Bars, Chains, and Broken Things

Bars, Chains, and Broken Things is a four-movement work for orchestra with a distinct social narrative: the American prison system. During my time working as a volunteer with the Pendleton Juvenile Correctional Facility, I came to know several young men and their stories. This piece serves as a loosely programmatic work chronicling the four most significant concepts which resonated with me. The individual movements are named and seek to musically represent these ideas: “Abandonment” - a common feeling among the incarcerated, “Imprisonment” - the effects and words of those feeling isolated, “Solace” - a state of calm acceptance, and “False Freedom” - a refutation of the belief that release from the prison system signifies the end of society’s punishment. It is my hope that this work serves as a musical contribution to awareness of the current issues faced in the American prison system

Most-favored-nation clauses in commercial contracts: legal and economic analysis and proposal for a guideline

The prevalent use of “most favored nation” (MFN) clauses in commercial agreements has garnered significant attention in the economics and legal literature and by practitioners and enforcement agencies. From an antitrust standpoint, there is a strong consensus that while MFN provisions can lead to procompetitive outcomes or at least play a competitively neutral role, they may also result in competitive harm and a loss of consumer welfare. Therefore, US and EU enforcement agencies and courts have held that MFNs should be reviewed on a case-by-case basis, considering the specific characteristics of both the contractual provision and the industry. While a case-by-case approach is valid, it is not ideal from a variety of standpoints: that of the competition authorities seeking to make best use of their limited resources and that of practitioners seeking to advise their clients. Accordingly, published guidelines on the use of MFNs, containing presumptions and safe harbors, would be both efficient and useful. The paper argues that it would increase the efficiency and accuracy of antitrust enforcement if one of the leading competition authorities issued MFN guidelines. The paper suggests a set of presumptions and safe harbors that should be included in any such guidelines. © 2015, The Author(s)

Utility of the FebriDx point-of-care assay in supporting a triage algorithm for medical admissions with possible COVID-19: an observational cohort study

Objective: To evaluate a triage algorithm used to identify and isolate patients with suspected COVID-19 among medical patients needing admission to hospital using simple clinical criteria and the FebriDx assay. Design:: Retrospective observational cohort. Setting Large acute National Health Service hospital in London, UK. Participants: All medical admissions from the emergency department between 10 August 2020 and 4 November 2020 with a valid SARS-CoV-2 RT-PCR result. Interventions: Medical admissions were triaged as likely, possible or unlikely COVID-19 based on clinical criteria. Patients triaged as possible COVID-19 underwent FebriDx lateral flow assay on capillary blood, and those positive for myxovirus resistance protein A (a host response protein) were managed as likely COVID-19. Primary outcome measures: Diagnostic accuracy (sensitivity, specificity and predictive values) of the algorithm and the FebriDx assay using SARS-CoV-2 RT-PCR from nasopharyngeal swabs as the reference standard. Results: 4.0% (136) of 3443 medical admissions had RT-PCR confirmed COVID-19. Prevalence of COVID-19 was 46% (80/175) in those triaged as likely, 4.1% (50/1225) in possible and 0.3% (6/2033) in unlikely COVID-19. Using a SARS-CoV-2 RT-PCR reference standard, clinical triage had sensitivity of 96% (95% CI 91% to 98%) and specificity of 61.5% (95% CI 59.8% to 63.1%), while the triage algorithm including FebriDx had sensitivity of 93% (95% CI 87% to 96%) and specificity of 86.4% (95% CI 85.2% to 87.5%). While 2033 patients were deemed not to require isolation using clinical criteria alone, the addition of FebriDx to clinical triage allowed a further 826 patients to be released from isolation, reducing the need for isolation rooms by 9.5 per day, 95% CI 8.9 to 10.2. Ten patients missed by the algorithm had mild or asymptomatic COVID-19. Conclusions: A triage algorithm including the FebriDx assay had good sensitivity and was useful to ‘rule-out’ COVID-19 among medical admissions to hospital

False-negative RT-PCR for COVID-19 and a diagnostic risk score: a retrospective cohort study among patients admitted to hospital

OBJECTIVE: To describe the characteristics and outcomes of patients with a clinical diagnosis of COVID-19 and false-negative SARS-CoV-2 reverse transcription-PCR (RT-PCR), and develop and internally validate a diagnostic risk score to predict risk of COVID-19 (including RT-PCR-negative COVID-19) among medical admissions. DESIGN: Retrospective cohort study. SETTING: Two hospitals within an acute NHS Trust in London, UK. PARTICIPANTS: All patients admitted to medical wards between 2 March and 3 May 2020. OUTCOMES: Main outcomes were diagnosis of COVID-19, SARS-CoV-2 RT-PCR results, sensitivity of SARS-CoV-2 RT-PCR and mortality during hospital admission. For the diagnostic risk score, we report discrimination, calibration and diagnostic accuracy of the model and simplified risk score and internal validation. RESULTS: 4008 patients were admitted between 2 March and 3 May 2020. 1792 patients (44.8%) were diagnosed with COVID-19, of whom 1391 were SARS-CoV-2 RT-PCR positive and 283 had only negative RT-PCRs. Compared with a clinical reference standard, sensitivity of RT-PCR in hospital patients was 83.1% (95% CI 81.2%-84.8%). Broadly, patients with false-negative RT-PCR COVID-19 and those confirmed by positive PCR had similar demographic and clinical characteristics but lower risk of intensive care unit admission and lower in-hospital mortality (adjusted OR 0.41, 95% CI 0.27-0.61). A simple diagnostic risk score comprising of age, sex, ethnicity, cough, fever or shortness of breath, National Early Warning Score 2, C reactive protein and chest radiograph appearance had moderate discrimination (area under the receiver-operator curve 0.83, 95% CI 0.82 to 0.85), good calibration and was internally validated. CONCLUSION: RT-PCR-negative COVID-19 is common and is associated with lower mortality despite similar presentation. Diagnostic risk scores could potentially help triage patients requiring admission but need external validation

The Direct and Indirect Influences of Parenting: The Facets of Time-Perspective and Impaired Control along the Alcohol-Related Problems Pathway

Background: Social Learning Theory suggests how one conceptualizes time will be passed from parent to child (Bandura & Walters, 1963). Through the lens of Behavioral Economics Theory (Vuchinich & Simpson, 1998), impaired control may be characterized as consuming alcohol as a form of immediate gratification as a choice over more distal rewards. Because impaired control reflects a self-regulation failure specific to the drinking situation, it may be directly related to time-perspectives. Objectives: This investigation explored whether or not the indirect influences of perceived parenting styles on alcohol use and related problems is mediated by both facets of time-perspective (e.g. hedonism, present-fatalism, future, past-positive, past-negative) and impaired control over drinking. Methods: We examined a structural equation model with 391 (207 women; 184 men) college student drinkers. We used an asymmetric bias-corrected bootstrap technique to conduct mediational analyses (MacKinnon, 2008). Results: Higher levels of past-positive time-perspective were indirectly linked to both less alcohol use and fewer alcohol-related problems through less impaired control. In contrast, higher levels of present-fatalism were indirectly linked to more alcohol use through more impaired control. Higher levels of father permissiveness and mother authoritarianism were indirectly linked to both more impaired control and alcohol use through more present-fatalism. In addition, higher levels of father authoritarianism were indirectly linked to more alcohol use through more hedonism. Conclusions/Implications: Our results support the notion that drinking beyond one’s self-prescribed limits is associated with time-perspectives related to negative aspects of the parent-offspring socialization process, such as fatalism

(Mis)understanding trauma informed approaches in mental health

The Journal of Mental Health has a history of publishing articles that explore the ways traumatic experiences lead to mental distress, and the experiences of trauma survivors (Cooke, 2016; Harper, Stalker, Palmer, & Gadbois, 2008; Karatzias, Ferguson, Gullone, & Cosgrove, 2016; Kucharska, 2017; Mueser & Rosenberg, 2003; Salter & Richters 2012; Xie, Jiuping, & Zhibin, 2017). These articles join other evi- dence demonstrating that large numbers of people in con- tact with mental health services have experienced traumatic events (Khalifeh et al., 2015), that these experiences are causal in the development of mental distress (Felitti et al., 1998; Morrison, Frame, & Larkin, 2003) and that there is a relationship between the severity, frequency and range of adverse experiences, and the subsequent impact on mental health (Dillon, Johnstone, & Longden, 2012). For instance, there is evidence of a strong link between childhood trauma and adulthood psychosis (Varese et al., 2012), and intimate partner violence and depression (Devries et al., 2013). It is also argued that social factors such as poverty and racism can be considered forms of trauma and that traumatic expe- riences are more common within ethnic minority and socially disadvantaged groups (Hatch & Dohrenwend, 2007; Paradies, 2006). This, coupled with evidence of iatrogenic harm in psychiatric services, has led to the development of trauma-informed approaches. Despite growing international interest, trauma-informed approaches can seem fuzzy, complex, something that service providers already do, or a theorised call for practitioners to “be nicer.” However, writing as trauma survivors and aca- demics/clinician, the more we learn about trauma-informed approaches, the more we argue that these approaches have the potential to lead to a fundamental shift in how mental health services are organised and delivered, meaning that they are better able to meet the needs of service users. In this editorial, we will explore the central drivers for trauma- informed approaches, outline the key principles of the approach, discuss some common misconceptions and high- light some of the dangers associated with trauma-informed practices. We conclude by arguing for the need for survivor organisations to have a key role in shaping the agenda

Semantics in active surveillance for men with localized prostate cancer - results of a modified Delphi consensus procedure

Active surveillance (AS) is broadly described as a management option for men with low-risk prostate cancer, but semantic heterogeneity exists in both the literature and in guidelines. To address this issue, a panel of leading prostate cancer specialists in the field of AS participated in a consensus-forming project using a modified Delphi method to reach international consensus on definitions of terms related to this management option. An iterative three-round sequence of online questionnaires designed to address 61 individual items was completed by each panel member. Consensus was considered to be reached if >= 70% of the experts agreed on a definition. To facilitate a common understanding among all experts involved and resolve potential ambiguities, a face-to-face consensus meeting was held between Delphi survey rounds two and three. Convenience sampling was used to construct the panel of experts. In total, 12 experts from Australia, France, Finland, Italy, the Netherlands, Japan, the UK, Canada and the USA participated. By the end of the Delphi process, formal consensus was achieved for 100% (n = 61) of the terms and a glossary was then developed. Agreement between international experts has been reached on relevant terms and subsequent definitions regarding AS for patients with localized prostate cancer. This standard terminology could support multidisciplinary communication, reduce the extent of variations in clinical practice and optimize clinical decision making.Peer reviewe

Reasons for Discontinuing Active Surveillance : Assessment of 21 Centres in 12 Countries in the Movember GAP3 Consortium

Background: Careful assessment of the reasons for discontinuation of active surveillance (AS) is required for men with prostate cancer (PCa). Objective: Using Movember's Global Action Plan Prostate Cancer Active Surveillance initiative (GAP3) database, we report on reasons for AS discontinuation. Design, setting, and participants: We compared data from 10 296 men on AS from 21 centres across 12 countries. Outcome measurements and statistical analysis: Cumulative incidence methods were used to estimate the cumulative incidence rates of AS discontinuation. Results and limitations: During 5-yr follow-up, 27.5% (95% confidence interval [CI]: 26.4-28.6%) men showed signs of disease progression, 12.8% (95% CI: 12.0-13.6%) converted to active treatment without evidence of progression, 1.7% (95% CI: 1.5-2.0%) continued to watchful waiting, and 1.7% (95% CI: 1.4-2.1%) died from other causes. Of the 7049 men who remained on AS, 2339 had follow-up for >5 yr, 4561 had follow-up for Conclusions: Our descriptive analyses of current AS practices worldwide showed that 43.6% of men drop out of AS during 5-yr follow-up, mainly due to signs of disease progression. Improvements in selection tools for AS are thus needed to correctly allocate men with PCa to AS, which will also reduce discontinuation due to conversion to active treatment without evidence of disease progression. Patient summary: Our assessment of a worldwide database of men with prostate cancer (PCa) on active surveillance (AS) shows that 43.6% drop out of AS within 5 yr, mainly due to signs of disease progression. Better tools are needed to select and monitor men with PCa as part of AS. (C) 2018 European Association of Urology. Published by Elsevier B.V. All rights reserved.Peer reviewe