Predictors of Drug Court Client Graduation

Background: Substance use disorder in the United States adversely effects society by burdening the justice system with offender incarceration for drug-related crimes, it also strains in the healthcare system with costs in excess of $216 billion dollars for treatment of drug-related mental and physical illnesses. Many offenders of nonviolent crimes with substance use disorder have been diverted to Drug Court (DC) for year-long supervised community-based drug addiction treatment as an alternative to incarceration for non-violent drug-related crimes. Drug Court program outcomes, however, have been studied as a criminal justice intervention, rather than a primary care mental health intervention. The majority of DC program evaluation has focused on admission data and outcomes using univariate and bivariate analyses, rather than longitudinal data using multivariate analyses to identify multivariate predictors of DC graduation. Objective: The purpose of this study is to: (a) describe the Sample Severity for DC clients; (b) discuss the differences between Drug Court graduates and dropouts for Sample Severity, Drug Court Practices, and In-Program Behavior; and (c) develop a prediction model for Drug Court graduation. Methods: This is a descriptive longitudinal design using secondary data analysis of existing DC Shelby County DC data. Data were analyzed from January 1, 2009 through March 17, 2011 for clients admitted to Shelby County DC, and either graduated or dropped out of DC. The MultiSite Adult Drug Court Evaluation (MADCE) Model guided the data selected at three points in time: (a) admission to the DC program (Sample Severity data); (b) during the DC program (DC Practices and In-Program Behavior data); and (c) end of DC program (graduation or dropout data). Results: The sample consisted of 310 Shelby County DC clients, predominately male (80.0%), and African American (60.3%) with a mean age of 29.9 years. Most DC clients had a high school diploma or GED (54.5%) or no high school diploma or GED (41.9%). Thirty-four percent were employed at DC admission and worked an average of 10.4 hours per week. Marijuana (56.1%) and alcohol (15.5%) were the top two primary drugs of choice. To compare differences between DC graduates and dropouts, data were analyzed using t-tests or Chi-squared, as appropriate. There were (48.1%) graduates and fewer male graduates (Χ² = 4.19, p = .041), and fewer African American graduates (Χ² = 4.26, p = .039). There were more graduates who had a high school diploma/GED or a college degree than dropouts (Χ² = 5.21, p = .022), and more DC graduates were employed at DC admission (Χ² = 23.09, p = .001). Of the seven primary drugs of choice, there was only one significant difference with more graduates listing alcohol as their primary drug of choice than dropouts (Χ² = 14.05, p = .002). Of the six DC programs, there were significant differences for four programs. There were fewer graduates who participated in the Outpatient program (Χ² = 4.04, p = .039) and Residential program (Χ² = 8.00, p = .004), more graduates in the Outpatient DUI program (Χ² = 27.5, p = .001), and no graduates in the Early Assessment Intervention Treatment program (Χ² = 5.66, p = 017). Graduates spent more days in DC programs (t-test = 15.17, p = .001), and participated in fewer DC programs (t-test = 2.17, p = .031). Of the ten treatment agencies, there were significant differences for only on agency that had no graduates (Χ² = 4.70, p = .030). Of the 27 candidate predictor variables, there were six significant predictors. Having more diluted urine drug screens (OR = 5.081, p = .002) and greater number of days in the DC programs (OR = 1.019, p = .001) were positive predictors of graduation. Male gender (OR = 0.373, p = 0.47), no high school diploma/GED (OR = 0.214, p = .004), rearrests (OR = 0373, p = .002), and number of jail sentencing sanctions (OR = 0.439, p = .001) were negative predictors of graduation. The Hosmer and Lemeshow Goodness of Fit statistic (Χ² = 11.3724, df = 8, p = .182) documented that the model predicts the data well. The c statistic (0.949) documented highly acceptable predictive ability of the model with 94.9% of all possible pairs of graduates and dropouts predicted correctly. Discussion: The final prediction model suggests that males with no high school education diploma or GED, greater rearrests, and more jail sentencing sanctions are at-risk for not graduating from the Shelby County DC. Education is the only modifiable factor for DC graduation which has implications for DC practice changes and future health literacy research with the DC client population. Drug Court practice changes include: (a) evaluate client literacy and health literacy after drug detoxification; (b) develop and evaluate low literacy DC materials and programs; (c) integrate and require adult reading and GED classes; (d) evaluate need for and design and evaluate programs for men; (e) evaluate and refine exiting programs for women. Future research will: (a) validate the prediction model using cross-validation statistics; (b) develop separate prediction models for men and women; (c) develop a unified data base with continuous variables and MADCE Model variables for DC program reports and evaluation; and (d) use the MADCE Model and Social-Ecological Model to examine Offender Perceptions and Post-Program Outcomes in clients

Health and Safety Effects of Airborne Soil Dust in the Americas and Beyond

The risks associated with airborne soil particles (dust) are often underappreciated, and the gap between the knowledge pool and public awareness can be costly for society. This study reviews the emission, chemical, physical, and biological characteristics of dust and its effects on human and environmental health and safety in the Americas. American dust originates from both local sources and long-range transport from Africa and Asia. Dust properties, trends and interactions with criteria air pollutants are summarized. Human exposure to dust has been associated with adverse health effects, including asthma, fungal infections, and premature death. One of the most striking effects of dust is Coccidioidomycosis(Valley fever), an infection caused by inhaling soil-dwelling fungi unique to this region. Dust affects environmental health through providing nutrients to phytoplankton, contaminating water supply and food, spreading crop and marine pathogens, infecting domestic and wild animals, transporting heavy metals and radionuclides, and reducing solar power generation. Dust is also a well-documented safety hazard to road transportation, aviation, and marine navigation, in particular in the southwestern United States where blowingdust is one of the deadliest weather hazards. To mitigate these harmful effects,coordinated regional and international efforts are needed to enhance dust observations and prediction capabilities (especially in South America), implement soil conservation measures, design specific dust mitigation projects for trans-portation, and conduct surveillance for Valley fever and other diseases. While focusing on the Americas, many of the dust effects found in this region also exist in other parts of the world

How fast is fast enough? Academic behavioural science impacting public health policy and practice

Background: COVID-19 emphasised the crucial role behaviour change plays in protecting population health. However, the interchange between academic behavioural science and Public Health (PH) policy and practice could be strengthened. We aimed to establish a sustainable method of joint working between two groups in North Scotland to enable rapid impact of behavioural science on population health.Methods: An implementation-sciences based approach tested the initial 4 steps of an 8-step collaboration process model, designed to identify a health problem (step 1), develop and test messaging interventions (step 2-4), implement the intervention (steps 5-6), and evaluate impact (steps 7-8).Results: Since October 2022, fortnightly meetings were established, implementing the process model. This project will focus on the following outcomes: perceived collaboration usefulness, collaboration-process barriers, and facilitators.Conclusions: Unless a sustainable method of joint working can be established in times where there are no urgent PH priorities, it is unlikely that the fruits of behavioural science can be aligned with PH challenges when outbreaks are happening to rapidly impact population health.<br/

How fast is fast enough? Academic behavioural science impacting public health policy and practice

Background: COVID-19 emphasised the crucial role behaviour change plays in protecting population health. However, the interchange between academic behavioural science and Public Health (PH) policy and practice could be strengthened. We aimed to establish a sustainable method of joint working between two groups in North Scotland to enable rapid impact of behavioural science on population health.Methods: An implementation-sciences based approach tested the initial 4 steps of an 8-step collaboration process model, designed to identify a health problem (step 1), develop and test messaging interventions (step 2-4), implement the intervention (steps 5-6), and evaluate impact (steps 7-8).Results: Since October 2022, fortnightly meetings were established, implementing the process model. This project will focus on the following outcomes: perceived collaboration usefulness, collaboration-process barriers, and facilitators.Conclusions: Unless a sustainable method of joint working can be established in times where there are no urgent PH priorities, it is unlikely that the fruits of behavioural science can be aligned with PH challenges when outbreaks are happening to rapidly impact population health.<br/

Environmentally-acquired bacteria influence microbial diversity and natural innate immune responses at gut surfaces

Background: Early microbial colonization of the gut reduces the incidence of infectious, inflammatory and autoimmune diseases. Recent population studies reveal that childhood hygiene is a significant risk factor for development of inflammatory bowel disease, thereby reinforcing the hygiene hypothesis and the potential importance of microbial colonization during early life. The extent to which early-life environment impacts on microbial diversity of the adult gut and subsequent immune processes has not been comprehensively investigated thus far. We addressed this important question using the pig as a model to evaluate the impact of early-life environment on microbe/host gut interactions during development. Results: Genetically-related piglets were housed in either indoor or outdoor environments or in experimental isolators. Analysis of over 3,000 16S rRNA sequences revealed major differences in mucosa-adherent microbial diversity in the ileum of adult pigs attributable to differences in early-life environment. Pigs housed in a natural outdoor environment showed a dominance of Firmicutes, in particular Lactobacillus, whereas animals housed in a hygienic indoor environment had reduced Lactobacillus and higher numbers of potentially pathogenic phylotypes. Our analysis revealed a strong negative correlation between the abundance of Firmicutes and pathogenic bacterial populations in the gut. These differences were exaggerated in animals housed in experimental isolators. Affymetrix microarray technology and Real-time Polymerase Chain Reaction revealed significant gut-specific gene responses also related to early-life environment. Significantly, indoor-housed pigs displayed increased expression of Type 1 interferon genes, Major Histocompatibility Complex class I and several chemokines. Gene Ontology and pathway analysis further confirmed these results. Conclusion: Early-life environment significantly affects both microbial composition of the adult gut and mucosal innate immune function. We observed that a microbiota dominated by lactobacilli may function to maintain mucosal immune homeostasis and limit pathogen colonization

Assistants, Guides, Collaborators, Friends: The Concealed Figures of Conflict Research

Recent scholarship has demonstrated an increasing awareness of the need for more grounded, empirical research into the micro-level dynamics of violent contexts. Research in these difficult, dangerous, and potentially violent conflict or post-conflict settings necessitates the formation of new relationships of dependency, and assistants, friends, collaborators, and guides become central figures in the field. However, all too often, these figures are written out of academic accounts and silenced in our analyses. This not only does them a significant disservice, but it also obscures potential biases, complexities, and ethical dilemmas that emerge in the way in which such research is carried out. Drawing upon fieldwork exploring the 2007–2008 Kenyan postelection violence, this paper argues that reliance upon insider-assistants is essential in conflict settings and explores the challenges inherent in these relationships. As researchers become increasingly engaged in micro-level studies of violent contexts, we must interrogate the realities of how our knowledge has been produced and engage in more open and honest discussions of the methodological and ethical challenges of conflict research

Ampullary cancers harbor ELF3 tumor suppressor gene mutations and exhibit frequent WNT dysregulation

The ampulla of Vater is a complex cellular environment from which adenocarcinomas arise to form a group of histopathologically heterogenous tumors. To evaluate the molecular features of these tumors, 98 ampullary adenocarcinomas were evaluated and compared to 44 distal bile duct and 18 duodenal adenocarcinomas. Genomic analyses revealed mutations in the WNT signaling pathway among half of the patients and in all three adenocarcinomas irrespective of their origin and histological morphology. These tumors were characterized by a high frequency of inactivating mutations of ELF3, a high rate of microsatellite instability, and common focal deletions and amplifications, suggesting common attributes in the molecular pathogenesis are at play in these tumors. The high frequency of WNT pathway activating mutation, coupled with small-molecule inhibitors of β-catenin in clinical trials, suggests future treatment decisions for these patients may be guided by genomic analysis

Building social capital through breastfeeding peer support: Insights from an evaluation of a voluntary breastfeeding peer support service in North-West England

Background: Peer support is reported to be a key method to help build social capital in communities. To date there are no studies that describe how this can be achieved through a breastfeeding peer support service. In this paper we present findings from an evaluation of a voluntary model of breastfeeding peer support in North-West England to describe how the service was operationalized and embedded into the community. This study was undertaken from May, 2012 to May, 2013. Methods: Interviews (group or individual) were held with 87 participants: 24 breastfeeding women, 13 peer supporters and 50 health and community professionals. The data contained within 23 monthly monitoring reports (January, 2011 to February 2013) compiled by the voluntary peer support service were also extracted and analysed. Results: Thematic analysis was undertaken using social capital concepts as a theoretical lens. Key findings were identified to resonate with ’bonding’, ‘bridging’ and ‘linking’ forms of social capital. These insights illuminate how the peer support service facilitates ‘bonds’ with its members, and within and between women who access the service; how the service ‘bridges’ with individuals from different interests and backgrounds, and how ‘links’ were forged with those in authority to gain access and reach to women and to promote a breastfeeding culture. Some of the tensions highlighted within the social capital literature were also identified. Conclusions: Horizontal and vertical relationships forged between the peer support service and community members enabled peer support to be embedded into care pathways, helped to promote positive attitudes to breastfeeding and to disseminate knowledge and maximise reach for breastfeeding support across the community. Further effort to engage with those of different ethnic backgrounds and to resolve tensions between peer supporters and health professionals is warranted

Association of Alcohol-Induced Loss of Consciousness and Overall Alcohol Consumption With Risk for Dementia

This cohort study examines the association of overall consumption of alcohol and resultant loss of consciousness with risk for dementia. Question Are alcohol-induced loss of consciousness and heavy weekly alcohol consumption associated with increased risk of future dementia? Findings In this multicohort study of 131x202f;415 adults, a 1.2-fold excess risk of dementia was associated with heavy vs moderate alcohol consumption. Those who reported having lost consciousness due to alcohol consumption, regardless of their overall weekly consumption, had a 2-fold increased risk of dementia compared with people who had not lost consciousness and were moderate drinkers. Meaning The findings of this study suggest that alcohol-induced loss of consciousness is a long-term risk factor for dementia among both heavy and moderate drinkers. Importance Evidence on alcohol consumption as a risk factor for dementia usually relates to overall consumption. The role of alcohol-induced loss of consciousness is uncertain. Objective To examine the risk of future dementia associated with overall alcohol consumption and alcohol-induced loss of consciousness in a population of current drinkers. Design, Setting, and Participants Seven cohort studies from the UK, France, Sweden, and Finland (IPD-Work consortium) including 131x202f;415 participants were examined. At baseline (1986-2012), participants were aged 18 to 77 years, reported alcohol consumption, and were free of diagnosed dementia. Dementia was examined during a mean follow-up of 14.4 years (range, 12.3-30.1). Data analysis was conducted from November 17, 2019, to May 23, 2020. Exposures Self-reported overall consumption and loss of consciousness due to alcohol consumption were assessed at baseline. Two thresholds were used to define heavy overall consumption: greater than 14 units (U) (UK definition) and greater than 21 U (US definition) per week. Main Outcomes and Measures Dementia and alcohol-related disorders to 2016 were ascertained from linked electronic health records. Results Of the 131x202f;415 participants (mean [SD] age, 43.0 [10.4] years; 80x202f;344 [61.1%] women), 1081 individuals (0.8%) developed dementia. After adjustment for potential confounders, the hazard ratio (HR) was 1.16 (95% CI, 0.98-1.37) for consuming greater than 14 vs 1 to 14 U of alcohol per week and 1.22 (95% CI, 1.01-1.48) for greater than 21 vs 1 to 21 U/wk. Of the 96x202f;591 participants with data on loss of consciousness, 10x202f;004 individuals (10.4%) reported having lost consciousness due to alcohol consumption in the past 12 months. The association between loss of consciousness and dementia was observed in men (HR, 2.86; 95% CI, 1.77-4.63) and women (HR, 2.09; 95% CI, 1.34-3.25) during the first 10 years of follow-up (HR, 2.72; 95% CI, 1.78-4.15), after excluding the first 10 years of follow-up (HR, 1.86; 95% CI, 1.16-2.99), and for early-onset (= 65 y: HR, 2.25; 95% CI, 1.38-3.66) dementia, Alzheimer disease (HR, 1.98; 95% CI, 1.28-3.07), and dementia with features of atherosclerotic cardiovascular disease (HR, 4.18; 95% CI, 1.86-9.37). The association with dementia was not explained by 14 other alcohol-related conditions. With moderate drinkers (1-14 U/wk) who had not lost consciousness as the reference group, the HR for dementia was twice as high in participants who reported having lost consciousness, whether their mean weekly consumption was moderate (HR, 2.19; 95% CI, 1.42-3.37) or heavy (HR, 2.36; 95% CI, 1.57-3.54). Conclusions and Relevance The findings of this study suggest that alcohol-induced loss of consciousness, irrespective of overall alcohol consumption, is associated with a subsequent increase in the risk of dementia.Peer reviewe

CpG-free plasmids confer reduced inflammation and sustained pulmonary gene expression.

Pulmonary delivery of plasmid DNA (pDNA)/cationic liposome complexes is associated with an acute unmethylated CG dinucleotide (CpG)-mediated inflammatory response and brief duration of transgene expression. We demonstrate that retention of even a single CpG in pDNA is sufficient to elicit an inflammatory response, whereas CpG-free pDNA vectors do not. Using a CpG-free pDNA expression vector, we achieved sustained (≥56 d) in vivo transgene expression in the absence of lung inflammation