The engagement of young people in drug interventions in coercive contexts: findings from a cross-national European study

Background: The engagement of young people has been a neglected area in youth justice and drugs policy and practice. This paper explores the concept of ‘engagement’ in relation to drugs interventions in custodial and community settings in different European countries. Methods: Interviews were undertaken with young people (aged 14-25 years) in contact with the criminal justice system who use illegal drugs and with practitioners involved in the delivery of interventions for our target group in Denmark, Italy, Poland the UK. Results: The key techniques to engage young people were described in similar terms across the countries. These included forming relationships based on trust, honesty and empathy, setting goals collaboratively and employing practitioners with lived experience and understanding. The objectives and activities on offer are often constrained by the criminal justice contexts. Conclusions: Despite the differences between the countries in terms of criminal justice systems and the structure of drug interventions, there were remarkable similarities in the ways young people and practitioners described effective engagement. Strong emphasis on operational engagement to ensure positive relationships between young people and practitioners was important in the design and delivery of interventions. Practitioners working in criminal justice contexts need to have flexibility and autonomy to work creatively to find ways to engage, connect and inspire young people

The cost of treating relapsed indolent non-Hodgkin's lymphoma in an international setting: retrospective analysis of resource use

Background and Objectives. Few economic data exist on the treatment of indolent non-Hodgkin´s lymphoma (NHL) and there are none in the published literature concerning relapsed disease. This international analysis (Canada, Germany, Italy) was established to estimate the overall direct cost of treating patients with relapsed indolent NHL and determine the main cost components of treatment. Design and Methods. Telephone interviews were used to identify the most commonly used treatment regimens in each country. CHOP, CVP and fludarabine were chosen for economic analysis, which was based on retrospective data from 424 patients. Results. Overall treatment costs for a course of six cycles varied more than 5-fold, from EURO3,445 to 17,940 between regimens and countries. The treatment setting had a major impact on costs, with in-patient costs being up to three times greater than the equivalent out-patient values. Drug administration costs comprised 46-60% of the overall treatment costs in the in-patient setting. Adverse event management was the major cost component for out-patient CHOP and CVP therapy (52-75%), and a significant proportion (24-40%) of in-patient costs for these regimens. Drug acquisition accounted for less than half of treatment costs for most of the regimens analyzed. Interpretation and Conclusions. This study shows that not simply drug acquisition costs, but the costs of drug administration, particularly in the in-patient setting, and adverse event management are major contributors to the overall treatment costs for relapsed indolent NHL

Clinical and functional characterisation of a novel TNFRSF1A c.605T > A/V173D cleavage site mutation associated with tumour necrosis factor receptor-associated periodic fever syndrome (TRAPS), cardiovascular complications and excellent response to etanercept treatment.

Objectives: To study the clinical outcome, treatment response, T-cell subsets and functional consequences of a novel tumour necrosis factor (TNF) receptor type 1 (TNFRSF1A) mutation affecting the receptor cleavage site. Methods: Patients with symptoms suggestive of tumour necrosis factor receptor-associated periodic syndrome (TRAPS) and 22 healthy controls (HC) were screened for mutations in the TNFRSF1A gene. Soluble TNFRSF1A and inflammatory cytokines were measured by ELISAs. TNFRSF1A shedding was examined by stimulation of peripheral blood mononuclear cells (PBMCs) with phorbol 12-myristate 13-acetate followed by flow cytometric analysis (FACS). Apoptosis of PBMCs was studied by stimulation with TNFa in the presence of cycloheximide and annexin V staining. T cell phenotypes were monitored by FACS. Results: TNFRSF1A sequencing disclosed a novel V173D/ p.Val202Asp substitution encoded by exon 6 in one family, the c.194–14G.A splice variant in another and the R92Q/p.Arg121Gln substitution in two families. Cardiovascular complications (lethal heart attack and peripheral arterial thrombosis) developed in two V173D patients. Subsequent etanercept treatment of the V173D carriers was highly effective over an 18-month follow-up period. Serum TNFRSF1A levels did not differ between TRAPS patients and HC, while TNFRSF1A cleavage from monocytes was significantly reduced in V173D and R92Q patients. TNFa-induced apoptosis of PBMCs and T-cell senescence were comparable between V173D patients and HC. Conclusions: The TNFRSF1A V173D cleavage site mutation may be associated with an increased risk for cardiovascular complications and shows a strong response to etanercept. T-cell senescence does not seem to have a pathogenetic role in affected patients

Building cultures of participation: involving young people in contact with the criminal justice system in the development of drug interventions in the United Kingdom, Denmark, Italy and Poland

This paper explores the participation of young people in contact with criminal justice systems in the development of drugs interventions. Interviews were undertaken with 160 young people (aged 15-25) and 66 practitioners involved in the design, delivery and commissioning of drug interventions. We analyse the key challenges in involving young people in the development of interventions including structural, organisational and individual factors. We argue that these barriers can be overcome by fostering flexible models of participation and identifying the most meaningful and appropriate approaches for involving young people at different stages and in different initiatives which consider socio-cultural contexts

Effectiveness of edema management techniques for subacute hand edema: A systematic review

Study Design: Systematic review. Introduction: Prolonged hand edema can have detrimental effects on range of motion and function. There is no consensus on how best to manage traumatic subacute edema. This is the first systematic review which examines the clinical effectiveness of edema treatments on hand volume. Purpose of the Study: The purpose of this systematic review was to examine the evidence of effectiveness of treatments for sub-acute hand edema. Methods: A literature search of AMED, CINAHL, Embase, and OVID MEDLINE (from inception to August 2015) was undertaken. Studies were selected if they met the following inclusion criteria: randomized controlled or controlled trials in adults who have subacute swelling after a recent upper limb musculoskeletal trauma or cerebral vascular attack or after surgery. Two independent assessors rated study quality and risk of bias using the 24-point MacDermid Structured Effectiveness Quality Evaluation Scale (SEQES). Results: Ten studies met the inclusion criteria. Study quality ranged from 23 to 41 out of 48 points on the SEQES. A total of 16 edema interventions were evaluated across the studies. Due to heterogeneity of the patient characteristics, interventions, and outcomes assessed, it was not possible to pool the results from all studies. Therefore, a narrative best evidence synthesis was undertaken. There is low to moderate quality evidence with limited confidence in the effect estimate to support the use of manual edema mobilization methods in conjunction with standard therapy to reduce problematic hand edema. Conclusion: Manual edema mobilization techniques should be considered in conjunction with conventional therapies, in cases of excessive edema or when the edema has not responded to conventional treatment alone; however, manual edema mobilization is not advocated as a routine intervention

Isotope dilution gas chromatography/mass spectrometry for platinum determination in urine

AbstractThe therapeutic importance of platinum (Pt) compounds, the growing accessibility of gas chromatography/mass spectrometry (GC/MS) systems in clinical laboratories, and the lack of a mass spectrometric method for the determination of Pt in biological samples motivated us to develop an isotope dilution GC/MS assay for Pt. The method is based on the use of lithium bis(trifluoroethyl)dithiocarbamate, Li(FDEDTC), as a chelating agent and enriched 192Pt for isotope dilution. Conditions were optimized for the precise and accurate determination of isotope ratios of Pt by using a 10-m DB-1 fused silica capillary column and a reverse-geometry double-focusing mass spectrometer with selected ion monitoring. An overall precision of 1% was obtained by combining within-run precision and between-run precision at the 10-ng level. No appreciable memory effect was observed when samples with different isotope ratios were analyzed sequentially. The method was validated by the quantitation of Pt in National Institute of Standards and Technology freeze-dried urine sample SRM 2670. A concentration value of 125 ± 6 μg/L (n = 6) was obtained by using four different sets of isotope ratios in the molecular ion and supports the National Institute of Standards and Technology recommended value of 120 ± ? μg/L. Limits-of-quantitation, estimated at 3 μg/L, are made possible by the high sensitivity of the method and the low blank value for t

U-statistics of local sample moments under weak dependence

In this paper, we study the asymptotic distribution of some U-statistics whose entries are functions of empirical moments computed from non-overlapping consecutive blocks of an underlying weakly dependent process. The length of these blocks converges to infinity, and thus we consider U-statistics of triangular arrays. We establish asymptotic normality of such U-statistics. The results can be used to construct tests for changes of higher order moments

Editorial DEPP: drug experienced young people in contact with the criminal justice system. Understanding the challenges and working towards solutions

The focus of this collection of papers is on young people (age 14–25) who are drug experienced and are in contact with the Criminal Justice System (CJS). In general, research tends to focus on either young people’s drug use or offending; equally, we see a tendency within policy and service responses to focus on interventions aimed either at drug use or at offending but rarely addressing complex problems that may include drug use and offending (Herold et al., 2019). By drawing on young peoples’ own perspectives and experiences and focusing on multiple problem areas at the same time, this collection presents findings that complement and augment the existing literature, and are highly relevant to policy development and service provision by: providing an account of young people’s own perspectives and experiences of their drug use and offending trajectories and the experienced relationship between these trajectories; describing young people’s own perspectives and experiences of different kinds of drug and/or offending reducing initiatives they have participated in and what they appreciate and/or find difficult in these institutional arrangements; showing how professionals engage with this group of young people, and how young people themselves consider engagement in services offered to them; and finally, highlighting the unintended consequences for and experienced by young people of the application of prohibitive drug policies and of involvement in the criminal justice system

Electrostatic correlations on the ionic selectivity of cylindrical membrane nanopores

We characterize the role of electrostatic fluctuations on the charge selectivity of cylindrical nanopores confining electrolyte mixtures. To this end, we develop an extended one-loop theory that can account for correlation effects induced by the surface charge, nanoconfinement of the electrolyte, and interfacial polarization charges associated with the low permittivity membrane. We validate the quantitative accuracy of the theory by comparisons with previously obtained Monte-Carlo simulation data from the literature, and scrutinize in detail the underlying forces driving the ionic selectivity of the nanopore. In the biologically relevant case of electrolytes with divalent cations such as CaCl2 in negatively charged nanopores, electrostatic correlations associated with the dense counterion layer in the channel result in an increase of the pore coion density with the surface charge. This peculiarity analogous to the charge inversion phenomenon remains intact for dielectrically inhomogeneous pores, which indicates that the effect should be observable in nanofiltration membranes or DNA-blocked nanopores characterized by a low membrane permittivity. Our results show that a quantitatively accurate consideration of correlation effects is necessary to determine the ionic selectivity of nanopores in the presence of electrolytes with multivalent counterions.Peer reviewe