Evaluating SUD/OUD Treatment Outcomes Related to Vocational Success for Previously Incarcerated Persons: A Review

The United States criminal justice system’s (CJS) primary purpose is for the rehabilitation of the individuals within it, which calls for a comprehensive evaluation and critique of its effectiveness. Though there are many variables of the CJS that can be evaluated, for those who are battling a substance or opioid use disorder, accessing treatment is particularly difficult. Further, upon release from the jail/prison system, such persons are often expected to maintain certain parameters such as holding a job. The complex interaction between all three of these variables (incarceration history, substance use history, and employment status) have not yet been evaluated together. A review of the extant literature on vocational outcomes as they relate to substance use treatments in prison clearly shows the limited success of these treatments for participants post-release. Such findings create curiosity about what might be missing in these substance use treatments, especially as they relate to employment. The purpose of the present manuscript is to investigate how these ideas have been historically documented and measured and subsequently to suggest a way in which to enhance the limited success of substance use treatments in the CJS. Vocational success is an outcome measure that takes into account, not only, traditional objective standards such as whether or not a person is employed, hours worked, etc., but also more subjective standards such as meaning- making in work which has not previously been included in prison-based substance use treatments. Such inclusion may increase vocational success and may lead to overall more positive recovery for individuals post-release. Future research recommendations are discussed

Non-Parametric Test for Ordered Medians: The Jonckheere Terpstra Test

In clinical trials, sample size is usually lesser as compared to other epidemiological studies to make it more feasible and cost effective. Small sizes of such trials discourage the use of parametric test due to violation of the assumption under which they are applicable. Therefore, the use of nonparametric test is substantial in clinical trials to test two or more independent samples. The Kruskal-Wallis h test is an alternative to one-way ANOVA and can be used to identify significant differences among different populations. When we have several independent samples and assumed to be arranged orderly, Jonckheere Terpstra test is a best choice to compare population medians instead of means. For the application of Jonckheere Terpstra test the data from the study of cleaning methods for ultrasound probes are used. The Jonckheere Terpstra test is recommended over Kruskal-Wallis h test as it compares and provides significant difference between more than two population medians when they arranged in order. Therefore, the aim of this research paper was to explore the use and significance of Jonckheere-Terpstra test with the use of practical example

Effects of a high-dose 24-h infusion of tranexamic acid on death and thromboembolic events in patients with acute gastrointestinal bleeding (HALT-IT): an international randomised, double-blind, placebo-controlled trial

Background: Tranexamic acid reduces surgical bleeding and reduces death due to bleeding in patients with trauma. Meta-analyses of small trials show that tranexamic acid might decrease deaths from gastrointestinal bleeding. We aimed to assess the effects of tranexamic acid in patients with gastrointestinal bleeding. Methods: We did an international, multicentre, randomised, placebo-controlled trial in 164 hospitals in 15 countries. Patients were enrolled if the responsible clinician was uncertain whether to use tranexamic acid, were aged above the minimum age considered an adult in their country (either aged 16 years and older or aged 18 years and older), and had significant (defined as at risk of bleeding to death) upper or lower gastrointestinal bleeding. Patients were randomly assigned by selection of a numbered treatment pack from a box containing eight packs that were identical apart from the pack number. Patients received either a loading dose of 1 g tranexamic acid, which was added to 100 mL infusion bag of 0·9% sodium chloride and infused by slow intravenous injection over 10 min, followed by a maintenance dose of 3 g tranexamic acid added to 1 L of any isotonic intravenous solution and infused at 125 mg/h for 24 h, or placebo (sodium chloride 0·9%). Patients, caregivers, and those assessing outcomes were masked to allocation. The primary outcome was death due to bleeding within 5 days of randomisation; analysis excluded patients who received neither dose of the allocated treatment and those for whom outcome data on death were unavailable. This trial was registered with Current Controlled Trials, ISRCTN11225767, and ClinicalTrials.gov, NCT01658124. Findings: Between July 4, 2013, and June 21, 2019, we randomly allocated 12 009 patients to receive tranexamic acid (5994, 49·9%) or matching placebo (6015, 50·1%), of whom 11 952 (99·5%) received the first dose of the allocated treatment. Death due to bleeding within 5 days of randomisation occurred in 222 (4%) of 5956 patients in the tranexamic acid group and in 226 (4%) of 5981 patients in the placebo group (risk ratio [RR] 0·99, 95% CI 0·82–1·18). Arterial thromboembolic events (myocardial infarction or stroke) were similar in the tranexamic acid group and placebo group (42 [0·7%] of 5952 vs 46 [0·8%] of 5977; 0·92; 0·60 to 1·39). Venous thromboembolic events (deep vein thrombosis or pulmonary embolism) were higher in tranexamic acid group than in the placebo group (48 [0·8%] of 5952 vs 26 [0·4%] of 5977; RR 1·85; 95% CI 1·15 to 2·98). Interpretation: We found that tranexamic acid did not reduce death from gastrointestinal bleeding. On the basis of our results, tranexamic acid should not be used for the treatment of gastrointestinal bleeding outside the context of a randomised trial

Convalescent plasma in patients admitted to hospital with COVID-19 (RECOVERY): a randomised controlled, open-label, platform trial

SummaryBackground Azithromycin has been proposed as a treatment for COVID-19 on the basis of its immunomodulatoryactions. We aimed to evaluate the safety and efficacy of azithromycin in patients admitted to hospital with COVID-19.Methods In this randomised, controlled, open-label, adaptive platform trial (Randomised Evaluation of COVID-19Therapy [RECOVERY]), several possible treatments were compared with usual care in patients admitted to hospitalwith COVID-19 in the UK. The trial is underway at 176 hospitals in the UK. Eligible and consenting patients wererandomly allocated to either usual standard of care alone or usual standard of care plus azithromycin 500 mg once perday by mouth or intravenously for 10 days or until discharge (or allocation to one of the other RECOVERY treatmentgroups). Patients were assigned via web-based simple (unstratified) randomisation with allocation concealment andwere twice as likely to be randomly assigned to usual care than to any of the active treatment groups. Participants andlocal study staff were not masked to the allocated treatment, but all others involved in the trial were masked to theoutcome data during the trial. The primary outcome was 28-day all-cause mortality, assessed in the intention-to-treatpopulation. The trial is registered with ISRCTN, 50189673, and ClinicalTrials.gov, NCT04381936.Findings Between April 7 and Nov 27, 2020, of 16 442 patients enrolled in the RECOVERY trial, 9433 (57%) wereeligible and 7763 were included in the assessment of azithromycin. The mean age of these study participants was65·3 years (SD 15·7) and approximately a third were women (2944 [38%] of 7763). 2582 patients were randomlyallocated to receive azithromycin and 5181 patients were randomly allocated to usual care alone. Overall,561 (22%) patients allocated to azithromycin and 1162 (22%) patients allocated to usual care died within 28 days(rate ratio 0·97, 95% CI 0·87–1·07; p=0·50). No significant difference was seen in duration of hospital stay (median10 days [IQR 5 to >28] vs 11 days [5 to >28]) or the proportion of patients discharged from hospital alive within 28 days(rate ratio 1·04, 95% CI 0·98–1·10; p=0·19). Among those not on invasive mechanical ventilation at baseline, nosignificant difference was seen in the proportion meeting the composite endpoint of invasive mechanical ventilationor death (risk ratio 0·95, 95% CI 0·87–1·03; p=0·24).Interpretation In patients admitted to hospital with COVID-19, azithromycin did not improve survival or otherprespecified clinical outcomes. Azithromycin use in patients admitted to hospital with COVID-19 should be restrictedto patients in whom there is a clear antimicrobial indication

Mitral leaflet separation index correlation with mitral stenosis severity, A reliable easy 2-d echocardiography technique

Objectives: To evaluate accuracy of mitral leaflet separation index for the determination of mitral stenosis severity in patients with rheumatic mitral stenosis.Methods: The prospective, cross-sectional study was conducted at the National Institute of Cardiovascular Diseases, Karachi, from March 2021 to February 2022, and comprised patients with rheumatic mitral stenosis detected on echocardiography. The best end-diastole parasternal long axis and apical four-chamber views were acquired and Mitral leaflet separation was measured as the distance between the inner edges of the tip of mitral leaflets. Pearson correlation coefficient was computed for mitral leaflet separation index and mitral valve area. Receiver operating characteristic curve was used to determine the cut-off value of the mitral leaflet separation indexto categorise mitral stenosis. Data was analysed using SPSS 19.Results: Of the 277 patients, 205(74%) were females and 72(26%) were males. The overall mean age was 39.93±11.22 years. The mean mitral leaflet separation index value was 7.65±2.23. The correlation was significant and strong between mitral leaflet separation index and mitral valve area on planimetry (pConclusions: The mitral leaflet separation index was found to be an independent, reliable and simple measure for assessing mitral stenosis severity

Frequency and Types of Gastrointestinal Tract Related Interventional Health Care Facilities

Background: To analyze the interventions performed in upper and lower gastrointestinal tract diseases .Methods: In this prospective study all the patients undergoing liver and gastrointestinal related procedures were included.Major types of procedures included endoscopies and liver biopsies. Demographic features, indications or presenting symptoms, endoscopic findings and types of interventions were noted. .Results: A total of 111 patients with a mean age of 46.05 ±13.22 years were assessed of whom 57.7% were males, with a male to female ratio of 1.36:1Majority(97.2%) patients were HCV positive. Upper GI endoscopy was the most frequently performed procedure(63.1 %). Esophageal varices and gastritis were the most common findings on upper gastrointestinal tract endoscopies. Unexplained weight loss(36.3%) and anemia(45.4%) were the commonest indications for lower GI endoscopyConclusion: It is required to expand diagnostic and therapeutic interventions for gastrointestinal diseases.

Transformational leadership and asian Indian values: duty, selfless service, and nonviolence

As reports increase of scandals and unethical behavior in Western corporations and organizations, public faith in leadership has declined, indicating the need for a reevaluation of what makes a good leader. We propose a transformational style of ethical leadership, supplemented by traditional Indian values, for leadership that focuses on duty, selfless service, and nonviolence. We address Indian cultural values of dharma, karma–yoga, and ahimsa in reference to transformational leadership, highlighting the contributions of influential Indian leaders like Mohandas K. Gandhi. We describe the consonance of these values and counseling psychology ideals, as well as their applications for leadership practice, training, and research

Figure piloting innovation : integrating the career adapt-abilities scale—UK into practice

Implementation of new theories that are rigorous and research-based into practice is challenging. It requires a willingness to take risks, both on the part of the individual practitioner, but also the employing organization. Funding mechanisms that reward a focus on placement into sustainable employment can operate as powerful inhibitors of innovatory practices that focus on holistic approaches to professional practice. The Career Adapt-Ability Scale International (CAAS-I), a scale developed to integrate vocational psychology with constructivist approaches is one such example of a theoretically informed innovation currently available. Here, validation and implementation of the scale adapted for the UK context into higher education, then a professional association are discussed, together with lessons learned regarding the implementation of innovatory practice