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Patients with previous foregut surgery who develop additional foregut pathology can be a challenge. Those who have formerly undergone gastric bypass and later develop achalasia are at increased risk related to previous surgery. In this case report, we describe an alternative approach for the Dor fundoplication after laparoscopic Heller myotomy in the setting of the altered anatomy. The technique and advantages of this approach are detailed in the discussion of this patient.

The problem of adolescent drug use places a huge toll on society and a heavy burden on the criminal justice system. Despite the ability of therapeutic communities (TCs) to lower drug relapse, a great deal remains unknown in terms of how the process of treatment actually works for adolescents. Using data collected as part of the Drug Abuse Treatment Outcomes Studies–Adolescents, this study examines the direct and indirect relationship between therapeutic engagement and posttreatment substance use. Though there are few direct effects of therapeutic engagement on substance use, findings suggest that those more engaged in treatment are more likely to complete treatment and, therefore, less likely to use substances. This suggests that instruments that evaluate therapeutic engagement are important in assessing involvement in treatment, and that programming designed to engage the adolescents in TC treatment should be utilized to reduce the risk of posttreatment relapse.

Since Gottfredson and Hirschi’s A General Theory of Crime was published in 1990, self-control has become a major focus in criminological theory and research and the issue of measuring self-control has been the topic of many debates. Much of this research has used Grasmick and colleagues’ 1993 attitudinal scale. In 2004, Hirschi provided a new definition for self-control designed to spur new measurements of the concept. Despite this effort, only Piquero and Bouffard (2007) have provided an in-depth attempt to measure the redefined concept. This study replicates the Piquero and Bouffard measurement and a traditional measure of self-control in order to compare their effectiveness in predicting criminal or deviant behaviours. The data used come from a random sample of undergraduate students. Results indicate that the strength of the relationship between self-control and crime/deviance varies significantly based on the way self-control is measured.

Analysts argue that the Internet can democratize the construction of social problems and reduce claimsmakers’ dependence on coverage in traditional media. This paper examines Internet claims about the relative sizes of 2010 rallies on the Washington, D.C. National Mall hosted by Glenn Beck and Jon Stewart/Stephen Colbert. Because crowd size is understood to be an index for the popularity of social causes, and because the two rallies were taken to stand for opposing positions in the culture war, numerous advocates offered competing analyses of the crowds’ relative sizes. Analysis of these claims suggests that the Internet offers a forum where a host of arguments and evidence can be presented in a short period of time. Yet, although crowd size is an empirical issue, there was little effort to reconcile competing arguments and arrive at general agreement, and, without media coverage, these claims failed to attract much public attention.

Modern desistance research has examined many facets of desistance, in terms of theoretical predictors of desistance and recidivism, and in terms of differing types of offending. Though predicting desistance from illegal drug use is among these topics, no research to date has examined the predictors of desisting from prescription opioid abuse. This study uses longitudinal data from 318 prescription opioid users to analyze the effects of various predictors of desistance on declining nonmedical prescription opioid use, with an emphasis on gender differences among participants. Results indicate that theoretical and demographic characteristics correspond with differing rates of decline and further vary by gender.

Despite much focus on school violence, there has been little research that explores the relationship between offending and victimization in various school climates. School climate theory suggests that the school’s social system, culture, milieu, and ecological structure affect student outcomes including academic performance, delinquency, and more recently, victimization. Hierarchical analysis of data from 5,037 11th-grade students in 33 schools found that offending behavior was the strongest predictor for both minor and more serious forms of victimization. School climate, specifically the social cohesion of schools, reduced serious violent victimization risk. However, school climate did not affect the relationship between offending and victimization, and was not substantially modified when characteristics of the school environment were considered.

In recent years, public schools have moved away from traditional grade configurations with junior high schools and have shifted toward integrating sixth-grade students into middle schools. It has been argued that the effect this will have on students is to allow for additional freedom and earlier social growth. However, the counterargument to this debate is that these sixth-grade students would then be exposed to an older cohort sooner and, therefore, would be exposed to negative peer influences. This study investigates the behavioral differences between sixth-grade students in elementary schools and their counterparts in middle schools, including suicidal thoughts, violence, and substance abuse. The data used come from the 2007 middle school Delaware Youth Risk Behavior Survey. Results indicate significant differences in suicidal thoughts or actions based on the grade configuration of school they attend, though not in violence or substance use.