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This article uses the concept of the "negotiated order" as developed by McAra and McVie to focus on the role and nature of the "family order" in shaping the initiation of methamphetamine use in Japan. Presenting empirical qualitative data from multiple life-story interviews with 11 men with a history of methamphetamine use, the findings demonstrate that while there were variegated paths that led to initiation of use, a common factor was family breakdown and exclusion. Given the "group-oriented" nature of social organization and relations in Japan and the risks emanating from marginalization from "insider" groups, understanding the importance of the ways in which the ascription and negotiation of identities within and around the family can lead to initiation in a severely stigmatized and criminalized activity in this cultural context provides useful lessons for thinking about formal and informal responses to illegal drugs. [ABSTRACT FROM AUTHOR]

The use of high flow nasal oxygen in the care of COVID-19-positive adult patients remains an area of contention. Early guidelines have discouraged the use of high flow nasal oxygen therapy in this setting due to the risk of viral spread to healthcare workers. However, there is the need to balance the relative risks of increased aerosol generation and virus transmission to healthcare workers against the role high flow nasal oxygen has in reducing hypoxaemia when managing the airway in high-risk patients during intubation or sedation procedures. The authors of this article undertook a narrative review to present results from several recent papers. Surrogate outcome studies suggest that the risk of high flow nasal oxygen in dispersing aerosol-sized particles is probably not as great as first perceived. Smoke laser-visualisation experiments and particle counter studies suggest that the generation and dispersion of bio-aerosols via high flow nasal oxygen with flow rates up to 60 l/min is similar to standard oxygen therapies. The risk appears to be similar to oxygen supplementation via a Hudson mask at 15 l/min and significantly less than low flow nasal prong oxygen 1-5 l/min, nasal continuous positive airway pressure with ill-fitting masks, bilevel positive airway pressure, or from a coughing patient. However, given the limited safety data, we recommend a cautious approach. For intubation in the COVID-positive or suspected COVID-positive patient we support the use of high flow nasal oxygen to extend time to desaturation in the at-risk groups, which include the morbidly obese, those with predicted difficult airways and patients with significant hypoxaemia, ensuring well-fitted high flow nasal oxygen prongs with staff wearing full personal protective equipment. For sedation cases, we support the use of high flow nasal oxygen when there is an elevated risk of hypoxaemia (e.g. bariatric endoscopy or prone-positioned procedures), but recommend securing the airway with a cuffed endotracheal tube for the longer duration procedures when theatre staff remain in close proximity to the upper airway, or considering the use of a surgical mask to reduce the risk of exhaled particle dispersion. [ABSTRACT FROM AUTHOR]

This article critically examines the role and influence of neuroscientific knowledge in problematising youth-to-adult (Y2A) offender transitions. Drawing upon empirical data from a policy Delphi panel (n = 33) in Wales (UK), it is argued that a 'neuro-deficits' model based around 'maturity' has permeated the understandings of policy-makers and practitioners working with youth offenders. In internalising such neuroscientific knowledge, the policy environment has in turn become problematised for inadequately catering towards such developmental deficits. While this 'neuroscientific turn' in Y2A transitions may serve to further legitimate a set of managerialist and risk-oriented practices, it also provides opportunities for broader meaningful reform. [ABSTRACT FROM AUTHOR]

The primary aim of this study was to evaluate the perceptions of Australian anaesthetists in relation to smartphone use within anaesthetic practice. In particular, we aimed to assess the frequency of smartphone use, the types and number of smartphone applications used, how reliant anaesthetists perceive themselves to be on smartphones and whether they perceive them to be a factor that aids or distracts from their practice. Secondly, we assessed whether there is an association between the type, frequency, reliance and perceptions of smartphone use and the years of experience as an anaesthetist. A 24-item questionnaire addressing these questions was created and distributed to an email list of credentialled anaesthetists in Melbourne, Australia. A total of 113 consultant anaesthetists who practise at 55 hospitals in Melbourne completed the questionnaire. Our results suggest that the majority of anaesthetists are using smartphones regularly in their practice. About 74% of respondents agreed that they rely on their smartphone for their work. We found that respondents were more likely to rely on smartphones and consider them to aid patient safety than to consider them a distraction. This phenomenon was particularly apparent in those who had been a consultant anaesthetist for less than three years. Furthermore, those who had been a consultant anaesthetist for less than three years were more likely to have more smartphone apps relating to anaesthetics, use them more often and rely on them to a greater degree. Our results highlight the ubiquitous and perceived useful nature of smartphones in anaesthetic practice. [ABSTRACT FROM AUTHOR]

An integrative review of the literature specific to leadership within the intensive care unit was planned to guide future research. Four databases were searched. Study selection was based on predetermined inclusion and exclusion criteria and a quality check was done. Data extraction and synthesis involved developing a preliminary thematic coding framework based on a sample of papers. The coding framework and all selected papers were entered into NVivo software. All papers were then coded to the previously identified themes. Themes were summarised and presented with illustrative quotes highlighting key findings. In total, 1102 relevant quotations were coded across the 28 included papers. Four themes pertaining to leadership were described and analysed: (a) leadership dimensions and discourses; (b) leadership experiences; (c) facilitators and/or barriers to leadership; and (d) leadership outcomes. The literature was found to focus on leader behaviours, as well as the leader dimensions of role allocation, clinical and communication skills and traditional hierarchies. Positive behaviours mentioned included good decision-making, staying calm under pressure and being approachable. Leadership experiences (and outcomes) are typically reported to be positive. Personal individual factors seem the biggest enablers and barriers to leadership within the intensive care unit. Training is considered to be a facilitator of leadership within the intensive care unit. This study highlights the current literature on leadership in intensive care medicine and provides a basis for future research on interventions to improve leadership in the intensive care unit. [ABSTRACT FROM AUTHOR]

The process of Welsh devolution has marshalled major political, social and institutional change. While scholars within various disciplines have attempted to make sense of these changes, the discipline of criminology remains something of an exception. This article offers an examination of the unique Welsh criminal justice policy space that has been opened up by devolution in Wales. The article provides a long overdue assessment of how drug policy in Wales, while continuing to straddle the UK Government's criminal justice responsibilities, is configured and shaped within post-devolution Wales. The empirical findings presented here reveal the existence of a distinct Welsh drug policy as well as discovering clear limitations to Welsh policy divergence. The article outlines the need for criminologists to take Wales – and the Welsh policy space – more seriously, while highlighting the need for criminologists to become more attuned to the considerable effects being made by constitutional change. [ABSTRACT FROM AUTHOR]

Indications of the national prevalence of illegal drug use in Japan have largely been presented from two main sources: official police-recorded statistics and a national self-report survey. Their findings have been often used to support a representation of Japan as having relatively low levels of illegal drug use in comparison to other developed countries. However, the use and presentation of these sources has rarely considered in any meaningful way their nature and accuracy in revealing patterns of illegal drug use. As such, there is a tendency to uncritically accept and reproduce dominant patterns that may distort and disguise a more realistic understanding. This article critically examines these two sources, identifying a series of methodological issues that may contribute toward an underrepresentation of illegal drug use. In doing so, it also argues that a more critical social science–informed perspective may allow for these sources to be better utilized and situated within the cultural context in which they are produced and which they claim to represent. [ABSTRACT FROM AUTHOR]

This paper draws upon an empirical comparative study of policy-making in England & Wales and the Netherlands. Recent changes in cannabis policy prima facie indicate some convergence towards a toughening of approaches, thereby suggesting commonalities in control cultures. However, analysis of findings illuminate significant differences in the policy process between these jurisdictions which contribute towards continued divergence towards small-scale supply and consumption of cannabis. It is argued that this can be understood and explained through an understanding of differences in both political institutions and cultures, and in organizational responsibilities and relations of power. Consequentially, this further supports the notion that comparative research and theorizing needs to take account of mechanisms and features which lead to variegated control cultures. [ABSTRACT FROM AUTHOR]

The use of minipigs in preclinical safety testing of pharmaceuticals is considered an alternative to the more traditional dog and nonhuman primate (NHP) nonrodent species. Substantial evidence exists to suggest that the anatomy, physiology, and biochemistry of minipigs are similar enough to humans to consider them as valid nonrodent models for pharmaceutical safety testing. Since the utilization of minipigs was last assessed over 5 years ago, the Preclinical Safety Leadership Group (DruSafe) of the International Consortium for Innovation and Quality in Pharmaceutical Development conducted this survey to provide an updated assessment of the utility, perceived value, and impediments to the use of minipigs in preclinical safety testing. Of the 32 participating members of DruSafe, 15 responded to the survey representing both large and small companies. Respondents indicated that the minipig has been utilized mostly for short-term safety assessment studies with dermal, oral, and parenteral routes of administration. Minipigs are widely accepted as appropriate models for cardiovascular assessments and have been used to a limited extent for reproductive toxicology testing. Overall responses indicated that safety testing for large molecules using this species is relatively low due to a lack of background data, reagents or biomarkers, concerns regarding immune system characterization and poor suitability for developmental toxicity assessments. Most companies utilized contract research organizations for definitive safety toxicity assessment studies. Conclusions of this survey indicate that minipig is an acceptable nonrodent species largely limited to studies using small molecules, primarily dermal products, and results are comparable to those reported 5 years ago. [ABSTRACT FROM AUTHOR]

Data collected from 182 marketed and nonmarketed pharmaceuticals demonstrate that there is little value gained in conducting a rat two-year carcinogenicity study for compounds that lack: (1) histopathologic risk factors for rat neoplasia in chronic toxicology studies, (2) evidence of hormonal perturbation, and (3) positive genetic toxicology results. Using a single positive result among these three criteria as a test for outcome in the two-year study, fifty-two of sixty-six rat tumorigens were correctly identified, yielding 79% test sensitivity. When all three criteria were negative, sixty-two of seventy-six pharmaceuticals (82%) were correctly predicted to be rat noncarcinogens. The fourteen rat false negatives had two-year study findings of questionable human relevance. Applying these criteria to eighty-six additional chemicals identified by the International Agency for Research on Cancer as likely human carcinogens and to drugs withdrawn from the market for carcinogenicity concerns confirmed their sensitivity for predicting rat carcinogenicity outcome. These analyses support a proposal to refine regulatory criteria for conducting a two-year rat study to be based on assessment of histopathologic findings from a rat six-month study, evidence of hormonal perturbation, genetic toxicology results, and the findings of a six-month transgenic mouse carcinogenicity study. This proposed decision paradigm has the potential to eliminate over 40% of rat two-year testing on new pharmaceuticals without compromise to patient safety. [ABSTRACT FROM PUBLISHER]

The diagnostic and predictive value of transcutaneous oxygen tension (tcPO2) measurements in patients undergoing lower extremity arterial recon structive surgery were evaluated. Foot tcPO2 was measured preoperatively in 114 patients, intraoperatively in 59 patients, and again seven days after surgery in 82 patients. Preoperative tcPO 2 values less than 30 mmHg were indicative of severe limb ischemia in 90% of patients with rest pain, impending gangrene, or ischemic ulcer. Fifteen minutes after revascularization, tcPO2 greater than 30 mmHg was predictive of a "good" result (determined clinically at one month) in 94% of patients, whereas values less than 30 mmHg predicted a "poor" result in 70% of patients. Measurements obtained seven days postoperatively exhibited an improved negative predictive tcPO2 value (85%) as compared with those ob tained intraoperatively. TCPO2 changes induced by oxygen inhalation were the most promising predictor of the outcome of surgery. TCPO2 was uniformly more reliable than hemodynamic tests (pulse volume recording and Doppler systolic pressure) when more severe disease was present and vice versa; their comple mentary nature suggests the two techniques can be used together to maximize noninvasive diagnostic value. [ABSTRACT FROM PUBLISHER]

This report describes a newly developed noninvasive method for extra-cranial cerebrovascular evaluation. Two hundred consecutive cases were studied at the Massachusetts General Hospital and matched with clinical and angiographic findings. There were three false negative and five false positive results. Two ulcerated plaques without stenosis were not detected. Management routes for different groups of patients with central nervous system symptoms are outlined. We emphasize the usefulness of monitoring postoperative ophthalmic artery pressure to aid in the early detection of carotid occlusion in patients developing neurologic symptoms following carotid endarterectomy. [ABSTRACT FROM AUTHOR]

Cancer registration is an essential element of any cancer control strategy. Data quality is, however, of paramount importance. This paper sets out some of the ways in which the quality of cancer registration data might be improved. In particular, the potential contribution of clinicians and pathologists is highlighted. [ABSTRACT FROM AUTHOR]

Recent randomized prospective trials have defined more clearly the role of carotid endarterectomy (CEA) in both symptomatic and asymptomatic patients.1-4 Simultaneously, technical refinements in the use of carotid noninvasive (CNIE) examination for diagnosing and categorizing carotid artery disease have changed the role of CNIE in the eyes of many vascular surgeons. Once seen primarily as a screening tool for selecting patients for more accurate invasive testing, CNIE now has the capability, in some situations, to serve as the sole diagnostic study, by supplying the information needed to make treatment decisions in patients with known or suspected carotid disease. For the last decade reports have appeared in the literature suggesting that under certain circumstances, relying on CNIE as the sole diagnostic study for selecting patients for CEA was not only feasible, but beneficial in terms of morbidity and cost.5 Simultaneously, evolution in the technical aspects of CNIE have both improved its accuracy and made earlier reports describing its role in the evaluation of these patients somewhat outdated.This article will briefly review some of the recent developments of CNIE technology and vascular laboratory regulation and then examine the current arguments for and against the use of CNIE as the sole diagnostic study prior to CEA. Finally, a strategy for the appropriate use of CNIE in the management of patients with carotid disease will be suggested. CNIE as used here refers to an integrated package of diagnostic modalities including standard duplex ultrasound, ophthalmic artery velocity measurements, and other tests which will be described. It should be understood that in validated laboratories, the information derived from these studies will be considered as a whole in diagnosing carotid disease. [ABSTRACT FROM PUBLISHER]