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Recent upticks of stimulant presence in overdose deaths suggest the opioid epidemic is morphing, which raises questions about what drugs are involved and who is impacted. We investigate annual and growth rate trends in combined opioid-stimulant overdose toxicology between 2013 and 2019 for White, Black, and Hispanic male and female decedents in Delaware. During these years, toxicology shifted to illegal drugs for all with fentanyl leading the increase and opioid-cocaine combinations rising substantially. While combined opioid-cocaine toxicology grew among Black and Hispanic Delawareans, White males continue to report the highest rates overall. These findings depart from historical patterns and may challenge existing opioid epidemic policies. [ABSTRACT FROM AUTHOR]

Objective The aim of this study was to describe clinical outcomes of bridled nasogastric tube (NGT) program implementation for infants requiring assisted home feeding (AHF) to discharge from the neonatal intensive care unit (NICU). Study Design This was a descriptive prospective analysis of a pilot cohort of infants after implementation of a bridled NGT AHF program to facilitate discharge from level III and IV NICUs from March 2019 to October 2020. Results Of 29 attempts in infants, 22 infants were discharged with bridled NGTs over 18 months. Bridle placement was unsuccessful in three patients, and four bridles were removed before discharge. Bridle use ranged from 7 to 125 days, with a median duration of 37 days. Dislodgement rate was 0.69 per 100 days. Seventeen infants (77%) achieved full oral feeds, while five (23%) discharged with bridled NGTs later converted to gastrostomy tubes. Conclusion Implementation of a bridled NGT program is feasible for level III and IV NICUs to facilitate discharging infants who require feeding support to transition home. Key Points Bridled NGT use after NICU is typically 1 month. Infants have low bridle NGT dislodgement. Most bridled NGT NICU grads attain full oral feeds. [ABSTRACT FROM AUTHOR]

Optune® treatment is a US FDA-approved treatment for glioblastoma (GBM) that employs alternating electric fields. Tumor treating field (TTF) therapy can exert its effects on GBM via cell cycle mitosis disruption and cytokinesis. We describe a patient with recurrent GBM who had disease progression following standard surgical treatment and concomitant chemoradiotherapy, and was found to have sarcomatous transformation after initiation of TTF therapy with bevacizumab. Upon tumor progression, repeat surgical resection revealed transformation into a GFAP-negative, reticulin-positive sarcoma with rhabdomyoid features. The possibility of a causal connection between TTF therapy and sarcomatous transformation needs to be further evaluated. No such case of apparent sarcoma formation in the CNS following chemoradiotherapy and/or TTF treatment for GBM has been reported.

We report the first case of a pediatric patient with glioblastoma (GBM; WHO grade IV astrocytoma) successfully treated with tumor treating fields (TTF). The patient was diagnosed with GBM when 13 years of age and progressed through surgical resection, radiotherapy and chemotherapy. Discrete tumor growth visualized on MRI with stable neurological examination was monitored for 6 months with subsequent stable disease observed radiographically and clinically for 7 months while adherent to Optune® (TTF). TTF thereby played a role in forestalling recurrent GBM growth in this young woman for 7 months without significant adverse effects. We propose that TTF therapy is a potential valuable treatment in this small, but sick, patient population.

Theories of desistance from crime have emphasized social processes like involvement in adult social bonds or prosocial social relationships to the deliberate neglect of individual subjective processes such as one’s identity. More recent theories, however, have stressed the role of identity and human agency in the desistance process. An important set of questions is whether identity theory adds anything to existing theories, and whether there is empirical evidence to suggest that such subjective processes are important. In this article, we provide an empirical assessment of individual subjective considerations in desistance by looking at the relationship between “good identities,” intentional self-change, and desistance using survival time data from a sample of serious drug-troubled adult offenders released from prison whose arrest records are followed for almost a 20-year period. The implications of our findings for all brands of criminal desistance theory are discussed.

Using a sample of 118 drug-involved women originally released from prison in the 1990s and re-interviewed between 2010 and 2011, this paper examines the role motherhood played in the desistance process from crime and substance abuse. Interview narratives revealed that motherhood rarely functioned as a turning point per se that activated desistance, but caring for children did serve to solidify prosocial identities once offenders had transformed their addict/criminal identities. Despite their identity transformations, however, the journey of desistance for the majority of mothers was still a long and arduous path. The reality for these mothers most often resembled a hostile terrain marked by the competing demands of battling addiction, finding employment and suitable housing with a criminal record, establishing visitation and custody rights in family court, and regaining the trust of children and family members who had long ago lost faith in their commitment to their families. This research illuminates the complexities inherent in the desistance process for a contemporary sample of drug involved adult women entrenched within the criminal justice system.

Using a mixed-race sample of male and female drug-involved offenders who were released from prison in the early 1990s and re-interviewed in 2009 through 2011, this article represents perhaps the first attempt to determine the utility of the identity theory of desistance (ITD) in explaining desistance in a contemporary cohort of adult drug-involved offenders. Supporting the ITD, interview narratives revealed that the vast majority of offenders who successfully desisted from crime and substance misuse had first transformed their offender identity into a non-offender identity. Although partnership and employment did not appear to be significant turning points per se for the majority of our respondents, rekindling relationships with extended family and finding living-wage employment did serve to solidify new prosocial identities once the transformation had occurred.