Promoting Healing and Avoiding Retraumatization: A Proposal to Improve Mental Health Care for Detained Unaccompanied Minors Through a Best Interests of the Child Standard

Part I of this Note will describe the circuit split. It will provide background on the A.M. [A.M. v. Luzerne County Juvenile Detention Center] and Doe 4 cases, including an explanation of the major precedents on which the Third and Fourth Circuits based their respective decisions. Then, Part II will argue that A.M. and its deliberate indifference standard cannot appropriately be applied in cases involving detained unaccompanied minors, also called Unaccompanied Alien Children (UACs). This almost twenty-year-old standard does not consider the latest information about immigration policy and the unique mental health needs of UACs such as Doe 4 who came to the United States to escape traumatic situations in their home countries. At the same time, though, Part II will explain why Doe 4’s substantial departure from professional judgment standard, which the Supreme Court declined to review, is still not the correct solution to the UAC-specific problems that A.M.’s standard does not cover. Part III will recommend possible alternative standards that would be better equipped to practically and efficiently ensure that detained UACs receive the mental health care to which they are entitled. Finally, Part IV will acknowledge and refute several potential counterarguments. This abstract has been taken from the author\u27s introduction

Promoting Healing and Avoiding Retraumatization: A Proposal to Improve Mental Health Care for Detained Unaccompanied Minors Through a Best Interests of the Child Standard

Part I of this Note will describe the circuit split. It will provide background on the A.M. [A.M. v. Luzerne County Juvenile Detention Center] and Doe 4 cases, including an explanation of the major precedents on which the Third and Fourth Circuits based their respective decisions. Then, Part II will argue that A.M. and its deliberate indifference standard cannot appropriately be applied in cases involving detained unaccompanied minors, also called Unaccompanied Alien Children (UACs). This almost twenty-year-old standard does not consider the latest information about immigration policy and the unique mental health needs of UACs such as Doe 4 who came to the United States to escape traumatic situations in their home countries. At the same time, though, Part II will explain why Doe 4’s substantial departure from professional judgment standard, which the Supreme Court declined to review, is still not the correct solution to the UAC-specific problems that A.M.’s standard does not cover. Part III will recommend possible alternative standards that would be better equipped to practically and efficiently ensure that detained UACs receive the mental health care to which they are entitled. Finally, Part IV will acknowledge and refute several potential counterarguments. This abstract has been taken from the author\u27s introduction

Microfluidic Biopsy Trapping Device for the Real-Time Monitoring of Tumor Microenvironment

<div><p>The tumor microenvironment is composed of cellular and stromal components such as tumor cells, mesenchymal cells, immune cells, cancer associated fibroblasts and the supporting extracellular matrix. The tumor microenvironment provides crucial support for growth and progression of tumor cells and affects tumor response to therapeutic interventions. To better understand tumor biology and to develop effective cancer therapeutic agents it is important to develop preclinical platforms that can faithfully recapitulate the tumor microenvironment and the complex interaction between the tumor and its surrounding stromal elements. Drug studies performed in vitro with conventional two-dimensional cancer cell line models do not optimally represent clinical drug response as they lack true tumor heterogeneity and are often performed in static culture conditions lacking stromal tumor components that significantly influence the metabolic activity and proliferation of cells. Recent microfluidic approaches aim to overcome such obstacles with the use of cell lines derived in artificial three-dimensional supportive gels or micro-chambers. However, absence of a true tumor microenvironment and full interstitial flow, leads to less than optimal evaluation of tumor response to drug treatment. Here we report a continuous perfusion microfluidic device coupled with microscopy and image analysis for the assessment of drug effects on intact fresh tumor tissue. We have demonstrated that fine needle aspirate biopsies obtained from patient-derived xenograft models of adenocarcinoma of the lung can successfully be analyzed for their response to ex vivo drug treatment within this biopsy trapping microfluidic device, wherein a protein kinase C inhibitor, staurosporine, was used to assess tumor cell death as a proof of principle. This approach has the potential to study tumor tissue within its intact microenvironment to better understand tumor response to drug treatments and eventually to choose the most effective drug and drug combination for individual patients in a cost effective and timely manner.</p></div

Calcein AM dye validation and FNAB sample viability assessment.

<p>Calcein AM dye validation and FNAB sample viability assessment.</p

Assessment of small molecule drug perfusion in a tumor FNA fragment using Doxorubicin HCL.

<p>(A) Drug perfusion after an 8-hour period showing distribution of drug indicated by green fluorescent intensity spatially similar throughout the FNAB tissue sample. (B) Drug perfusion after a 24-hour period showing intensity peaks spatially similar throughout the FNAB tissue sample and the formation of apoptotic bodies.</p

Evaluation of antibody perfusion through the tumor FNAB on device.

<p>(A) 10x Phase contrast image of FNAB sample in trap of device and 10x fluorescent z-axis images (z5, z7, z9, z11) 24 hours post the staining procedure using isotype control antibodies for both EpCAM (red-Cy5) and CD44 (green-FITC). (B) 10x Phase contrast image of FNAB sample in trap of device and 10x fluorescent z-axis images (z5, z7, z9, z11) 24 hours post the staining procedure using EpCAM (red-Cy5) and CD44 (green-FITC).</p

Comparison of the calculated viability index of the tumor FNAB samples during 5 days of treatment.

<p>(A) Comparison of the mean averaged VI of negative control group and staurosporine treated group from the baseline over the 5 day exposure period with n = 18 within each group. The difference in means between each treatment group was statistically significant, except for the baseline. (B.1, B.3) A 3-dimensional view of a representative FNAB sample from the negative control group at day 1 and day 5 respectively. (B.2, B.4) Histogram of the relative intensity values across the negative control FNAB samples for day 1 and day 5, respectively. (C.1, C.3) A 3-dimensional view of a representative FNAB sample from the 50 μM staurosporine treated group at day 1 and day 5 respectively. (C.2, C.4) Histogram of the relative intensity values across the 50 μM staurosporine treated FNAB samples for day 1 and day 5 respectively.</p

Microfluidic device design.

<p>(A) Exploded view of the device showing the main body made from PDMS containing the 1 mm diameter inlet and outlets punched for each of the 10 channels. The main body is then sealed to a 25 x 75 mm glass slide by plasma gas treatment. Tubing is inserted into each of the inlet and outlets of the device. (B) Fully assembled PDMS prototype. (C) Solid Works rendering of a channel in the device showing the central post arrangement used to trap each FNAB tissue sample. The channel is 10 mm long, 600 μm wide and 125 μm in height. Each post is 150 μm long, 75 μm wide and 125 μm in height.</p