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BACKGROUND AND OBJECTIVES: When given within 24 hours of birth, the hepatitis B vaccine is up to 90% effective in preventing perinatal infection. The American Academy of Pediatrics now recommends administration within 24 hours for infants with a birth weight >2 kg, but a national benchmark for compliance with this time frame has not been established. We aimed to increase the monthly average of eligible newborns receiving the vaccine on time from 40% to 80% over a 9-month period. METHODS: A series of plan-do-study-act cycles were conducted to improve timeliness of hepatitis B vaccine birth dose administration among newborns in the level 1 nursery at our academic community hospital. Interventions included staff education, nurse-driven consent and vaccine ordering, and earlier initial newborn assessments performed by nursing staff. Our primary outcome was the monthly percentage of newborns receiving the vaccine within 24 hours of birth, and our secondary outcome was the frequency of nonvaccination events. Statistical process control was used to analyze the effectiveness of interventions. RESULTS: Our mean monthly rate of vaccine administration within the 24-hour time frame increased from 40% to 92%. Predischarge vaccination rate improved from a mean of 13 to 61 cases between infants discharged without vaccination. CONCLUSIONS: Nurse-led interventions, including the ability to obtain consent and incorporation of the vaccine into our nurse-activated admission order set, were significant contributors to improvement in the timeliness of hepatitis B vaccine administration. We propose a mean of 90% compliance with the American Academy of Pediatrics recommendations as a benchmark for other institutions.

This thesis investigates linear programming methods for the numerical solution of parabolic equations backwards in time. These problems are ill-posed. Hence an approximate numerical solution for such problems canonly be obtained if additional constraints (called regularizations) are imposed on the solution in order to guarantee its stability under small perturbations. Previous authors hae implemented regularizations on the backwards heat equation which used (linear or nonlinear) least squares, or linear programming. These regularizations used the exact form of the kernel for the heat equation, however, and so are not generalizable to problems with an unknown kernel or unknown eigenfunction expansion. Furthermore, the least squares methods can not easily handle the nonnegativity constraint that a positive temperature, for example, must have.

This paper describes a methodology for estimating safe withdrawal rates during retirement that is based on a retiree’s age, risk tolerance and investment strategy, and then provides results obtained from using that methodology. The estimates are generated by a three-step process. In the first step, Monte Carlo simulations of future inflation rates, 10-year treasury rates, corporate bond rates (AAA and BAA), the S&P 500 index values and S&P 500 dividend yields are performed. In the second step, portfolio composition and withdrawal rate combinations are evaluated against each of the Monte Carlo simulations in order to calculate portfolio longevity likelihood tables, which are tables that show the likelihood that a portfolio will survive a certain number of years for a given withdrawal rate. In the third and final step, portfolio longevity tables are compared with standard mortality tables in order to estimate the likelihood that the portfolio outlasts the retiree. This three-step approach was then applied using both a Monte Carlo random walk model and an ARIMA/GARCH model based upon over 100 years of monthly historical data. The end result was estimates of the likelihood of portfolio survival to mortality for over 500,000 retiree age/sex/portfolio/withdrawal rate combinations, each combination supported by at least 10,000 Monte Carlo economic simulation points per model. Both models are supported by 100 years of historical data. The first model is a random walk with step sizes determined by bootstrapping, and the second is an ARIMA/GARCH regression model. This data is analyzed to predict safe withdrawal rates and portfolio composition strategies appropriate for the late 2021 economic environment.

Analyzing stakeholder needs and transforming them into requirements is an important early step in the systems engineering lifecycle [1]. In regulated industries, important technical requirements can be found in state and federal laws and regulations. Casino gaming is one such industry. This paper analyzes South Dakota and Nevada slot machine regulations and applies automated natural language processing to extract and analyze technical requirements derived from them. First, each parts of speech (POS) in the regulations is identified. From this, the important adjective and noun keywords and keyword combinations are extracted using the Rapid Automatic Keyword Extraction (RAKE) algorithm [2]. Next, slot machine requirements are extracted from the gaming laws, many of which lack a “shall” in them. To perform this, a 12-rule pattern matching algorithm that applies phrase substitutions and identifies leader-subordinate paragraph headings is applied to the slot machine gaming rules. This approach successfully extracts nearly all of the slot machine technical and operations requirements, though fails to separate compound requirements accounting for approximately 3% of the total. Then, after stemming and stopping the regulations, a Naïve Bayes model for identifying functional requirements is constructed from the South Dakota regulations and applied to the Nevada regulations. This model is able to predict the Nevada functional product requirements from amongst the full set of extracted requirements with 87.5% accuracy. Finally, using a modified version of the Dice similarity metric where the word counts are weighted by the term frequency-inverse document frequency (TF-TDF) scores, the South Dakota requirements most similar to each of the Nevada requirements is determined. The paired South Dakota and Nevada requirements are then assessed using systems engineering expertise for equivalency and relatedness. Using the geometric mean of sensitivity and specificity as a scoring metric, the pairing algorithm optimum performance is 96.1% accurate in identifying equivalent requirements between the two sets of regulations, and 82.0% accurate in identifying related requirements.

Background: Information regarding morbidity and mortality of infants born with end-stage renal disease (ESRD) requiring dialysis early in life is critical to optimize patient care and better counsel families. Objective: We evaluated outcomes of infants born regionally with ESRD, and those within our broader catchment area referred for dialysis. Study Design: We screened deaths at 5 regional referral hospitals, identifying infants with ESRD who did not survive to transfer for dialysis. We also screened all infants Results: We identified 14 infants from regional hospitals who died prior to transfer and 12 infants at our institution who were dialyzed. Because of the large burden of lethal comorbidities in our regional referral centers, overall survival was low, with 73% dying at birth hospitals. Amongst dialyzed infants, 42% survived to transplant. Conclusion: This study is unusual in reporting survival of infants with ESRD including those not referred for dialysis, which yields an expectedly lower survival rate than reported by dialysis registries.

This study was a randomized effectiveness trial of the use of incentives to improve treatment retention and post-treatment outcomes among parolees in community treatment. Parolees entering community treatment were randomized to incentives ( N = 104) or brief education ( N = 98). It was hypothesized that the use of incentives to increase treatment retention would result in improved post-treatment outcomes (i.e., arrest, employment, and drug use), but at 18 months post-intake, there were no group differences for any outcome. In secondary analyses, rearrest by 18 months post-intake was predicted by substance use, greater number or severity of psychological symptoms, treatment non-completion, unemployment, and younger age. Contrary to expectations, results indicated that participants who received incentives for attendance had arrest, employment, and drug use outcomes similar to those who received a brief education session. Our findings, in concert with those of several other researchers, suggest that there may be certain populations or settings where incentives may not be effective.

Although research indicates that organizational characteristics substantially influence the adoption and use of evidence-based practices (EBPs), there has been little empirical research on organizational factors most likely to influence successful implementation of EBPs, particularly in criminal justice settings. This study examined organizational characteristics related to the success of change teams in achieving improvements in assessment and case-planning procedures for persons leaving correctional settings and receiving community services. In this evaluation of the Organizational Process Improvement Intervention (OPII), part of the National Institute on Drug Abuse's (NIDA's) Criminal Justice Drug Abuse Treatment Studies (CJDATS) cooperative, 21 sites were randomized to an early-start or a delayed-start condition. For this analysis, data from both conditions were combined. Agencies with fewer program needs, good communication, adequate staffing levels, good supervision, positive attitude toward rehabilitation, and higher institutional capacity for change were better able to implement planned changes in assessment and case-planning procedures. Such agencies may be better candidates for implementation improvement strategies, whereas other agencies could benefit from pre-intervention efforts aimed at strengthening these characteristics before attempting to improve assessment procedures.

Because weak interagency coordination between community correctional agencies (e.g., probation and parole) and community-based treatment providers has been identified as a major barrier to the use of evidence-based practices (EBPs) for treating drug-involved offenders, this study sought to examine how key organizational (e.g., leadership, support, staffing) and individual (e.g., burnout, satisfaction) factors influence interagency relationships between these agencies. At each of 20 sites, probation/parole officials ( n = 366) and community treatment providers ( n = 204) were surveyed about characteristics of their agencies, themselves, and interorganizational relationships with each other. Key organizational and individual correlates of interagency relationships were examined using hierarchical linear models (HLM) analyses, supplemented by interview data. The strongest correlates included Adaptability, Efficacy, and Burnout. Implications for policy and practice are discussed.

This study is a randomized effectiveness trial of the use of incentives to improve treatment utilization among parolees in community treatment. In prison, Admission Phase parolees were randomized to either Admission Incentive ( n = 31) or Education ( n = 29). Attendance Phase parolees entering community treatment were randomized to Attendance Incentive ( n = 104) or Education ( n = 98). In the Attendance Phase, study participants received a monetary incentive for each day that they remained in treatment (up to 22 weeks). There was no main effect for incentives in either phase of the study (Admission to community treatment, Incentive 60% and Education 64%, p = .74; Intervention completion, Incentive 22% and Education 27%, p = .46). Using Cox regression, age, first arrest age, and type of parole status predicted time-in-treatment ( p < .05), but treatment group did not. Providing incentives did not increase the likelihood that parolees enrolled in or stayed in community treatment. In light of other studies with similar outcomes, criminal justice practitioners who are considering the use of incentives should be aware that they may not produce the desired outcomes.

Objectives Despite evidence that treatment is effective in reducing recidivism among inmates with substance use problems, scarce resources mean that few of those in need of treatment actually receive it. Computerized substance abuse interventions could be used to expand access to treatment in prisons without placing an undue burden on resources. The major aim of the study was to compare treatment conditions in terms of their service utilization, skills acquisition, and treatment satisfaction. Methods The study recruited men and women with substance use disorders from 10 prisons in 4 states. In an open label clinical trial, 494 subjects were randomly assigned either to the Experimental condition, a computerized drug treatment intervention, the Therapeutic Education System (TES; n = 249), or to the Control condition, Standard Care (n = 245). Chi-square tests compared groups on categorical variables and independent samples t tests were used for interval level continuous variables. Results Initial evidence demonstrated: (1) comparable group rates of session attendance and high rates of TES module completion for experimental subjects; (2) comparable group gains in the development of coping skills; and (3) a more favorable view of TES than of Standard Care. Conclusions Collectively, these results show that a computerized intervention, such as TES, can be implemented successfully in prison. Given the barriers to the delivery of substance abuse treatment typically encountered in correctional settings, computerized interventions have the potential to fill a significant treatment gap and are particularly well suited to inmates with mild to moderate substance use disorders who often are not treated.

Self-reports of drug use by high-risk offenders interviewed on two occasions were compared to determine the extent to which the reports were consistent at the two interview points. Self-reports of frequency of drug use over the same 12-month period were compared among parolees ( N = 380) who had participated in prison drug treatment and who were interviewed at 1 and 5 years following prison release. The kappa coefficient was .31 ( p < .001), generally considered a fair level of agreement. Total concordance in retrospective recall of primary drug use frequency was 54.5%.

Background Screening, brief intervention, and referral to treatment (SBIRT) is an evidence-based practice that has been shown to reduce alcohol and drug use in healthcare, educational, and other settings, but research on the effectiveness of SBIRT with populations involved in the criminal justice system is limited. These populations have high rates of substance use but have limited access to interventions. Methods The study randomized 732 jail inmates from a large urban jail to the SBIRT intervention or to the control group. Using the Alcohol, Smoking, and Substance Involvement Screening Test (ASSIST), the intervention assessed the risk level for drug and alcohol misuse by inmates and provided those who were at low or medium risk with a brief intervention in jail and referred those at high risk to community treatment following release, including the opportunity to participate in a brief treatment (eight sessions) protocol. Using interview and records data from a 12-month follow-up, analyses compared the two groups with respect to the primary study outcomes of reductions in drug and alcohol use and the secondary outcomes of participation in treatment, rearrest, reduction in HIV risk behaviors, and quality of life. In addition, the costs of delivering the SBIRT intervention were calculated. Results When baseline differences were controlled, the groups did not differ at follow-up on any of the primary or secondary outcomes. Conclusions Future research should develop and evaluate SBIRT models that are specifically adapted to the characteristics and needs of the jail population. Until more favorable results emerge, attempts to use SBIRT with jail inmates should be implemented with caution, if at all. Trial registration number: NCT01683643

Depression is rare in early childhood and unusual in autism in this age group. We describe a female child aged 6 years with autism who presented with regression of developmental skills previously gained. Her sleep and appetite were poor, her affect was sad, and she had morbid speech content. She responded to treatment with antidepressant medication. When this clinical picture occurs in adults it is called depressive pseudodementia; paediatric neurologists and neuropsychiatrists need to be aware of it in children.

HIV risk-behaviors are high in criminal justice populations and more efforts are necessary to address them among criminal justice-involved substance abusers. This study examines the role of incentives in promoting HIV testing among parolees. Participants were randomly assigned to either an incentive (n = 104) or education group (control; n = 98), where the incentive group received a voucher for testing for HIV. Bivariate comparisons showed that a larger proportion of those in the incentive group received HIV testing (59% versus 47%), but this was not statistically significant (p = .09). However, in a multivariate logistic regression model controlling for covariates likely to influence HIV-testing behavior, those in the incentive group had increased odds of HIV testing in comparison to those in the education group (OR = 1.99, p < .05, CI [1.05, 3.78]). As a first of its kind, this study provides a foundation for further research on the utility of incentives in promoting HIV testing and other healthy behaviors in criminal justice populations.

Of the 13 principles of drug addiction treatment disseminated by the National Institute on Drug Abuse (NIDA), 7 were meta-analyzed as part of the Evidence-based Principles of Treatment (EPT) project. By averaging outcomes over the diverse programs included in the EPT, we found that 5 of the NIDA principles examined are supported: matching treatment to the client's needs, attending to the multiple needs of clients, behavioral counseling interventions, treatment plan reassessment, and counseling to reduce risk of HIV. Two of the NIDA principles are not supported: remaining in treatment for an adequate period and frequency of testing for drug use. These weak effects could be the result of the principles being stated too generally to apply to the diverse interventions and programs that exist or unmeasured moderator variables being confounded with the moderators that measured the principles. Meta-analysis should be a standard tool for developing principles of effective treatment for substance use disorders.

Background To investigate how incarceration may affect risk of acquiring HIV and other sexually transmitted infections, we tested associations of ex-offenders' sexual risk behavior with the male-female sex ratio and the male incarceration rate. Methods Longitudinal data from 1287 drug-involved persons on probation and parole as part of the Criminal Justice Drug Abuse Treatment Studies were matched by county of residence with population factors, and stratified by race/ethnicity and gender. Generalized estimating equations assessed associations of having unprotected sex with a partner who had HIV risk factors, and having >1 sex partner in the past month. Results Among non-Hispanic black men and women, low sex ratios were associated with greater risk of having unprotected sex with a risky partner (adjusted relative risk [ARR] = 1.76, 95% confidence interval [CI] = 1.29, 2.42; ARR = 2.48, 95% CI = 1.31, 4.73, respectively). Among non-Hispanic black and non-Hispanic white (NHW) women, low sex ratios were associated with having >1 sex partner (ARR = 2.00, 95% CI = 1.02, 3.94; ARR = 1.71, 95% CI = 1.06, 2.75, respectively). High incarceration rates were associated with greater risk of having a risky partner for all men (non-Hispanic black: ARR = 2.14, 95% CI = 1.39, 3.30; NHW: ARR = 1.39, 95% CI: 1.05, 1.85; Hispanic: ARR = 3.99, 95% CI = 1.55, 10.26) and having >1 partner among NHW men (ARR = 1.92, 95% CI = 1.40, 2.64). Conclusions Low sex ratios and high incarceration rates may influence the number and risk characteristics of sex partners of ex-offenders. HIV-prevention policies and programs for ex-offenders could be improved by addressing structural barriers to safer sexual behavior.

Infants with congenital diaphragmatic hernia (CDH) or anterior wall defects (AWD) can suffer abnormal antenatal lung growth, the risk, however, may be greater for CDH infants. The objectives of this study were to test the hypothesis that following surgical correction, CDH infants would have worse lung function at follow-up than AWD infants and to determine whether fetal lung volume (FLV) results correlated with the lung function results at follow-up. Thirteen infants with CDH and 13 infants with AWD had lung function measurements at a median age of 11 (range 6–24) months; 17 of the infants had had their FLV assessed. Lung function was assessed by plethysmographic measurement of lung volume (FRCpleth) and airway resistance (Raw). In addition, functional residual capacity was assessed by a helium gas dilution technique (FRCHe); tidal breathing parameters (TPTEF:Te) and compliance and resistance of the respiratory system (Crs and Rrs, respectively) were also determined. FLV was assessed using three-dimensional (3D) ultrasound and virtual organ computer aided analysis. The CDH compared to the AWD infants had a higher median FRCpleth (41 ml/kg vs. 37 ml/kg, P = 0.043) and a lower median Crs (1.45 ml/cm H2O/kg vs. 2.78 ml/cm H2O/kg, P = 0.041). FRCpleth results correlated significantly with FLV results (r = 0.721, P

Following research indicating that the treatment needs of women are different from those of men, researchers and clinicians have argued that drug treatment programs for women should be designed to take their needs into account. Such programs tend to admit only women and incorporate philosophies and activities that are based on a social, peer-based model that is responsive to women's needs. To assess the relative effectiveness of women-only (WO) outpatient programs compared with mixed-gender (MG) outpatient programs, 291 study volunteers were recruited (152 WO, 139 MG), and a 1-year follow-up was completed with 259 women (135 WO, 124 MG). Using bivariate, logistic regression, and generalized estimating equation analysis, the following four outcomes were examined: drug and alcohol use, criminal activity, arrests, and employment. In both groups, women showed improvement in the four outcome measures. Comparison of the groups on outcomes yielded mixed results; women who participated in the WO treatment reported significantly less substance use and criminal activity than women in the MG treatment, but there were no differences in arrest or employment status at follow-up compared with those in the MG treatment.

OBJECTIVES: To test whether strengths-based case management provided during an inmate's transition from incarceration to the community increases participation in community substance abuse treatment, enhances access to needed social services, and improves drug use, crime, and HIV risk outcomes. METHODS: In a multi-site trial, inmates (men and women) in four states (n = 812) were randomly assigned (within site) to receive either Transitional Case Management (TCM group), based on strengths-based principles, or standard parole services (SR group). Data were collected at baseline and at 3 and 9 months following release from prison. Analyses compared the two groups with respect to services received and to drug use, crime, and HIV risk behavior outcomes. RESULTS: There were no significant differences between parolees in the TCM group and the SR group on outcomes related to participation in drug abuse treatment, receipt of social services, or drug use, crime, and HIV risk behaviors. For specific services (e.g., residential treatment, mental health), although significant differences were found for length of participation or for number of visits, the number of participants in these services was small and the direction of effect was not consistent. CONCLUSION: In contrast to positive findings in earlier studies of strengths-based case management with mental-health and drug-abuse clients, this study found that case management did not improve treatment participation or behavioral outcomes for parolees with drug problems. The discussion includes possible reasons for the findings and suggestions for modifications to the intervention that could be addressed in future research.

Please cite this paper as: Prendergast M, Rafferty G, Davenport M, Persico N, Jani J, Nicolaides K, Greenough A. Three-dimensional ultrasound fetal lung volumes and infant respiratory outcome: a prospective observational study. BJOG 2011;118:608–614. Objective To determine if fetal lung volumes (FLVs), determined by three-dimensional rotational ultrasound and virtual organ computer-aided analysis software (vocal), correlated with neonatal respiratory outcomes in surviving infants who had a high risk [fetuses with congenital diaphragmatic hernia (CDH)], lower risk [fetuses with anterior wall defects (AWDs)] and no risk (controls) of abnormal antenatal lung growth. Design Prospective observational study. Setting Tertiary fetal medicine and neonatal intensive care units. Population Sixty fetuses (25 with CDH, 25 with AWDs and ten controls). Methods FLVs were measured and expressed as the percentage of the observed compared with the expected for gestational age. Main outcome measures Neonatal respiratory outcome was determined by the duration of supplemental oxygen, mechanical ventilation and dependencies, and assessment of lung volume using a gas dilution technique to measure functional residual capacity (FRC). Results The infants with CDH had lower FLV results than both the infants with AWDs (P = 0.05) and the controls (P

Within prison settings, the reliance on punishment for controlling inappropriate or non-compliant behavior is self-evident. What is not so evident is the similarity between this reliance on punishment and the use of positive reinforcements to increase desired behaviors. However, seldom do inmates receive positive reinforcement for engaging in prosocial behaviors or, for inmates receiving drug treatment, behaviors that are consistent with or support their recovery. This study provides an overview of the development and implementation of a positive behavioral reinforcement intervention in male and female prison-based drug treatment programs. The active involvement of institutional staff, treatment staff, and inmates enrolled in the treatment programs in the development of the intervention along with the successful branding of the intervention were effective at promoting support and participation. However, these factors may also have ultimately impacted the ability of the randomized design to reliably demonstrate the effectiveness of the intervention.

To determine whether prematurely born infants exposed to chorioamnionitis compared to those not exposed have poorer lung function and are more likely to develop severe bronchopulmonary dysplasia (BPD).Results were analysed from consecutive infants born at33 weeks gestation with placental histology results and lung function measurement results on days 2 and/or 7 after birth and/or at 36 weeks postmenstrual age (PMA).Tertiary neonatal intensive care unit.120 infants with a median gestational age of 29 (range 23-32) weeks were studied, 76 (63%) developed BPD and 41 (34%) had been exposed to chorioamnionitis and/or funisitis.Chorioamnionitis was diagnosed histologically.Lung function was assessed by measurement of lung volume and compliance and resistance of the respiratory system. If the infants remained oxygen dependent beyond 28 days, they were diagnosed at 36 weeks PMA to have mild BPD (no longer oxygen dependent), moderate BPD (required less than 30% oxygen) or severe BPD (required more than 30% oxygen and/or positive pressure support).No significant differences were found in the lung function results between the chorioamnionitis and non-chorioamnionitis groups at any postnatal age. There was no significant relationship between chorioamnionitis and the occurrence or severity of BPD. Regression analysis demonstrated BPD was significantly related only to birth weight, gestational age and use of surfactant.In prematurely born infants, routinely exposed to antenatal steroids and postnatal surfactant, chorioamnionitis was not associated with worse lung function or more severe BPD.

Although evaluations have found prison treatment programs to be generally effective, most studies report that paroled graduates of these programs are much more likely to remain drug-free if they receive continuing treatment in the community. This article reviews research findings on principles of effective correctional treatment and the interventions that have been shown to be effective with drug-abusing parolees or that have been tested with general drug-abusing populations and show promise for use with parolees. The article concludes with a discussion of several issues that clinicians need to consider in adopting and implementing these interventions.

OBJECTIVES. The objectives of this study were to determine the impact of different volume-targeted levels on the work of breathing and to investigate whether a level that reduced the work of breathing below that experienced during ventilatory support without volume targeting could be determined. METHODS. The transdiaphragmatic pressure-time product, as an estimate of the work of breathing, was measured for 20 infants (median gestational age: 28 weeks) who were being weaned from respiratory support by using patient-triggered ventilation (either assist-control ventilation or synchronous intermittent mandatory ventilation). The transdiaphragmatic pressure-time product was measured first without volume targeting (baseline) and then at volume-targeted levels of 4, 5, and 6 mL/kg, delivered in random order. After each volume-targeted level, the infants were returned to baseline. Each step was maintained for 20 minutes. RESULTS. The mean transdiaphragmatic pressure-time product was higher with volume targeting at 4 mL/kg in comparison with baseline, regardless of the patient-triggered mode. The transdiaphragmatic pressure-time product was higher at a volume-targeted level of 4 mL/kg in comparison with 5 mL/kg and at 5 mL/kg in comparison with 6 mL/kg. The mean work of breathing was below that at baseline only at a volume-targeted level of 6 mL/kg. CONCLUSIONS. Low volume-targeted levels increase the work of breathing during volume-targeted ventilation. Our results suggest that, during weaning, a volume-targeted level of 6 mL/kg, rather than a lower level, could be used to avoid an increase in the work of breathing.

Objectives To determine whether chest radiograph (CXR) thoracic areas and lung volumes differed between infants who did and did not develop BPD and according to the severity of BPD developed. Working Hypothesis Infants developing BPD, particularly if moderate or severe, would have low CXR thoracic areas and lung volumes in the perinatal period. Study Design Prospective study. Patient-Subject Selection 53 infants with a median gestational age of 28 (range 24–32) weeks. Methodology CXR thoracic areas were calculated using a Picture Archiving and Communicating System (PACS) and lung volume assessed by measurement of functional residual capacity (FRC) in the first 72 hr after birth. BPD was diagnosed if the infants were oxygen dependent beyond 28 days, mild BPD in infants no longer oxygen dependent at 36 weeks post-menstrual age (PMA) and moderate/severe BPD in infants who required supplementary oxygen with or without respiratory support at 36 weeks PMA. Results Thirty two infants developed BPD, 21 had moderate/severe BPD. The median CXR thoracic areas were higher (P

The present study examines the relationship between substance use, mental health problems, and violence in a sample of offenders released from prison and referred to substance abuse treatment programs. Data from 34 sites (n = 1,349) in a federally funded cooperative, the Criminal Justice Drug Abuse Treatment Studies (CJDATS), were analyzed. Among parolees referred to substance abuse treatment, self-reports for the six-month period before the arrest resulting in their incarceration revealed frequent problems with both substance use and mental health. For most offenders with substance use problems, the quantity of alcohol consumed and the frequency of drug use were associated with a greater probability of self-reported violence. Mental health problems were not indicative of increases in violent behavior, with the exception of antisocial personality problems, which were associated with violence. The paper emphasizes the importance of providing substance abuse treatment in relation to violent behavior among offenders with mental health problems being discharged to the community. Language: en

Among prisoners, past research has associated several factors with HIV risk behaviors, including illicit drug use, engaging in sex trade, older age (for drug-related risk), younger age (for sex-related risk), low education, low income, type of offense, history of abuse, mental health disorders, vulnerability and low self-perceived efficacy. This study employs data collected through the Transitional Case Management study of the Criminal Justice Drug Abuse Treatment Studies collaborative to analyze characteristics of prisoners who engaged in high-risk behaviors prior to incarceration. For the first 787 participants of this study, we employed recursive partitioning techniques to better identify groups at varying levels of HIV risk behaviors. Those more likely to engage in risky needle use were White and either unemployed and less likely to justify their behavior, or employed with poor decision making capacity. Risky sexual behavior was associated with a general tendency toward risk-taking or a history of unstable housing. Those engaging in any type of HIV risk behavior were risk-takers in general and were aged 25 to 47 with a history of unstable housing. Recursive partitioning, a technique seldom used previously, offers a useful method for identifying subpopulations at elevated risk for HIV risk behaviors.

This study examined the relationships between substance abuse, mental health problems and HIV risk behavior in offenders discharged from prison and referred to substance abuse treatment programs. Data from 34 sites (n = 1,358) in a federally-funded cooperative agreement, the Criminal Justice Drug Abuse Treatment Studies (CJDATS), were analyzed. Among parolees referred to substance abuse treatment, self reports for the six-month period before the arrest resulting in their incarceration revealed frequent problems with both substance use and mental health. HIV risk behavior was operationalized as either (a) unsafe injection drug use, e.g., sharing needles and/or sharing injection equipment, or (b) unsafe sex, e.g., sex without a condom. The findings were that (1) unsafe injection drug use was associated with unsafe sex and vice versa, (2) unsafe sex behavior was related to frequency of drug use, and (3) unsafe sex behavior was related to frequency of alcohol use. In these samples, mental health problems did not have a significant effect on risk behavior, controlling for other variables. Future research should probe this "nonfinding" using standardized diagnostic and symptom measures to provide greater detail on the mental health problems (e.g., age of onset, frequency, and severity of the problem).

In response to the growing number of drug offenders cycling in and out of the criminal justice system without treatment for underlying drug problems, the judicial system has increasingly adopted drug courts as a strategy to divert these offenders from incarceration to supervised drug treatment. Our aim was to determine if drug court treatment effectiveness could be improved using contingency management, in the form of twice-weekly vouchers, to reinforce abstinence and positive behaviors for 163 clients over 26 weeks. We found no significant differences in outcomes among the study groups, although the Treatment Plan Group that received reinforcement for positive behaviors showed a trend toward poorer performance. We suspect that the influence of the judge within the courtroom had a stronger impact on drug court clients' attitudes, drug use behaviors, and other outcomes than the relatively low-value vouchers awarded as part of the treatment protocol.

Drug abusers vary considerably in their drug use and criminal behavior over time, and these trajectories are likely to influence drug treatment participation and treatment outcomes. Drawing on longitudinal natural history data from three samples of adult male drug users, we identify four groups with distinctive drug use and crime trajectories during the 5 years prior to their first treatment episode. The groups' characteristics of initial treatment are compared. The trajectory groups are then included in Poisson growth curve models to predict drug use, incarceration, and employment during the 5 years following first treatment. Findings indicate that posttreatment drug use decreased and posttreatment employment increased. There was little change in posttreatment incarceration. Posttreatment trajectories for drug use, incarceration, and employment were significantly different across the four trajectory groups.

This study is the first to examine ketamine use and its association with HIV sexual risk behaviors among a criminal offending population in the United States. Data were collected from 716 inmates as part of the Transitional Case Management (TCM) protocol within the Criminal Justice Drug Abuse Treatment Studies (CJ-DATS) cooperative agreement. Bivariate analyses were used to identify differences between ketamine users (n=44) and non-ketamine users (n=672). Three Poisson regression models were used to identify the significant correlates of high risk sexual behaviors in the 30 days prior to incarceration-- (1) number of times had unprotected sex while high, (2) number of times had unprotected vaginal sex, and (3) number of times had unprotected anal sex. Results indicate that ketamine was a significant correlate in all of the Poisson regression models. Findings add to the literature and indicate that ketamine use may be a marker for engaging in HIV risk behaviors among criminal offenders.

This study describes the prevalence of childhood adverse events (CAEs) among men and women prisoners and assesses the relationship of CAEs to adult symptoms of traumatic distress. Interview data for 427 men and 315 women were analyzed assessing childhood abuse and household dysfunction, drug and criminal histories, and symptoms of traumatic distress. Women offenders had much greater exposure to CAEs than did men and more often reported continued sexual abuse in adolescence and as an adult. Linear regression results showed that the impact of CAEs on traumatic distress was strong and cumulative for both men and women (greater exposure to CAEs increased the likelihood of 6 out of 7 mental health outcomes, although women had higher levels of traumatic distress overall). The findings indicate the need for early prevention and intervention as well as trauma-based treatment within the correctional setting.

Bronchopulmonary dysplasia, chronic oxygen dependency, is a common adverse outcome of very premature birth. It has important implications for health resource utilization, since affected children require frequent readmissions to hospital in the first 2 years after birth and, even as adolescents, have lung function abnormalities and troublesome respiratory symptoms. The current population of very prematurely born infants may develop chronic oxygen dependency in the absence of severe, acute respiratory distress, so-called 'new' bronchopulmonary dysplasia. This appears to be the result of impaired antenatal lung growth; antenatal infection and inflammation make the premature infant's lungs more vulnerable to injury.

Aims To examine the effectiveness of contingency management (CM) techniques in treating substance use disorders (i.e. illicit drugs, alcohol, tobacco). Design Meta-analysis was used to determine the average effect size and potential moderators in 47 comparisons of the effectiveness of CM from studies based on a treatment–control group design and published between 1970 and 2002. Findings The mean effect size (ES) of CM was positive, with a magnitude of d = 0.42 using a fixed effects model. The magnitude of the ES declined over time, following treatment. CM was more effective in treating opiate use (d = 0.65) and cocaine use (d = 0.66), compared with tobacco (d = 0.31) or multiple drugs (d = 0.42). Larger effect sizes were associated with higher researcher involvement, earlier studies and shorter treatment duration. Conclusions Study findings suggest that CM is among the more effective approaches to promoting abstinence during the treatment of substance use disorders. CM improves the ability of clients to remain abstinent, thereby allowing them to take fuller advantage of other clinical treatment components.

The purpose of this study was to examine differences between men and women entering prison-based therapeutic community (TC) treatment and to explore the relationship of those differences to posttreatment outcomes (i.e., aftercare participation and reincarceration rates). Extensive treatment-intake interview data for 4,386 women and 4,164 men from 16 prison-based TCs in California were compared using chi-square analyses and t-tests. Logistic regression analyses were then conducted separately for men and women to identify gender-specific factors associated with post-treatment outcomes. Prison intake data and treatment participation data come from a 5-year process and outcome evaluation of the California Department of Corrections' (CDC) Prison Treatment Expansion Initiative. The return-to-custody data came from the CDC's Offender Based Information System. Bivariate results showed that women were at a substantial disadvantage compared with their male counterparts with regard to histories of employment, substance abuse, psychological functioning, and sexual and physical abuse prior to incarceration. In contrast, men had more serious criminal justice involvement than women prior to incarceration. After controlling for these and other factors related to outcomes, regression findings showed that there were both similarities and differences with regard to gender-specific predictors of posttreatment outcomes. Time in treatment and motivation for treatment were similar predictors of aftercare participation for men and women. Psychological impairment was the strongest predictor of recidivism for both men and women. Substantial differences in background characteristics and the limited number of predictors related to posttreatment outcomes for women suggests the plausibility of gender-specific paths in the recovery process.

Drug courts are popular for dealing with drug-abusing offenders. However, relatively little is known about participant characteristics that reliably predict either success or failure in these treatment settings. In this article, we report on 99 individuals who were enrolled in a drug court program (approximately one-half of whom successfully completed the program). Using, logistic regression techniques we identified 2 significant predictors of outcome. First, individuals who were employed at the time of their enrollment into the drug court program were more likely to successfully complete the treatment program. Second, individuals with a history of illicit intravenous drug use were less likely to complete the program.

This report compares requests for goods or services made by participants in two clinical trials of contingency management for the treatment of substance abuse. One trial was for participants involved with the criminal justice system and one was for participants who were not involved with the criminal justice system. In both trials, participants earned vouchers that could be exchanged for goods or services. Results indicated that the criminal justice group used the majority of their vouchers for paying fees or fines related to the criminal justice system while the other group used only a small portion of their vouchers for paying costs related to the criminal justice system. However, when the costs for the criminal justice system are removed, the proportion of vouchers exchanged for various goods and services are similar between the two groups. The results suggest that for those substance abusers involved in the criminal justice system, assistance in paying fines and fees related to their criminal justice system involvement may be a potentially powerful source of reinforcement that could be used in creative treatment strategies.

To ensure microbiological stability and safety in minimally processed (MP) salad vegetables, it is essential to consider the microbiology of this produce during cultivation and harvesting, and the potential changes to this microbiology through preparation, distribution and storage. This study takes two salad vegetables (lettuce and white cabbage) and, having enumerated a range of different physiological groups of microorganisms present on unwashed produce, determines the impact on each microbial group of applying a decontamination step in the preparation protocol. The disinfectant used was sodium dichloroisocyanurate. Decontamination reduced the total microbial load significantly on both vegetables. The levels of different microbial groups enumerated differed significantly between vegetables. All the microbial populations were reduced, but the biocidal effect of chlorine treatment varied with vegetable type. Reduction of the levels of lactic acid bacteria and aerobic psychrotrophs on cabbage was only achieved with inclusion of the decontamination step, and this effect, in general, did not last more than 3 days. Decontamination significantly reduced the levels of coliforms, and although the levels increased during refrigerated storage, they did not exceed initial levels found on unwashed produce. In addition, the levels found on treated cabbage remained lower than produce washed with water only.

This paper extends previous research that performed a cost-effectiveness analysis (CEA) of the Amity in-prison therapeutic community (TC) and Vista aftercare programs for criminal offenders in sout...

The extent to which therapeutic community (TC) methods meet the treatment needs of offenders with substance abuse disorders and co-occurring psychiatric disorders in prison is largely unknown. Very little research has been conducted with this population. The purposes of this study were to generate profiles of co-disordered drug offenders entering TC treatment in prison and to assess their post-release reincarceration rates, compared with drug offenders without psychiatric disorders. Extensive intake interview data for over 8,500 men and women who received treatment in one of 16 prison-based TCs in California were analyzed to produce profiles of co-disordered participants. Intake data come from a 5 year process and outcome evaluation of the California Department of Corrections' (CDC's) treatment initiative. Post-release reincarceration rates come from the CDC's Offender Based Information System. Compared with non-psychiatric disordered drug offenders, co-disordered offenders had substantially more severe substance abuse and criminal histories, in addition to their psychiatric impairment, at treatment entry. Logistic regression results indicated that, compared with drug offenders without psychiatric illness, co-disordered offenders were significantly more likely to be reincarcerated during the first year of their parole. These results suggest that prison treatment programs may need to use more comprehensive diagnostic assessments at intake to assess the diverse mental health needs of drug offenders with co-occurring psychiatric disorders and to develop treatment approaches suitable for this population. Copyright © 2004 John Wiley & Sons, Ltd.

Inmate welfare, staff security, public health concerns, and the need for recovery-friendly prison environments have been cited as supporting efforts to control in prison substance use. This article reports on the California Department of Corrections (CDC) Drug Reduction Strategy Project, which involved systematic random urine testing and drug interdiction measures. The two-phase evaluation took place at four CDC institutions, with three serving as test sites and one serving as a standard-procedures comparison site. The results of Phase I, random urine testing of 150 inmates per week from the eligible inmate general population, supported the effectiveness of systematic random urine testing in reducing in-prison substance use, as measured by the number of inmates refusing to test or testing positive for illicit substances. The results of Phase II, which involved continued random urine testing at the three test sites in addition to K-9 drug detection teams at one institution and drug detection equipment at another institution, led to further reductions in substance use, but few drug finds resulted from the additional interdiction measures.

Forever Free is an in-prison, residential, substance abuse treatment program employing a cognitive-behavioral curriculum designed for women. To assess this treatment model, 215 study volunteers in prison were recruited (119 treatment, 96 comparison); a 1-year follow-up was completed with 180 women (101 treatment, 79 comparison). Recidivism, drug use, and employment were examined. Bivariate analyses showed that treated women had significantly fewer arrests, less drug use, and greater employment. Cox regression analysis of time to reincarceration revealed that those with more lifetime arrests had a significantly increased risk of reincarceration; treatment group members and older subjects showed a trend toward decreased risk. Logistic regression analysis showed that treatment group membership and greater age predicted a lowered likelihood of drug use; heroin as the primary drug predicted a greater likeli-hood of use; and increased days in postrelease treatment and higher levels of education predicted employment.

Few studies have examined outcomes of prison-based treatment programs over a 5-year observation period. The present analysis was based on a sample of 715 prisoners randomly assigned either to the Amity therapeutic community program or to a notreatment group. At 5-years postrelease, 90% of the original participants were located and 81% were interviewed. The main findings were based on a conservative intent-to-treat approach. On measures of recidivism, the Amity treatment group had significantly lower rates of reincarceration than the control group, but in multivariate analysis of time to first reincarceration, this main treatment effect disappeared and other factors (age and postrelease treatment) became significant predictors of delayed time to reincarceration. As in previous reports on this cohort, those who attended aftercare had lower levels of reincarceration, longer time to reincarceration, and higher levels of employment.