and Medicaid in 1965. Most of the act remains in effect. The ACA's major provisions came into force in 2014. By 2016, the uninsured share of the population had roughly halved, with estimates ranging from 20 to 24 million additional people covered. The law also enacted delivery system reforms intended to constrain healthcare costs and improve quality. After it came into effect, increases in overall healthcare spending slowed, including premiums for employer-based insurance plans. The increased coverage was due, roughly equally, to an expansion of Medicaid eligibility and changes to individual insurance markets. Both received new spending, funded by a combination of new taxes and cuts to Medicare provider rates and Medicare Advantage. Several Congressional Budget Office (CBO) reports stated that overall these provisions reduced the budget deficit, that repealing ACA would increase the deficit, and that the law reduced income inequality. The act largely retained the existing structure of Medicare, Medicaid, and the employer market, but individual markets were radically overhauled. Insurers were made to accept all applicants without charging based on pre-existing conditions or demographic status (except age). To combat the resultant adverse selection, the act mandated that individuals buy insurance (or pay a monetary penalty) and that insurers cover a list of "essential health benefits". Young people were allowed to stay on their parents' insurance plans until they were 26 years old. Before and after its enactment the ACA faced strong political opposition, calls for repeal, and legal challenges. In the Sebelius decision, the U.S. Supreme Court ruled that Congress cannot use the Commerce Clause to compel individuals to buy health insurance but upheld the individual mandate by recharacterizing the penalty as a tax. The Court also held that states could opt out of the ACA's Medicaid expansion without losing existing federal Medicaid funding, while otherwise upholding the law. This led Republican-controlled states to not participate in Medicaid expansion. Polls initially found that 43% of Americans wanted to see the law repealed or scaled back and 49% wanted to see it expanded or enacted as is. By 2017, the law had majority support.

mendments made to it by the Health Care and Education Reconciliation Act of 2010, it represents the U.S. healthcare system's most significant regulatory overhaul and expansion of coverage since the enactment of Medicare and Medicaid in 1965. Most of the act remains in effect. The ACA's major provisions came into force in 2014. By 2016, the uninsured share of the population had roughly halved, with estimates ranging from 20 to 24 million additional people covered. The law also enacted delivery system reforms intended to constrain healthcare costs and improve quality. After it came into effect, increases in overall healthcare spending slowed, including premiums for employer-based insurance plans. The increased coverage was due, roughly equally, to an expansion of Medicaid eligibility and changes to individual insurance markets. Both received new spending, funded by a combination of new taxes and cuts to Medicare provider rates and Medicare Advantage. Several Congressional Budget Office (CBO) reports stated that overall these provisions reduced the budget deficit, that repealing ACA would increase the deficit, and that the law reduced income inequality. The act largely retained the existing structure of Medicare, Medicaid, and the employer market, but individual markets were radically overhauled. Insurers were made to accept all applicants without charging based on pre-existing conditions or demographic status (except age). To combat the resultant adverse selection, the act mandated that individuals buy insurance (or pay a monetary penalty) and that insurers cover a list of "essential health benefits". Young people were allowed to stay on their parents' insurance plans until they were 26 years old. Before and after its enactment the ACA faced strong political opposition, calls for repeal, and legal challenges. In the Sebelius decision, the U.S. Supreme Court ruled that Congress cannot use the Commerce Clause to compel individuals to buy health insurance but upheld the individual mandate by recharacterizing the penalty as a tax. The Court also held that states could opt out of the ACA's Medicaid expansion without losing existing federal Medicaid funding, while otherwise upholding the law. This led Republican-controlled states to not participate in Medicaid expansion. Polls initially found that 43% of Americans wanted to see the law repealed or scaled back and 49% wanted to see it expanded or enacted as is. By 2017, the law had majority support.

A's major provisions came into force in 2014. By 2016, the uninsured share of the population had roughly halved, with estimates ranging from 20 to 24 million additional people covered. The law also enacted delivery system reforms intended to constrain healthcare costs and improve quality. After it came into effect, increases in overall healthcare spending slowed, including premiums for employer-based insurance plans. The increased coverage was due, roughly equally, to an expansion of Medicaid eligibility and changes to individual insurance markets. Both received new spending, funded by a combination of new taxes and cuts to Medicare provider rates and Medicare Advantage. Several Congressional Budget Office (CBO) reports stated that overall these provisions reduced the budget deficit, that repealing ACA would increase the deficit, and that the law reduced income inequality. The act largely retained the existing structure of Medicare, Medicaid, and the employer market, but individual markets were radically overhauled. Insurers were made to accept all applicants without charging based on pre-existing conditions or demographic status (except age). To combat the resultant adverse selection, the act mandated that individuals buy insurance (or pay a monetary penalty) and that insurers cover a list of "essential health benefits". Young people were allowed to stay on their parents' insurance plans until they were 26 years old. Before and after its enactment the ACA faced strong political opposition, calls for repeal, and legal challenges. In the Sebelius decision, the U.S. Supreme Court ruled that Congress cannot use the Commerce Clause to compel individuals to buy health insurance but upheld the individual mandate by recharacterizing the penalty as a tax. The Court also held that states could opt out of the ACA's Medicaid expansion without losing existing federal Medicaid funding, while otherwise upholding the law. This led Republican-controlled states to not participate in Medicaid expansion. Polls initially found that 43% of Americans wanted to see the law repealed or scaled back and 49% wanted to see it expanded or enacted as is. By 2017, the law had majority support.

e of chronic diseases and deaths from these diseases. There are many methods for prevention of disease. One of them is prevention of teenage smoking through information giving. It is recommended that adults and children aim to visit their doctor for regular check-ups, even if they feel healthy, to perform disease screening, identify risk factors for disease, discuss tips for a healthy and balanced lifestyle, stay up to date with immunizations and boosters, and maintain a good relationship with a healthcare provider. In pediatrics, some common examples of primary prevention are encouraging parents to turn down the temperature of their home water heater in order to avoid scalding burns, encouraging children to wear bicycle helmets, and suggesting that people use the air quality index (AQI) to check the level of pollution in the outside air before engaging in sporting activities. Some common disease screenings include checking for hypertension (high blood pressure), hyperglycemia (high blood sugar, a risk factor for diabetes mellitus), hypercholesterolemia (high blood cholesterol), screening for colon cancer, depression, HIV and other common types of sexually transmitted disease such as chlamydia, syphilis, and gonorrhea, mammography (to screen for breast cancer), colorectal cancer screening, a Pap test (to check for cervical cancer), and screening for osteoporosis. Genetic testing can also be performed to screen for mutations that cause genetic disorders or predisposition to certain diseases such as breast or ovarian cancer.

Obesity Obesity is a major risk factor for a wide variety of conditions including cardiovascular diseases, hypertension, certain cancers, and type 2 diabetes. In order to prevent obesity, it is recommended that individuals adhere to a consistent exercise regimen as well as a nutritious and balanced diet. A healthy individual should aim for acquiring 10% of their energy from proteins, 15-20% from fat, and over 50% from complex carbohydrates, while avoiding alcohol as well as foods high in fat, salt, and sugar. Sedentary adults should aim for at least half an hour of moderate-level daily physical activity and eventually increase to include at least 20 minutes of intense exercise, three times a week. Preventive health care offers many benefits to those that chose to participate in taking an active role in the culture. The medical system in our society is geared toward curing acute symptoms of disease after the fact that they have brought us into the emergency room. An ongoing epidemic within American culture is the prevalence of obesity. Healthy eating and regular exercise play a significant role in reducing an individual's risk for type 2 diabetes. A 2008 study concluded that about 23.6 million people in the United States had diabetes, including 5.7 million that had not been diagnosed. 90 to 95 percent of people with diabetes have type 2 diabetes.

Lung cancer is the leading cause of cancer-related deaths in the United States and Europe and is a major cause of death in other countries. Tobacco is an environmental carcinogen and the major underlying cause of lung cancer. Between 25% and 40% of all cancer deaths and about 90% of lung cancer cases are associated with tobacco use. Other carcinogens include asbestos and radioactive materials. Both smoking and second-hand exposure from other smokers can lead to lung cancer and eventually death. Prevention of tobacco use is paramount to prevention of lung cancer. Individual, community, and statewide interventions can prevent or cease tobacco use. 90% of adults in the U.S. who have ever smoked did so prior to the age of 20. In-school prevention/educational programs, as well as counseling resources, can help prevent and cease adolescent smoking. Other cessation techniques include group support programs, nicotine replacement therapy (NRT), hypnosis, and self-motivated behavioral change. Studies have shown long term success rates (>1 year) of 20% for hypnosis and 10%-20% for group therapy. Cancer screening programs serve as effective sources of secondary prevention. The Mayo Clinic, Johns Hopkins, and Memorial Sloan-Kettering hospitals conducted annual x-ray screenings and sputum cytology tests and found that lung cancer was detected at higher rates, earlier stages, and had more favorable treatment outcomes, which supports widespread investment in such programs. Legislation can also affect smoking prevention and cessation. In 1992, Massachusetts (United States) voters passed a bill adding an extra 25 cent tax to each pack of cigarettes, despite intense lobbying and $7.3 million spent by the tobacco industry to oppose this bill. Tax revenue goes toward tobacco education and control programs and has led to a decline of tobacco use in the state. Lung cancer and tobacco smoking are increasing worldwide, especially in China. China is responsible for about one-third of the global consumption and production of tobacco products. Tobacco control policies have been ineffective as China is home to 350 million regular smokers and 750 million passive smokers and the annual death toll is over 1 million. Recommended actions to reduce tobacco use include decreasing tobacco supply, increasing tobacco taxes, widespread educational campaigns, decreasing advertising from the tobacco industry, and increasing tobacco cessation support resources. In Wuhan, China, a 1998 school-based program implemented an anti-tobacco curriculum for adolescents and reduced the number of regular smokers, though it did not significantly decrease the number of adolescents who initiated smoking.

Boise (locally also ) is the capital and most populous city in the U.S. state of Idaho. It is the county seat of Ada County. The population of the city was 235,685 at the 2020 census. The Boise metropolitan area, located in the Treasure Valley, includes five counties of Idaho with an estimated population of 846,000, the most populous metropolitan area in Idaho and 95th-most populous in the United States. Located on the Boise River in southwestern Idaho, it is 41 miles (66 km) east of the Oregon border and 110 miles (177 km) north of the Nevada border. Downtown Boise's elevation is 2,704 feet (824 m) above sea level. Boise is home to major employers in the technology, manufacturing, and service sectors, including companies such as Micron Technology and Hewlett-Packard.

an area in Idaho and 95th-most populous in the United States. Located on the Boise River in southwestern Idaho, it is 41 miles (66 km) east of the Oregon border and 110 miles (177 km) north of the Nevada border. Downtown Boise's elevation is 2,704 feet (824 m) above sea level. Boise is home to major employers in the technology, manufacturing, and service sectors, including companies such as Micron Technology and Hewlett-Packard.

...that the military should continue killing Indians 'until the last Indian in the Territories was either on his reservation or enriched the sagebrush with his decaying carcass.' ...if the Indians refused to move there, 'they will be killed or put on the reservation by force, and certainly shot if they don't stay there.' Furthermore, the editor continues, 'The idea that the Indians have any right to the soil is ridiculous. ...They have no more rights to the soil of the Territories of the United States than wolves or coyotes...' This would be our plan of establishing friendship upon an eternal basis with our Indians: Let all the hostile bands of Idaho Territory be called in (they will not be caught in any other manner) to attend a grand treaty; plenty of blankets and nice little trinkets distributed among them; plenty of grub on hand; have a real jolly time with them; then just before the big feast put strychnine in their meat and poison to death the last mother's son of them. At the same time, native warriors around the valley, under the leadership of Howluck also known as "Bigfoot" among white settlers, among others, waged an escalating and intensified guerrilla campaign of harassment of passerby caravans along the Oregon Trail. The United States Army also escalated and intensified "punitive expeditions" against formations of warriors and against civilian communities as well. This marked the start of the "unofficial" Snake War in 1866. This war lasted until 1868, and is statistically the deadliest of the Indian Wars in the West in terms of casualties. In the end, 1,762 men were counted as the casualties of this war from both sides. In 1868, Fort Hall Indian Reservation was established in Southeastern Idaho, about 220 miles upstream, according to the terms of Fort Bridger Treaty. The Boise Valley Shoshone and Bannock Tribes were not party to this treaty. Nevertheless, in April 1869, the United States Military embarked on a campaign of "Removal, rounding up of natives in the region including in and around Boise, and expelling them with cavalry escort to Fort Hall Indian Reservation. This period is known among the Shoshone and Bannock people as Idaho's Trail of Tears. Some of the natives managed to escape, and they ran to either Duck Valley or Fort McDermitt in Nevada. Incorporation and growth Boise's early growth was significantly driven by its role in supplying the nearby gold towns that sprung up in the 1860s northeast and then southwest of the town. Miners sometimes wintered in Boise and a number of early prominent businessmen were miners who settled in town in the years after the gold rush waned. By 1864 substantial agricultural production was underway on easily irrigated lands near the river and three canal companies had been incorporated. Early transportation improvements were largely a result of toll road franchises awarded by the territorial legislature starting in the 1860s. These first ran from Fort Boise to the mining centers in the Boise Basin and east to Rocky Bar and to Rattlesnake Station where they connected to the Oregon Trail. Territorial census records from a special 1864 enumeration list the population of Boise as 1,658, and an act of December 12, 1864, was the first attempt by the Idaho Territorial Legislature to incorporate the city. This was rejected by voters the following March. Two more unsuccessful attempts were made to organize a city administration by election before the 1866 version of the city charter was approved by voters on January 6, 1868. The growing number of homes and businesses, for which owners wanted proper legal title, may have contributed to the eventual success of incorporation. All of these rejected efforts to incorporate the city came after Boise had been controversially made the state capital in 1864 over strong opposition from northern Idaho interests. This decision reflected the rapid shift of population growth from north to south after the discovery of gold in southern Idaho. By 1868 Boise had over 400 permanent buildings with a wide range of commercial services. 1868 also marked the formal beginning of a long advocacy for railroad connections to other Idaho communities and, just as importantly, to other growing cities in the west such as Portland, Oregon. Competing railroad and western state government interests frustrated these efforts for many years. Designed by Alfred B. Mullett, the U.S. Assay Office at 210 Main Street was built in 1871 and today is a National Historic Landmark. It first began accepting gold and silver for purchase on March 2, 1872, largely eliminating the need to transport ore to the mint in San Francisco. A territorial penitentiary, now known as the Old Idaho State Penitentiary, opened the same month several miles east of town. Mining continued to be important to Boise's economic growth and periodic booms contributed to population growth as well, though production of gold and silver probably peaked in the 1860s. 1882's gold and silver production of $3,500,000 declined to $1,488,315 (including lead) by 1899. Boise began to earn its City of Trees nickname in this period with a popular focus on a range of tree planting projects. Thomas J. Davis planted several thousand fruit trees in 1864 and several other early businessmen either founded nurseries or orchards of their own. In the 1870s tree planting began in earnest in downtown Boise led by prominent hotels as well as businessmen and residents. In 1907 Davis donated 43 acres of his orchard property to the city for use as a park in the name of his wife Julia. Commercial agriculture continued to expand, but was slowed by the lack of reliable rail links to regional and national markets and by a lack of large scale irrigation projects, which themselves were often tied to hoped-for railroad projects for financing. A.D. Foote, a successful mining engineer, drew up plans to irrigate up to 500,000 acres immediately south of Boise in 1882, but progress was halting and smaller farms were the norm until after the turn of the century with most located near to the river bottom where soil was productive and irrigation more easily achieved. Fruit orchards proliferated and sugar beets, still an important agricultural industry in Idaho, began to be widely cultivated in the 1890s. Cattle and sheep farming became increasingly important as the century closed. With the exception of dairy, most livestock products were exported from Idaho, unlike other agricultural products which were still largely scaled to support local markets. The timber industry also increasingly thrived in the Boise market in the 1880s and 1890s. Large quantities of timber were exported from elsewhere in Idaho, but a growing Boise supported the expansion of Alexander Rossi's sawmill, first established in 1865. Prominent early Boisean William Ridenbaugh had inherited control of the canal now bearing his name from his uncle William Morris in 1878 and later partnered with Rossi to expand the sawmill capacity under the name Rossi and Ridenbaugh Lumber Company. Their materials supported bridge building and the rapid expansion of Boise in the 1890s. As with many early infrastructure ventures, electrification succeeded only after at least one false start. July 4, 1887, marked the start of electrical transmission from a plant located on the Bench. William Ridenbaugh provided expertise and manpower for the water supply and several months were spent rigging poles and lines from the Bench to the service area across the river. Additional electrical supplies allowed the building of an electric streetcar line in 1891. This ran without interruption until buses replaced the lines in 1927, tracking—and sometimes driving—the development of Boise and nearby communities. This system expanded over several decades, reaching into the North End, South Boise and across the river on Front St. A loop line, completed in 1912, ran as far as Caldwell and Nampa, providing transport throughout the valley. Three early trolley companies merged in 1912 to form the Idaho Traction Company with a depot at 7th and Bannock Streets downtown. Additional services and urban amenities arrived in the 1890s as Boise grew. Exploratory drilling for hot water was successful in 1890 and by the end of the decade many homes along Warm Springs avenue were being heated by this source. A natatorium was built in 1892 close to the source of the hot water near the Idaho State Penitentiary. Churches serving several denominations, a Jewish synagogue, a major hardware store and department store, a Masonic hall, the Columbia Theater, Saint Alphonsus' Hospital, a number of parochial and secular schools, a City Hall and a new Union Pacific passenger station, constructed when service was finally extended to downtown, were all built during the 1890s. Falk's Department Store sponsored a semi-professional baseball team representing Boise from at least 1892 and the city supported other organized sports as they became popular.

ce portability standards. In addition to these programs, CMS has other responsibilities, including the administrative simplification standards from the Health Insurance Portability and Accountability Act of 1996 (HIPAA), quality standards in long-term care facilities (more commonly referred to as nursing homes) through its survey and certification process, clinical laboratory quality standards under the Clinical Laboratory Improvement Amendments, and oversight of HealthCare.gov. CMS was previously known as the Health Care Financing Administration (HCFA) until 2001. CMS actively inspects and reports on every nursing home in the United States.

ry quality standards under the Clinical Laboratory Improvement Amendments, and oversight of HealthCare.gov. CMS was previously known as the Health Care Financing Administration (HCFA) until 2001. CMS actively inspects and reports on every nursing home in the United States. This includes maintaining the 5-Star Quality Rating System. Organization The agency carries out its responsibilities from its national headquarters located in Woodlawn, Maryland, and its 10 regional offices. It is organized around six centers to support its key functions.

Workforce CMS employs over 6,000 people, of whom about 4,000 are located at its headquarters in Woodlawn, Maryland. The remaining employees are located in the Hubert H. Humphrey Building in Washington, D.C., the 10 regional offices listed below, and in various field offices located throughout the United States. The head of CMS is the administrator of the Centers for Medicare & Medicaid Services. The position is appointed by the president and confirmed by the Senate. On May 27, 2021, Chiquita Brooks-LaSure was sworn in as administrator, the first black woman to serve in the role. History Originally, the name "Medicare" in the United States referred to a program providing medical care for families of people serving in the military as part of the Dependents' Medical Care Act, which was passed in 1956. President Dwight D. Eisenhower held the first White House Conference on Aging in January 1961, in which creating a health care program for social security beneficiaries was proposed. President Lyndon B. Johnson signed the Social Security Amendments on July 30, 1965, establishing both Medicare and Medicaid. Arthur E. Hess, a deputy commissioner of the Social Security Administration, was named as first director of the Bureau of Health Insurance in 1965, placing him as the first executive in charge of the Medicare program. At the time, the program provided health insurance to 19 million Americans. The Social Security Administration (SSA) became responsible for the administration of Medicare and the Social and Rehabilitation Service (SRS) became responsible for the administration of Medicaid. Both agencies were organized under what was then known as the Department of Health, Education, and Welfare (HEW), in 1965. Since then, HEW, has been reorganized as the Department of Health and Human Services (HHS) in 1980. This consequently brought Medicare and Medicaid under the jurisdiction of the HHS. In March 1977, the Health Care Financing Administration (HCFA) was established under HEW. HCFA became responsible for the coordination of Medicare and Medicaid. The responsibility for enrolling beneficiaries into Medicare and processing premium payments remained with SSA. HCFA was renamed the Centers for Medicare & Medicaid Services on July 1, 2001. This was later codified in law by the Medicare Prescription Drug, Improvement, and Modernization Act of 2003. In 2013, a report by the inspector general found that CMS had paid $23 million in benefits to deceased beneficiaries in 2011. In April 2014, CMS released raw claims data from 2012 that gave a look into what types of doctors billed Medicare the most. In January 2018, CMS released guidelines for states to use to require Medicaid beneficiaries to continue receiving coverage. These guidelines came in response to then-President Trump's announcement that he would allow states to impose work requirements in Medicaid. In October, CMS reported a data breach of 75,000 people's personal data due to a hack. In February 2018, CMS removed a notice from its website that informed insurance companies they were not allowed to charge physicians a fee when the companies paid the doctors for their work. This has resulted in doctors being charged up to a 5% fee on their compensation, adding up to billions of dollars annually. In January 2021, CMS passed a rule that would cover "breakthrough technology" for four years after they received FDA approval. In September 2021, CMS submitted a proposal to repeal the rule based on safety concerns. On September 19, 2023, the Subcommittee on Health held a hearing titled "Examining Policies to Improve Seniors’ Access to Innovative Drugs, Medical Devices, and Technology." Dora Hughes, the acting director of the Center for Clinical Standards and Quality at the U.S. Centers for Medicare and Medicaid Services (CMS), defended the proposed Transitional Coverage for Emerging Technologies (TCET) pathway, which aims to restrict coverage for breakthrough medical devices to five reviews a year. Some lawmakers and medtech trade groups called for expanding the pathway to include diagnostics.

Drug rehabilitation is the process of medical or psychotherapeutic treatment for dependency on psychoactive substances such as alcohol, prescription drugs, and street drugs such as cannabis, cocaine, heroin, and amphetamines.

Types Various types of programs offer help in drug rehabilitation, including residential treatment (in-patient/out-patient), local support groups, extended care centers, recovery or sober houses, addiction counselling, mental health, and medical care. Some rehab centers offer age- and gender-specific programs. In an American survey by three separate institutions (the National Association of Alcoholism and Drug Abuse Counselors, Rational Recovery Systems and the Society of Psychologists in Addictive Behaviors) measuring treatment responses on the Spiritual Belief Scale (a scale measuring belief in the four spiritual characteristics Alcoholics Anonymous identified by Ernest Kurtz); the scores were found to explain 41% of the variance in the treatment provider's responses on the Addiction Belief Scale (a scale measuring adherence to the disease model or the free-will model addiction). Effective treatment addresses the multiple needs of the patient rather than treating addiction alone. In addition, medically assisted drug detoxification or alcohol detoxification alone is ineffective as a treatment for addiction. The National Institute on Drug Abuse (NIDA) recommends detoxification followed by both medication (where applicable) and behavioral therapy, followed by relapse prevention. According to NIDA, effective treatment must address medical and mental health services as well as follow-up options, such as community or family-based recovery support systems. Whatever the methodology, patient motivation is an important factor in treatment success. For individuals addicted to prescription drugs, treatments tend to be similar to those who are addicted to drugs affecting the same brain systems.

Cognitive behavioral therapy, which seeks to help patients to recognize, avoid and cope with situations in which they are most likely to relapse. Multidimensional family therapy, which is designed to support the recovery of the patient by improving family functioning. Motivational interviewing, which is designed to increase patient motivation to change behavior and enter treatment. Motivational incentives, which uses positive reinforcement to encourage abstinence from the addictive substance. EEG Biofeedback augmented treatment improves abstinence rates of 12-step, faith-based, and medically assisted addiction for cocaine, methamphetamine, alcohol use disorder, and opioid addictions. Treatment can be a long process and the duration is dependent upon the patient's needs and history of substance use.

ion, increased tolerance with use, and withdrawal symptoms after discontinuing opioids. Opioid withdrawal symptoms include nausea, muscle aches, diarrhea, trouble sleeping, agitation, and a low mood. Addiction and dependence are important components of opioid use disorder. Risk factors include a history of opioid misuse, current opioid misuse, young age, socioeconomic status, race, untreated psychiatric disorders, and environments that promote misuse (social, family, professional, etc.). Complications may include opioid overdose, suicide, HIV/AIDS, hepatitis C, and problems meeting social or professional responsibilities. Diagnosis may be based on criteria by the American Psychiatric Association in the DSM-5. Opioids include substances such as heroin, morphine, fentanyl, codeine, dihydrocodeine, oxycodone, hydrocodone, and tramadol. A useful standard for the relative strength of different opioids is morphine milligram equivalents (MME). It is recommended for clinicians to refer to daily MMEs when prescribing opioids to decrease the risk of misuse and adverse effects. Long-term opioid use occurs in about 4% of people following their use for trauma or surgery-related pain. In the United States, most heroin users begin by using prescription opioids that may also be bought illegally. People with opioid use disorder are often treated with opioid replacement therapy using methadone or buprenorphine. Such treatment reduces the risk of death. Additionally, they may benefit from cognitive behavioral therapy, other forms of support from mental health professionals such as individual or group therapy, twelve-step programs, and other peer support programs. The medication naltrexone may also be useful to prevent relapse. Naloxone is useful for treating an opioid overdose and giving those at risk naloxone to take home is beneficial. This disorder is much more prevalent than first realized. In 2020, the CDC estimated that nearly 3 million people in the U.S. were living with OUD and more than 65,000 people died by opioid overdose, of whom more than 15,000 overdosed on heroin. In 2022, the U.S. reported 81,806 deaths caused by opioid-related overdoses.

Cause Opioid use disorder can develop for many reasons, including systemic failures such as pervasive marketing strategies, over-prescribing, and self-medication. Scoring systems have been derived to assess the likelihood of opiate addiction in chronic pain patients. Healthcare practitioners have long been aware that despite the effective use of opioids for managing pain, empirical evidence supporting long-term opioid use is minimal. Many studies of patients with chronic pain have failed to show any sustained improvement in their pain or ability to function with long-term opioid use. A 2024 literature review suggests that adverse childhood experiences (ACEs) are significantly associated with opioid use disorder later in life.

Addiction Addiction is a chronic brain disorder characterized by compulsive drug use despite adverse consequences. Addiction involves the overstimulation of the brain's mesocorticolimbic reward circuit (reward system), essential for motivating behaviors linked to survival and reproductive fitness, like seeking food and sex. This reward system encourages associative learning and goal-directed behavior. In addiction, substances overactivate this circuit, causing compulsive behavior due to changes in brain synapses. In the brain's mesolimbic region, Nucleus Accumbens (NAc) accepts releases of dopamine triggered by the neurotransmitters. The brain reward circuitry is rooted in these networks, interacting between the mesolimbic and prefrontal cortex; these systems link motivation, anti-stress, incentive salience, and wellbeing. The incentive-sensitization theory differentiates between "wanting" (driven by dopamine in the reward circuit) and "liking" (related to brain pleasure centers). This explains the addictive potential of non-pleasurable substances and the persistence of opioid addiction despite tolerance to their euphoric effects. Addiction surpasses mere avoidance of withdrawal, involving cues and stress that reactivate reward-driven behaviors.

The Health Insurance Portability and Accountability Act of 1996 (HIPAA or the Kennedy–Kassebaum Act) is a United States Act of Congress enacted by the 104th United States Congress and signed into law by President Bill Clinton on August 21, 1996. It aimed to alter the transfer of healthcare information and stipulated guidelines by which personally identifiable information maintained by the healthcare and healthcare insurance industries should be protected from fraud and theft, and addressed some limitations on healthcare insurance coverage. It generally prohibits healthcare providers and businesses called covered entities from disclosing protected information to anyone other than a patient and the patient's authorized representatives without their consent. The law does not restrict patients from accessing their own information, except in limited cases.

ormation however they choose, nor does it require confidentiality where a patient discloses medical information to family members, friends, or other individuals not employees of a covered entity. The act consists of five titles: Title I protects health insurance coverage for workers and their families if they change or lose their jobs. Title II, known as the Administrative Simplification (AS) provisions, requires the establishment of national standards for electronic health care transactions and national identifiers for providers, health insurance plans, and employers. Title III sets guidelines for pre-tax medical spending accounts. Title IV sets guidelines for group health plans. Title V governs company-owned life insurance policies.

Title I protects health insurance coverage for workers and their families if they change or lose their jobs. Title II, known as the Administrative Simplification (AS) provisions, requires the establishment of national standards for electronic health care transactions and national identifiers for providers, health insurance plans, and employers. Title III sets guidelines for pre-tax medical spending accounts. Title IV sets guidelines for group health plans. Title V governs company-owned life insurance policies.

and breastfeeding, delivery of vaccinations, promoting ventilation and improved air quality both indoors and outdoors, suicide prevention, smoking cessation, obesity education, increasing healthcare accessibility and distribution of condoms to control the spread of sexually transmitted diseases. There is a significant disparity in access to health care and public health initiatives between developed countries and developing countries, as well as within developing countries. In developing countries, public health infrastructures are still forming. There may not be enough trained healthcare workers, monetary resources, or, in some cases, sufficient knowledge to provide even a basic level of medical care and disease prevention. A major public health concern in developing countries is poor maternal and child health, exacerbated by malnutrition and poverty and limited implementation of comprehensive public health policies. Developed nations are at greater risk of certain public health crises, including childhood obesity, although overweight populations in low- and middle-income countries are catching up. From the beginnings of human civilization, communities promoted health and fought disease at the population level. In complex, pre-industrialized societies, interventions designed to reduce health risks could be the initiative of different stakeholders, such as army generals, the clergy or rulers. Great Britain became a leader in the development of public health initiatives, beginning in the 19th century, due to the fact that it was the first modern urban nation worldwide. The public health initiatives that began to emerge initially focused on sanitation (for example, the Liverpool and London sewerage systems), control of infectious diseases (including vaccination and quarantine) and an evolving infrastructure of various sciences, e.g.

tion, smoking cessation, obesity education, increasing healthcare accessibility and distribution of condoms to control the spread of sexually transmitted diseases. There is a significant disparity in access to health care and public health initiatives between developed countries and developing countries, as well as within developing countries. In developing countries, public health infrastructures are still forming. There may not be enough trained healthcare workers, monetary resources, or, in some cases, sufficient knowledge to provide even a basic level of medical care and disease prevention. A major public health concern in developing countries is poor maternal and child health, exacerbated by malnutrition and poverty and limited implementation of comprehensive public health policies. Developed nations are at greater risk of certain public health crises, including childhood obesity, although overweight populations in low- and middle-income countries are catching up. From the beginnings of human civilization, communities promoted health and fought disease at the population level. In complex, pre-industrialized societies, interventions designed to reduce health risks could be the initiative of different stakeholders, such as army generals, the clergy or rulers. Great Britain became a leader in the development of public health initiatives, beginning in the 19th century, due to the fact that it was the first modern urban nation worldwide. The public health initiatives that began to emerge initially focused on sanitation (for example, the Liverpool and London sewerage systems), control of infectious diseases (including vaccination and quarantine) and an evolving infrastructure of various sciences, e.g.

Components Public health is a complex term, composed of many elements and different practices. It is a multi-faceted, interdisciplinary field. For example, epidemiology, biostatistics, social sciences and management of health services are all relevant. Other important sub-fields include environmental health, community health, behavioral health, health economics, public policy, mental health, health education, health politics, occupational safety, disability, gender issues in health, and sexual and reproductive health. Modern public health practice requires multidisciplinary teams of public health workers and professionals. Teams might include epidemiologists, biostatisticians, physician assistants, public health nurses, midwives, medical microbiologists, pharmacists, economists, sociologists, geneticists, data managers, environmental health officers (public health inspectors), bioethicists, gender experts, sexual and reproductive health specialists, physicians, and veterinarians. The elements and priorities of public health have evolved over time, and are continuing to evolve. Common public health initiatives include promotion of hand-washing and breastfeeding, delivery of vaccinations, suicide prevention, smoking cessation, obesity education, increasing healthcare accessibility and distribution of condoms to control the spread of sexually transmitted diseases. Methods Public health aims are achieved through surveillance of cases and the promotion of healthy behaviors, communities and environments. Analyzing the determinants of health of a population and the threats it faces is the basis for public health. Many diseases are preventable through simple, nonmedical methods. For example, research has shown that the simple act of handwashing with soap can prevent the spread of many contagious diseases. In other cases, treating a disease or controlling a pathogen can be vital to preventing its spread to others, either during an outbreak of infectious disease or through contamination of food or water supplies. Public health, together with primary care, secondary care, and tertiary care, is part of a country's overall health care system.

tive laboratory measures (biomarkers) for diagnosis. Treatment may include psychotropics (psychiatric medicines), psychotherapy, substance-abuse treatment, and other modalities such as interventional approaches, assertive community treatment, community reinforcement, and supported employment. Treatment may be delivered on an inpatient or outpatient basis, depending on the severity of functional impairment or risk to the individual or community. Research within psychiatry is conducted by psychiatrists on an interdisciplinary basis with other professionals, including clinical psychologists, epidemiologists, nurses, social workers, and occupational therapists.

The World Psychiatric Association issues an ethical code to govern the conduct of psychiatrists (like other purveyors of professional ethics). The psychiatric code of ethics, first set forth through the Declaration of Hawaii in 1977 has been expanded through a 1983 Vienna update and in the broader Madrid Declaration in 1996. The code was further revised during the organization's general assemblies in 1999, 2002, 2005, and 2011. The World Psychiatric Association code covers such matters as confidentiality, the death penalty, ethnic or cultural discrimination, euthanasia, genetics, the human dignity of incapacitated patients, media relations, organ transplantation, patient assessment, research ethics, sex selection, coercion, torture, and up-to-date knowledge. In establishing such ethical codes, the profession has responded to a number of controversies about the practice of psychiatry, for example, surrounding the use of lobotomy and electroconvulsive therapy. Discredited psychiatrists who operated outside the norms of medical ethics include Harry Bailey, Donald Ewen Cameron, Samuel A. Cartwright, Henry Cotton, and Andrei Snezhnevsky. Approaches Psychiatric illnesses can be conceptualised in several different ways. The biomedical approach examines signs and symptoms and compares them with diagnostic criteria. Mental illness can be assessed, conversely, through a narrative which tries to incorporate symptoms into a meaningful life history and to frame them as responses to external conditions. For example, the Power Threat Meaning Framework (PTMF) is a conceptual approach to understanding mental distress that serves as an alternative to traditional psychiatric diagnostic systems. Rather than viewing distress primarily as a symptom of an underlying mental disorder, the framework emphasizes the role of adversity, trauma, social inequalities, relationships, and cultural contexts in shaping people's experiences, and proposes that many forms of distress can be understood as meaningful responses to difficult circumstances. Both approaches are considered important in the field of psychiatry, but have not sufficiently reconciled to settle controversy over either the selection of a psychiatric paradigm or the specification of psychopathology. The biopsychosocial model is used to explain the multifactorial origins of clinical impairment, recognizing that biological, psychological, and social factors all play a role in health and disease. Once a medical professional diagnoses a patient there are numerous ways that they could choose to treat the patient. Often psychiatrists will develop a treatment strategy that incorporates different facets of different approaches into one. Drug prescriptions are very commonly written to be regimented to patients along with any therapy they receive. There are three major pillars of psychotherapy that treatment strategies are most regularly drawn from. Humanistic psychology attempts to put the "whole" of the patient in perspective; it also focuses on self exploration. Behaviorism is a therapeutic school of thought that elects to focus solely on real and observable events, rather than mining the unconscious or subconscious. Psychoanalysis, on the other hand, concentrates its dealings on early childhood, irrational drives, the unconscious, and conflict between conscious and unconscious streams.

Approaches Psychiatric illnesses can be conceptualised in several different ways. The biomedical approach examines signs and symptoms and compares them with diagnostic criteria. Mental illness can be assessed, conversely, through a narrative which tries to incorporate symptoms into a meaningful life history and to frame them as responses to external conditions. For example, the Power Threat Meaning Framework (PTMF) is a conceptual approach to understanding mental distress that serves as an alternative to traditional psychiatric diagnostic systems. Rather than viewing distress primarily as a symptom of an underlying mental disorder, the framework emphasizes the role of adversity, trauma, social inequalities, relationships, and cultural contexts in shaping people's experiences, and proposes that many forms of distress can be understood as meaningful responses to difficult circumstances. Both approaches are considered important in the field of psychiatry, but have not sufficiently reconciled to settle controversy over either the selection of a psychiatric paradigm or the specification of psychopathology. The biopsychosocial model is used to explain the multifactorial origins of clinical impairment, recognizing that biological, psychological, and social factors all play a role in health and disease. Once a medical professional diagnoses a patient there are numerous ways that they could choose to treat the patient. Often psychiatrists will develop a treatment strategy that incorporates different facets of different approaches into one. Drug prescriptions are very commonly written to be regimented to patients along with any therapy they receive. There are three major pillars of psychotherapy that treatment strategies are most regularly drawn from. Humanistic psychology attempts to put the "whole" of the patient in perspective; it also focuses on self exploration. Behaviorism is a therapeutic school of thought that elects to focus solely on real and observable events, rather than mining the unconscious or subconscious. Psychoanalysis, on the other hand, concentrates its dealings on early childhood, irrational drives, the unconscious, and conflict between conscious and unconscious streams.

Idaho Department of Health and Welfare is a public health agency in the state of Idaho. History The department was founded in 1972. Functions The department provides healthcare services, records management, children and family services, food assistance programs, and healthcare services.

Crisis intervention is a time-limited intervention with a specific psychotherapeutic approach to immediately stabilize those in crisis. Cross-national approaches Across different countries, crisis intervention following mass trauma events such as natural disasters relies on trained professionals who provide immediate support, coping strategies, and resource coordination to help individuals navigate psychological distress. Intervention process often begins with an assessment. In countries such as the Czech Republic, crisis intervention is an individual therapy, usually lasting four to six weeks, and includes assistance with housing, food, and legal matters. Long waiting times for resident psychotherapists and in Germany, explicit exclusions of couples therapy and other therapies complicate implementation. In the United States, licensed professional counselors (LPCs) provide mental health care to those in need.

Crisis and Intervention A crisis can have physical or psychological effects. Usually significant and more widespread, the latter lacks the former's obvious signs, complicating diagnosis. It is defined as a breakdown of psychological equilibrium, and being unable to benefit from normal methods of coping. Three factors define crisis: negative events, feelings of hopelessness, and unpredictable events. People who experience a crisis perceive it as a negative event that generate physical emotion, pain, or both. They also feel helpless, powerless, trapped, and a loss of control over their lives. Crisis events tend to occur suddenly and without warning, leaving little time to respond and resulting in trauma. In intervention for individuals facing personal or societal crises, there are five universal principles to guide the process. Prompt intervention is essential as victims are initially at high risk for maladaptive coping or immobilization, such as displaying distress behaviours that carry varying levels of risk. Stabilization involves mobilizing resources to help victims regain a sense of order and normalcy, promoting independent functioning. Comprehension of the traumatic event is facilitated to aid the individual in understanding and expressing their feelings about the experience. Problem-solving is a crucial aspect where counselors assist victims in resolving issues within their unique circumstances, promoting self-efficacy and self-reliance. Lastly, the goal is to help individuals return to normalcy by actively facilitating problem-solving, supporting the development of appropriate coping strategies, and assisting in their implementation.

Critical incident debriefing Critical incident debriefing is a widespread approach to support those who experienced crisis. This technique is done in a group setting 24–72 hours after the event occurred, and is typically a one-time meeting that lasts 3–4 hours, but can be done over numerous sessions if needed. Debriefing is a process by which facilitators describe various symptoms related PTSD and other anxiety disorders that individuals are likely to experience due to exposure to a trauma. The group setting allows participants to process negative emotions surrounding the traumatic event collectively in a safe environment. Facilitators also guide participants through techniques that involve active cognitive engagement while introducing attentional tasks that may serve to distract and ground individuals as they recount distressing experiences, allowing for less stressful emotional processing. However, critical incident debriefing has been the subject of substantial academic criticism regarding its effectiveness in reducing the impact of harm from crisis situations. Some studies show that individuals exposed to debriefing are actually more likely to exhibit symptoms of PTSD at a 13-month follow-up than those who received no intervention. Most recipients of debriefing reported that they found the intervention helpful.

pa ( ) is the most populous city in Canyon County, Idaho, United States. The population was 100,200 at the 2020 census. It is Idaho's third-most populous city. Nampa is about 20 miles (32 km) west of Boise along Interstate 84, and 6 miles (9.7 km) west of Meridian. It is the second principal city of the Boise metropolitan area. The name "Nampa" may have come from a Shoshoni word meaning 'moccasin' or 'footprint'. According to toponymist William O. Bright, the name comes from the Shoshoni word /nampai/, meaning "foot".

History Nampa had its beginnings in the early 1880s when the Oregon Short Line Railroad built a line from Granger, Wyoming, to Huntington, Oregon, that passed through Nampa. In Nampa there is a history museum that marks the railroad's significance. More railroad lines sprang up through Nampa, making it an important railroad town. Alexander and Hannah Duffes established one of the town's first homesteads, eventually forming the Nampa Land and Improvement Company with the help of their friend and co-founder, James McGee. Despite the name, many early settlers called the town "New Jerusalem" because of its citizens' strong religious focus. After only a year the town grew from 15 homes to 50. As amenities were added, Nampa continued to grow, and it was incorporated in 1891. Downtown Nampa's street grid is oriented with the railroad tracks, which run northwest–southeast; this was done intentionally by Alexander Duffes to prevent accidents like one that occurred earlier in a town he had platted near Toronto, where a woman and her two children were killed by a train when their buggy wheel got stuck as they crossed the tracks. As the Oregon Short Line railroad originally bypassed Boise, Nampa has the fanciest of many railroad depots built in the area. Nampa gained attention in 1889 due to a purported archaeological discovery known as the Nampa figurine. George Frederick Wright wrote up details that year for the Boston Society of Natural History. The first elementary school was built in the 1890s. Lakeview School was on a hill on 6th Street and 12th Avenue North, with a view of Lake Ethel. Just after the school's centennial celebration, it was condemned as a school and sold to the First Mennonite Church. In 2008 the building was refurbished, and it is now used by the Idaho Arts Charter School. Lake Ethel, an irrigation reservoir, had long been the site of community picnics, and many citizens fished, swam, boated, and even hunted on it and its surrounding property. But the hunting didn't last long, as O. F. Persons, owner of the adjoining homestead, took offense when local hunters started shooting his pet ducks. The city later auctioned off the lake. E. H. Dewey (a former Nampa mayor) was the only bidder. But occasional flooding led to a series of lawsuits from neighbors. Dewey eventually drained Lake Ethel. Not long after, the city council became interested in buying back the Fritz Miller property as well as the Dewey home. Pressure had been building for more than four years. Nampa citizens wanted another park. On August 7, 1924, the city council passed an ordinance to purchase the Miller property and name it Lakeview Park. A bandstand was completed in 1928, and the municipal swimming pool opened on August 13, 1934. It is Nampa's largest park and many community celebrations are held there. Colonel William H. Dewey, a man who made a fortune mining in Silver City, built the Dewey Palace Hotel in 1902 for $250,000. He died in his hotel in 1903, leaving his son $1 million. The hotel survived the great fire of 1909, which burned several blocks of downtown Nampa, but was razed in 1963 after redevelopment plans failed. Relics from the hotel such as the chandelier and the hotel safe can be found at the Canyon County Historical Museum, which is in the old train depot on Front Street and Nampa City Hall. After demolition the location on First Street between 11th and 12th Ave. South was sold to private enterprise, including a bank and tire store, replacing this building with modern structures. A public-use postage stamp sized park was later placed across the street from the old palace property as a collaboration between the Downtown Alliance of Nampa (the local business council) and an Eagle Scout Project for the Boy Scouts of America. The park includes a large mural/wall sculpture of running horses commissioned for the project. A Carnegie library was built downtown in 1908; it burned down after the library moved in 1966. Nampa Public Library was then on the corner of 1st Street and 11th Avenue South in the old bank building. A new library, on 12th Avenue South, opened in 2015. Deer Flat Reservoir, an offstream irrigation storage reservoir, was constructed by the United States Bureau of Reclamation between 1906 and 1911. Known locally as Lake Lowell, it is surrounded by the Deer Flat National Wildlife Refuge, established in 1909 by President Theodore Roosevelt. The refuge is administered by the U.S. Fish and Wildlife Service. Lake Lowell is filled by the concrete New York Canal; the water is diverted from the Boise River a few miles below Lucky Peak Dam. In 1910, the Idaho State School and Hospital was built northwest of Nampa for the state's developmentally challenged population. It opened in 1918. The institution was largely self-sufficient, with a large farm staffed by the residents. The higher-functioning residents also cared for residents who could not care for themselves. The land for the farm was sold and is now golf courses (Centennial and Ridgecrest), and the residents no longer give primary care to other residents. The institution is modernized and remains in operation, though a few of the oldest buildings now house juvenile offenders. Nampa held an annual harvest festival and farmers' market from about 1908, a time of celebration and community fun. From this festival emerged the Snake River Stampede Rodeo in 1937, which continues to this day. It is one of the top 12 rodeos in the pro rodeo circuits. In 1913, a local congregation of the Church of the Nazarene built a small elementary school, which became to Northwest Nazarene College in 1915 and finally Northwest Nazarene University. As of 2025, the university has approximately 1,800 undergraduate and graduate students. Karcher Mall opened in 1965, the first enclosed shopping mall in the Treasure Valley. It was "the place to gather" for several decades until the Boise Towne Square mall was built in Boise in 1988, drawing business away. Karcher Mall was renamed District 208 in 2022. The Idaho Press-Tribune is the local newspaper for the Canyon County area.

Idaho Hispanic Community Center (IH2C) In 2003, the Hispanic Cultural Center of Idaho (HCCI) opened thanks to community support. It has recently transitioned back to the City of Nampa and was renamed the Idaho Hispanic Community Center (IH2C) and is home to the Idaho Hispanic Foundation. It hosts events, classes, and festivals, including Día de los Muertos, Hispanic Heritage Month, and Día Internacional de la Mujer. It serves as a meeting place for associations and groups. Displays of cultural history are available to the public. Nampa Train Depot Museum The Nampa Train Depot Museum is a historical depot with displays and archives of the area's railroad and cultural history. The Canyon County Historical Society saved the depot from demolition in 1972. Annual Festival of the Arts Nampa's Festival of the Arts, which began in 1987, is held in Lakeview Park every year and includes local art, music, dance, and food.

Ada County is located in the southwestern part of Idaho, United States. As of the 2020 census, the county had a population of 494,967, which by 2025 was estimated to have risen to 546,141. Ada County is by far the state's most populous county; it is home to 26.8% of the state's population. The county seat and largest city is Boise, which is also the state capital. Ada County is included in the Boise metropolitan area. The Ada County Highway District has jurisdiction over all the local county and city streets, except for private roads and state roads.

populous county; it is home to 26.8% of the state's population. The county seat and largest city is Boise, which is also the state capital. Ada County is included in the Boise metropolitan area. The Ada County Highway District has jurisdiction over all the local county and city streets, except for private roads and state roads.

ea. The Ada County Highway District has jurisdiction over all the local county and city streets, except for private roads and state roads. In the interior Pacific Northwest east of the Cascade Range, Ada County ranks second in population, behind Spokane County, Washington. History Ada County was created by the Idaho Territory legislature on December 22, 1864, partitioned from Boise County. It is named for Ada Riggs, the daughter of H. C. Riggs, a member of the legislature; he established the county and was a co-founder of Boise.

105, which by 2025 was estimated to have risen to 275,123, making it the second-most populous county in Idaho. The county seat is Caldwell, and its largest city is Nampa. Canyon County is part of the Boise metropolitan area. History Hudson's Bay Company established Fort Boise in 1834 near what is now Parma, but abandoned it in 1855. Emigrants traveled through Canyon County on the Oregon Trail. Discovery of gold in the Boise Basin in 1862 brought settlement to the region again. The lower Boise River was fully contained within Boise County from 1863 until the formation of Ada County in 1864. Settlement of the lower Boise River west of Boise City was limited prior to the completion of the Oregon Short Line Railroad. Middleton was the first European settlement of Canyon County, starting in 1863. The 1870 Census for Ada County listed 76 residents of the Boise Valley, excluding Boise City and the 1880 Census listed 44 residents at Middleton. The arrival of the railroad at Caldwell led to the establishment of a town there as of August 1883. Businessmen James A. McGee and Alexander Duffes filed the plat for nearby Nampa in 1886. Parma was settled around the same time, with the Old Fort Boise post office being moved to the town's location; it was incorporated in 1904. Ada County established precincts for each of the settlements with a combined 1890 Census population of 2,311. Significant settlement of Greenleaf and Notus started around 1904 with the two settlements listed as precincts at the 1910 census. Notus was incorporated in 1921 while Greenleaf was incorporated prior to 1980. Melba was incorporated in 1912 while Wilder was incorporated in 1919. The City of Star annexed a portion of territory in northeast Canyon County prior to 2007, becoming the county's ninth incorporated city. The majority of Star is located within Ada County. The Idaho Legislature created Canyon County from Ada County in an act approved March 7, 1891, effective at the November 26, 1892, election. Caldwell was established as the county seat. The county originally contained all of Canyon and Payette counties and part of Gem; Gem County formed in 1915 and Payette County in 1917.

History Hudson's Bay Company established Fort Boise in 1834 near what is now Parma, but abandoned it in 1855. Emigrants traveled through Canyon County on the Oregon Trail. Discovery of gold in the Boise Basin in 1862 brought settlement to the region again. The lower Boise River was fully contained within Boise County from 1863 until the formation of Ada County in 1864. Settlement of the lower Boise River west of Boise City was limited prior to the completion of the Oregon Short Line Railroad. Middleton was the first European settlement of Canyon County, starting in 1863. The 1870 Census for Ada County listed 76 residents of the Boise Valley, excluding Boise City and the 1880 Census listed 44 residents at Middleton. The arrival of the railroad at Caldwell led to the establishment of a town there as of August 1883. Businessmen James A. McGee and Alexander Duffes filed the plat for nearby Nampa in 1886. Parma was settled around the same time, with the Old Fort Boise post office being moved to the town's location; it was incorporated in 1904. Ada County established precincts for each of the settlements with a combined 1890 Census population of 2,311. Significant settlement of Greenleaf and Notus started around 1904 with the two settlements listed as precincts at the 1910 census. Notus was incorporated in 1921 while Greenleaf was incorporated prior to 1980. Melba was incorporated in 1912 while Wilder was incorporated in 1919. The City of Star annexed a portion of territory in northeast Canyon County prior to 2007, becoming the county's ninth incorporated city. The majority of Star is located within Ada County. The Idaho Legislature created Canyon County from Ada County in an act approved March 7, 1891, effective at the November 26, 1892, election. Caldwell was established as the county seat. The county originally contained all of Canyon and Payette counties and part of Gem; Gem County formed in 1915 and Payette County in 1917.

2000 census As of the 2000 census, there were 131,441 people, 45,018 households and 33,943 families living in the county. The population density was 223 people per square mile (86 people/km2). There were 47,965 housing units at an average density of 81 units per square mile (31 units/km2). The racial makeup of the county was 83.10% White, 0.32% Black or African American, 0.85% Native American, 0.80% Asian, 0.13% Pacific Islander, 12.17% from other races, and 2.62% from two or more races. Hispanic or Latino of any race were 18.61% of the population. 15.9% were of German, 12.7% English, 10.3% American and 7.6% Irish ancestry. There were 45,018 households, of which 39.80% had children under the age of 18 living with them, 60.70% were married couples living together, 10.10% had a female householder with no husband present, and 24.60% were non-families. 19.80% of all households were made up of individuals, and 8.40% had someone living alone who was 65 years of age or older. The average household size was 2.85 and the average family size was 3.28. 30.90% of the population were under the age of 18, 10.70% from 18 to 24, 28.30% from 25 to 44, 19.10% from 45 to 64, and 11.00% who were 65 years of age or older. The median age was 30 years. For every 100 females, there were 98.70 males. For every 100 females age 18 and over, there were 96.30 males. The median household income was $35,884 and the median family income was $40,377. Males had a median income of $29,418 compared with $22,044 for females. The per capita income for the county was $15,155. About 8.70% of families and 12.00% of the population were below the poverty line, including 14.50% of those under age 18 and 10.70% of those age 65 or over. Communities Cities Unincorporated communities Bowmont Huston Roswell Sunnyslope Walters Ferry, Idaho Politics Like the majority of Idaho, Canyon County is reliably Republican by comfortable margins. The last time a Democratic candidate carried the county was in 1936 by Franklin D. Roosevelt.

the county seat of Canyon County, Idaho, United States. Caldwell is the 5th most populous city in Idaho. As of the 2020 census, Caldwell had a population of 59,996. Caldwell is considered part of the Boise metropolitan area, and is the location of the College of Idaho. The city is located approximately 24 miles (39 km) west of Boise, and approximately 17 miles (27 km) east of the Oregon border. History The present-day location of Caldwell is along a natural passageway to the Inland and Pacific Northwest. Native American tribes from the west coast, north Idaho and as far away as Colorado came to the banks of the Boise River for annual trading fairs, or rendezvous. European and some Hawaiian explorers and traders soon followed the paths left by Native Americans and hopeful emigrants later forged the Oregon Trail and followed those paths to seek a better life in the Oregon Territory. Pioneers of the Trail traveled along the Boise River to Canyon Hill and forded the river close to the Silver Bridge on Plymouth Street. During the Civil War, the discovery of gold in Idaho's mountains brought a variety of new settlers into the area. Many never made it to the mines but settled along the Boise River and run ferries, stage stations, and freighting businesses. These early entrepreneurs created small ranches and farms in the river valleys. Caldwell's inception occurred largely as a result of the construction of the Oregon Short Line Railroad, which connected Wyoming to Oregon through Idaho. Robert E. Strahorn came to the Boise River Valley in 1883 to select a route for the railroad. He rejected the grade into Boise City as too steep and chose a site 30 miles to the west. He drove a stake into an alkali flat of sagebrush and greasewood and the City of Caldwell was platted. Caldwell was named after one of Strahorn's business partners, Alexander Caldwell, a former senator from Kansas. When Caldwell was platted in August 1883, its founder, the Idaho and Oregon Land Improvement Company, started persuading settlers and businessmen to move to the area. Within four months, Caldwell had 600 residents living in 150 dwellings, 40 businesses, a school, a telephone exchange, and two newspapers. On January 15, 1890, the Board of Commissioners of Ada County issued a handwritten order incorporating the City of Caldwell. The College of Idaho was founded in Caldwell in 1891. In 1892, Canyon County was established from a portion of Ada County, and Caldwell was named the county seat. Irrigation canals and waterways were constructed throughout Canyon County, providing the foundation for an agricultural economy. The Oregon Short Line Railroad became part of the larger Union Pacific Railroad network and in 1906 the Caldwell freight and passenger depot was constructed. Caldwell experienced moderate growth as an agricultural processing, commercial retail and educational center during the 20th century. In 2009, the City of Caldwell completed a revitalization project to restore Indian Creek, which runs through downtown Caldwell, but had been used for sewage disposal by local industries and been covered over.

History The present-day location of Caldwell is along a natural passageway to the Inland and Pacific Northwest. Native American tribes from the west coast, north Idaho and as far away as Colorado came to the banks of the Boise River for annual trading fairs, or rendezvous. European and some Hawaiian explorers and traders soon followed the paths left by Native Americans and hopeful emigrants later forged the Oregon Trail and followed those paths to seek a better life in the Oregon Territory. Pioneers of the Trail traveled along the Boise River to Canyon Hill and forded the river close to the Silver Bridge on Plymouth Street. During the Civil War, the discovery of gold in Idaho's mountains brought a variety of new settlers into the area. Many never made it to the mines but settled along the Boise River and run ferries, stage stations, and freighting businesses. These early entrepreneurs created small ranches and farms in the river valleys. Caldwell's inception occurred largely as a result of the construction of the Oregon Short Line Railroad, which connected Wyoming to Oregon through Idaho. Robert E. Strahorn came to the Boise River Valley in 1883 to select a route for the railroad. He rejected the grade into Boise City as too steep and chose a site 30 miles to the west. He drove a stake into an alkali flat of sagebrush and greasewood and the City of Caldwell was platted. Caldwell was named after one of Strahorn's business partners, Alexander Caldwell, a former senator from Kansas. When Caldwell was platted in August 1883, its founder, the Idaho and Oregon Land Improvement Company, started persuading settlers and businessmen to move to the area. Within four months, Caldwell had 600 residents living in 150 dwellings, 40 businesses, a school, a telephone exchange, and two newspapers. On January 15, 1890, the Board of Commissioners of Ada County issued a handwritten order incorporating the City of Caldwell. The College of Idaho was founded in Caldwell in 1891. In 1892, Canyon County was established from a portion of Ada County, and Caldwell was named the county seat. Irrigation canals and waterways were constructed throughout Canyon County, providing the foundation for an agricultural economy. The Oregon Short Line Railroad became part of the larger Union Pacific Railroad network and in 1906 the Caldwell freight and passenger depot was constructed. Caldwell experienced moderate growth as an agricultural processing, commercial retail and educational center during the 20th century. In 2009, the City of Caldwell completed a revitalization project to restore Indian Creek, which runs through downtown Caldwell, but had been used for sewage disposal by local industries and been covered over.

location of the College of Idaho. The city is located approximately 24 miles (39 km) west of Boise, and approximately 17 miles (27 km) east of the Oregon border. History The present-day location of Caldwell is along a natural passageway to the Inland and Pacific Northwest. Native American tribes from the west coast, north Idaho and as far away as Colorado came to the banks of the Boise River for annual trading fairs, or rendezvous. European and some Hawaiian explorers and traders soon followed the paths left by Native Americans and hopeful emigrants later forged the Oregon Trail and followed those paths to seek a better life in the Oregon Territory. Pioneers of the Trail traveled along the Boise River to Canyon Hill and forded the river close to the Silver Bridge on Plymouth Street. During the Civil War, the discovery of gold in Idaho's mountains brought a variety of new settlers into the area. Many never made it to the mines but settled along the Boise River and run ferries, stage stations, and freighting businesses. These early entrepreneurs created small ranches and farms in the river valleys. Caldwell's inception occurred largely as a result of the construction of the Oregon Short Line Railroad, which connected Wyoming to Oregon through Idaho. Robert E. Strahorn came to the Boise River Valley in 1883 to select a route for the railroad. He rejected the grade into Boise City as too steep and chose a site 30 miles to the west. He drove a stake into an alkali flat of sagebrush and greasewood and the City of Caldwell was platted. Caldwell was named after one of Strahorn's business partners, Alexander Caldwell, a former senator from Kansas. When Caldwell was platted in August 1883, its founder, the Idaho and Oregon Land Improvement Company, started persuading settlers and businessmen to move to the area. Within four months, Caldwell had 600 residents living in 150 dwellings, 40 businesses, a school, a telephone exchange, and two newspapers. On January 15, 1890, the Board of Commissioners of Ada County issued a handwritten order incorporating the City of Caldwell. The College of Idaho was founded in Caldwell in 1891. In 1892, Canyon County was established from a portion of Ada County, and Caldwell was named the county seat. Irrigation canals and waterways were constructed throughout Canyon County, providing the foundation for an agricultural economy. The Oregon Short Line Railroad became part of the larger Union Pacific Railroad network and in 1906 the Caldwell freight and passenger depot was constructed. Caldwell experienced moderate growth as an agricultural processing, commercial retail and educational center during the 20th century. In 2009, the City of Caldwell completed a revitalization project to restore Indian Creek, which runs through downtown Caldwell, but had been used for sewage disposal by local industries and been covered over.

Meridian is a city located in Ada County, Idaho, United States. The population was 117,635 at the 2020 census, making it the second most populous city in the county and Idaho, after Boise, the state capital.

Rail transportation (1908–28) Following the raising of $4,000 to lay the Interurban rail line from Onweiler (Meridian and Ustick Roads), the tracks were completed into the village center. Turning east on Broadway and ending at East Second, the last car would spend the night in Meridian before returning to Boise early the next morning with passengers and freight. The interurban Station and Generator building (west one-third of the old library at Meridian and Idaho Streets) was built in 1912, and the line continued on to Nampa via Meridian. The tracks down Broadway were not used after 1912. The Interurban Company entered into receivership and closed in 1928 after 20 years of providing continuous transportation to neighboring towns. It was Meridian's main connection to the area outside the local community. The Union Pacific Railroad spur opened in 1900 and is currently operated by the Boise Valley Railroad. Many industrial customers continue to ship forest, agricultural, and chemical products along this corridor. Creamery (1929–70) The city's official website describes the history of the Ada County Dairymen's cooperative creamery as follows:The lowest days of the Great Depression brightened for area dairymen when the Ada County Dairymen's cooperative creamery began operation in 1929. It provided milk checks to those who were members of the cooperative, enabling them to pay their taxes and provide food for their families. Other community members hauled milk to the creamery and were employed by the creamery, whose product was Challenge Butter. The creamery ran seven days a week for 40 years. Additions and improvements were made while the plant was in full operation. Later years saw the Wyeth Laboratories affiliate with the creamery to manufacture SMA baby formula.

Creamery (1929–70) The city's official website describes the history of the Ada County Dairymen's cooperative creamery as follows:The lowest days of the Great Depression brightened for area dairymen when the Ada County Dairymen's cooperative creamery began operation in 1929. It provided milk checks to those who were members of the cooperative, enabling them to pay their taxes and provide food for their families. Other community members hauled milk to the creamery and were employed by the creamery, whose product was Challenge Butter. The creamery ran seven days a week for 40 years. Additions and improvements were made while the plant was in full operation. Later years saw the Wyeth Laboratories affiliate with the creamery to manufacture SMA baby formula.