Introduction to Criminal Justice (KSU)

This Grants Collection for Introduction to Criminal Justice was created under a Round Ten ALG Textbook Transformation Grant. Affordable Learning Georgia Grants Collections are intended to provide faculty with the frameworks to quickly implement or revise the same materials as a Textbook Transformation Grants team, along with the aims and lessons learned from project teams during the implementation process. Documents are in .pdf format, with a separate .docx (Word) version available for download. Each collection contains the following materials: Linked Syllabus Initial Proposal Final Reporthttps://oer.galileo.usg.edu/criminal-collections/1004/thumbnail.jp

Incisional hernia following colorectal cancer surgery according to suture technique: Hughes Abdominal Repair Randomized Trial (HART)

BackgroundIncisional hernias cause morbidity and may require further surgery. HART (Hughes Abdominal Repair Trial) assessed the effect of an alternative suture method on the incidence of incisional hernia following colorectal cancer surgery.MethodsA pragmatic multicentre single-blind RCT allocated patients undergoing midline incision for colorectal cancer to either Hughes closure (double far–near–near–far sutures of 1 nylon suture at 2-cm intervals along the fascia combined with conventional mass closure) or the surgeon’s standard closure. The primary outcome was the incidence of incisional hernia at 1 year assessed by clinical examination. An intention-to-treat analysis was performed.ResultsBetween August 2014 and February 2018, 802 patients were randomized to either Hughes closure (401) or the standard mass closure group (401). At 1 year after surgery, 672 patients (83.7 per cent) were included in the primary outcome analysis; 50 of 339 patients (14.8 per cent) in the Hughes group and 57 of 333 (17.1 per cent) in the standard closure group had incisional hernia (OR 0.84, 95 per cent c.i. 0.55 to 1.27; P = 0.402). At 2 years, 78 patients (28.7 per cent) in the Hughes repair group and 84 (31.8 per cent) in the standard closure group had incisional hernia (OR 0.86, 0.59 to 1.25; P = 0.429). Adverse events were similar in the two groups, apart from the rate of surgical-site infection, which was higher in the Hughes group (13.2 versus 7.7 per cent; OR 1.82, 1.14 to 2.91; P = 0.011).ConclusionThe incidence of incisional hernia after colorectal cancer surgery is high. There was no statistical difference in incidence between Hughes closure and mass closure at 1 or 2 years.Registration numberISRCTN25616490 (http://www.controlled-trials.com)

Hughes abdominal closure versus standard mass closure to reduce incisional hernias following surgery for colorectal cancer: the HART RCT

BackgroundIncisional hernias can cause chronic pain and complications and affect quality of life. Surgical repair requires health-care resources and has a significant associated failure rate. A prospective, multicentre, single-blinded randomised controlled trial was conducted to investigate the clinical effectiveness and cost-effectiveness of the Hughes abdominal closure method compared with standard mass closure following surgery for colorectal cancer. The study randomised, in a 1 : 1 ratio, 802 adult patients (aged ≥ 18 years) undergoing surgical resection for colorectal cancer from 28 surgical departments in UK centres.InterventionHughes abdominal closure or standard mass closure.Main outcome measuresThe primary outcome was the incidence of incisional hernias at 1 year, as assessed by clinical examination. Within-trial cost-effectiveness and cost–utility analyses over 1 year were conducted from an NHS and a social care perspective. A key secondary outcome was quality of life, and other outcomes included the incidence of incisional hernias as detected by computed tomography scanning.ResultsThe incidence of incisional hernia at 1-year clinical examination was 50 (14.8%) in the Hughes abdominal closure arm compared with 57 (17.1%) in the standard mass closure arm (odds ratio 0.84, 95% confidence interval 0.55 to 1.27; p = 0.4). In year 2, the incidence of incisional hernia was 78 (28.7%) in the Hughes abdominal closure arm compared with 84 (31.8%) in the standard mass closure arm (odds ratio 0.86, 95% confidence interval 0.59 to 1.25; p = 0.43). Computed tomography scanning identified a total of 301 incisional hernias across both arms, compared with 100 identified by clinical examination at the 1-year follow-up. Computed tomography scanning missed 16 incisional hernias that were picked up by clinical examination. Hughes abdominal closure was found to be less cost-effective than standard mass closure. The mean incremental cost for patients undergoing Hughes abdominal closure was £616.45 (95% confidence interval –£699.56 to £1932.47; p = 0.3580). Quality of life did not differ significantly between the study arms at any time point.LimitationsAs this was a pragmatic trial, the control arm allowed surgeon discretion in the approach to standard mass closure, introducing variability in the techniques and equipment used. Intraoperative randomisation may result in a loss of equipoise for some surgeons. Follow-up was limited to 2 years, which may not have been enough time to see a difference in the primary outcome.ConclusionsHughes abdominal closure did not significantly reduce the incidence of incisional hernias detected by clinical examination and was less cost-effective at 1 year than standard mass closure in colorectal cancer patients. Computed tomography scanning may be more effective at identifying incisional hernias than clinical examination, but the clinical benefit of this needs further research.Future workAn extended follow-up using routinely collected NHS data sets aims to report on incisional hernia rates at 2–5 years post surgery to investigate any potential mortality benefit of the closure methods. Furthermore, the proportion of incisional hernias identified by a computed tomography scan (at 1 and 2 years post surgery), but not during clinical examination (occult hernias), proceeding to surgical repair within 3–5 years after the initial operation will be explored.Trial registrationThis trial is registered as ISRCTN25616490

The development of a collaborative framework for commissioning health and social care

Background: Integrating health and social care is a national priority. This paper presents an evaluation of an approach for collaborative commissioning designed to improve quality and experience and reduce cost within integrated health and social care. The approach, termed CAREMORE®, provides an acronym for the seven components considered essential for effective planning and commissioning of services. Methods: We used a multi-method approach using qualitative interviews, documentary analysis and non-participant observation. The data gathered are explored using thematic analysis, combining deductive and inductive analysis methods. Findings: Our study provides evidence that CAREMORE® has the means to effectively facilitate a collaborative approach to developing services through its requirement for key stakeholders with relevant knowledge to come together in the co-production of a legally binding Framework Agreement for the commissioning health and social care services. Beyond offering an assessment of the relative success or otherwise of CAREMORE, we also draw out general lessons relevant to the wider implementation of this commissioning method within NHS Wales. Conclusions: This research presents an innovative method for collaborative commissioning and reveals activities that appear to contribute to more effective commissioning processes. The findings suggest that CAREMORE® provides a suitable framework for the collaborative commissioning of integrated health and social care, and that further research is now needed to provide a definitive evaluation of its’ value outside of Wales

Atmospheric deposition at groundwater dependent wetlands phase 2 : nutrient source apportionment case studies from England and Wales

Groundwater dependent terrestrial ecosystems (GWDTEs) face multiple pressures from both atmospheric and terrestrial sources, resulting in the loss of protected habitats and biodiversity. One of the most critical issues facing GWDTEs in England and Wales is anthropogenic pollution from nutrients. Anthropogenic nutrients can originate from a wide range of sources including industry and agriculture, and can be transmitted via multiple pathways including; surface waters, catchment runoff, groundwater, and atmospheric deposition. These multiple pathways pose a problem for environmental regulators and managers. In order to reduce nutrient damage to wetlands, environmental regulators must first have the tools to identify the dominant sources and pathways (source attribution) of nutrients. Environmental regulators need cost effective tools to identify the most common source of nutrients in order to implement effective measures to reduce pressures. However there are a lack of source apportionment studies for GWDTEs, and no framework by which to assess multiple sources of nitrogen. This report aims to bridge that gap by considering both atmospheric and terrestrial sources of nitrogen in one study. Three GWDTEs were studied all characterised during previous Water Framework Directive investigations; Wybunbury Moss, Newbald Becksies and Cors Bodeilio. Each site benefited from existing monitoring data and an evidenced based conceptual model, significantly reducing costs to this project. Field data collection included; inorganic chemistry of groundwater, surface water and rainfall, nitrogen and oxygen isotopes and CFC /SF6 and NH3 /NO2 diffusion tubes deployed to quantify atmospheric dry gaseous deposition. Desk based analysis included; modeled atmospheric source apportionment from www.APIS.ac.uk, catchment nutrient modelling using the ‘Farmscoper’ tool and calculation and comparison of nutrient fluxes against site relevant critical loads from both modeled and measured atmospheric deposition data. We found that; Modelled atmospheric deposition data (www.APIS.ac.uk) was broadly comparable to our monthly on-site data collected at the three GWDTEs, but individual sites showed differing variability in ammonia concentrations compared with the national data. Modeled data provides a reliable way to quickly assess atmospheric loading at GWDTEs for national scale assessments, however site specific assessments should undertake their own measurements of ammonia concentrations. Detailed on site assessments of the pressure from atmospheric deposition to individual habitats are possible using National Vegetation Classification (NVC) mapping combined with Critical Load thresholds and modelled atmospheric deposition. Together these can provide a high resolution picture at site scale, provided vegetation mapping is available Open access modelling tool FarmScoper (ADAS) was successfully applied, however in both examples the modelling shows that even with land use changes the reduction in terrestrial nitrate would not be significant enough to meet the proposed groundwater ‘threshold’ values for nitrate

Labeling of mesenchymal stem cells for MRI with single-cell sensitivity

Sensitive cell detection by magnetic resonance imaging (MRI) is an important tool for the development of cell therapies. However, clinically approved contrast agents that allow single-cell detection are currently not available. Therefore, we compared very small iron oxide nanoparticles (VSOP) and new multicore carboxymethyl dextran-coated iron oxide nanoparticles (multicore particles, MCP) designed by our department for magnetic particle imaging (MPI) with discontinued Resovist® regarding their suitability for detection of single mesenchymal stem cells (MSC) by MRI. We achieved an average intracellular nanoparticle (NP) load of .10 pg Fe per cell without the use of transfection agents. NP loading did not lead to significantly different results in proliferation, colony formation, and multilineage in vitro differentiation assays in comparison to controls. MRI allowed single-cell detection using VSOP, MCP, and Resovist® in conjunction with high-resolution T2*-weighted imaging at 7 T with postprocessing of phase images in agarose cell phantoms and in vivo after delivery of 2,000 NP-labeled MSC into mouse brains via the left carotid artery. With optimized labeling conditions, a detection rate of ~45% was achieved; however, the experiments were limited by nonhomogeneous NP loading of the MSC population. Attempts should be made to achieve better cell separation for homogeneous NP loading and to thus improve NP-uptake-dependent biocompatibility studies and cell detection by MRI and future MPI. Additionally, using a 7 T MR imager equipped with a cryocoil resulted in approximately two times higher detection. In conclusion, we established labeling conditions for new high-relaxivity MCP, VSOP, and Resovist® for improved MRI of MSC with single-cell sensitivity