A self-administered instrument for assessing therapeutic approaches of drug-user treatment counselors

In this article we describe the development and psychometric properties of a self-administered instrument for assessing drug-user treatment counselors' therapeutic approaches such as psychodynamic or interpersonal, cognitive-behavioral, family systems or dynamics, 12-step, and case management. We generated an initial pool of items corresponding to these five approaches and modified them based on expert ratings. We developed three sets of items. The first concerned the beliefs underlying each therapeutic approach. The second and third concerned the practices of each applicable approach within individual and group counseling, respectively. With the exception of case management, an approach that originated within social work and which is only applicable to individual counseling, the other four approaches are applicable, at least theoretically, to both individual and group counseling. Additionally, we included items that describe techniques used exclusively with groups (i.e., group techniques). Finally, we included some items that are not associated with any of the traditional approaches but which reflect the practical approach that drug-user treatment programs often take to both individual and group counseling (i.e., practical counseling). The initial instrument consisted of 17 subscales with a total of 76 items. This instrument was administered to 226 counselors from 45 drug-user treatment programs in Los Angeles County. Based on this data, we further refined these scales using confirmatory factor analysis to ensure both construct validity and discriminant validity. The final instrument consisted of 14 subscales with a total of 48 items.     

Similarity of behavior within addict couples. Part I. Methodology and narcotics patterns

The development and initial assessment of a methodology for measuring the similarity of behavioral patterns within addicted couples over the duration of a relationship is presented. Two subsamples of addicts from methadone maintenance programs in southern California were established: one of couples who had a real relationship during their addiction and treatment careers, and a group of pseudocouples (matched as closely as possible) created from unrelated clients in the same programs. Narcotics use, abstinence, and support patterns are analyzed for couples before, during, and after their relationship. When it occurs during the relationship, treatment effects are also analyzed.     

Sequences of powder cocaine and crack use among arrestees in Los Angeles County

The epidemic of cocaine abuse has led to numerous studies on the substance. While extent of use, characteristics of users, patterns of use, and consequences of dependence are well documented for both powder cocaine and crack, few studies have dealt with the sequence or progression of use between the two forms of cocaine. This paper draws on arrestee data collected from county jails in Los Angeles, California. It identifies four sequences of powder cocaine and crack use and examines each sequence in terms of user characteristics, history of use, dependence, contact with the criminal justice system, and concomitant use of other drugs. Findings not only confirm some already established observations, but also offer new knowledge on powder cocaine and crack abuse. For instance, (a) whereas powder cocaine-initiated users are more likely to progress to crack than to restrict their use to powder cocaine only, crack-initiated users tend more often to use crack only than to progress to powder cocaine; and (b) powder cocaine and crack, when used interchangeably, can interact and reinforce each other, resulting in a higher level of use and dependence on both forms of the substance. This paper contributes to the understanding of powder cocaine and crack use among criminal offenders, in particular, and across the adult population, in general. It also sheds light on prevention, treatment, and social control policies of both cocaine abuse and overall illicit drug use.     

Computer-assisted patellar resection system: development and insights

Incorrect resection of the patella during total knee arthroplasty (TKA) can lead to anterior knee pain (AKP), patellar maltracking, patellofemoral impingement, patellar fracture, component loosening, and reduced range of motion. Computer-assisted surgery (CAS) systems for the tibia and femur improve cut accuracy, but no CAS system is available for patellar resection. We developed a system that included an optoelectronic localizer, marker arrays on the patella and instruments, and navigation software. Three users performed resections on artificial patellae mounted in a simulated surgical setup using five techniques (two CAS, three conventional), each repeated at least three times in randomized order. Computer-assisted patellar resection produced better or equal cut symmetry compared to conventional techniques, particularly superoinferiorly. Using CAS with a sawguide produced better results than using CAS freehand with an oscillating saw. This study showed the feasibility of computer-assisted patellar resection, which could lead to reduced pain and complications after TKA. The feedback provided could also make patellar CAS a valuable training tool.     

Social and community program approaches to participants: Exploring best practices

This article presents the results of a deepened study of the best practices and outcomes of 15 programs (across 9 countries) that work with socioeconomically disadvantagedd communities. Using thematic analysis, we identified best practices that participants, community leaders, and professionals recognized as key. Data collection involved in loco observation and semistructured interviews with participants and professionals, and focus groups with professionals. Associated with best practices, programs adopted two central perspectives on approaching participants: approaching participants as users and approaching participants as contributors. Such approaches were crossed with best practices and outcomes identified througout the analysis. For programs that approached participants as users, the best practices were valuing, facilitating the access to resources, showing availability, and promoting competencies and openness, and the main outcome was participants’ improved self‐confidence. For programs that approached participants as contributors, the best practices were contributing, encouraging participation, valuing participants, becoming masters, and reciprocity, and the main outcome was participants having an impact.     

A fast,accurate and closed-form method for pose recognition of an intramedullary nail using a tracked C-arm

Purpose

The main challenge of intramedullary nail (IM-nail) fixation surgery is to achieve the X-ray shot in which the distal holes of the IM-nail appear as circles (desired view); screw insertion is then performed. Although C-arm X-ray devices are routinely used in IM-nail fixation procedures, the surgeons or radiation technologists (rad-techs) usually utilize them in a trial-and-error manner. This increases both radiation exposure and surgery time. This study addresses the problem by presenting a C-arm-based IM-nail pose recognition method.

Methods

The specific purpose of this study was to develop and validate an automated technique for identifying the current pose of the IM-nail relative to the C-arm. An accuracy assessment is performed to test the reliability of the navigation results. The algorithm starts with a sequential biplanar set of X-ray imagery (acquired from a tracked C-arm) of the distal part of an inserted IM-nail. The image-processing module then extracts features of interest, and a mathematical model incorporates them to calculate the six degree-of-freedom position and orientation parameters of the nail.

Results

Translational accuracy was demonstrated to be better than 0.5 mm, rotational accuracy for roll and pitch to be better than \(2^{\circ }\) and for yaw to be better than \(2.5^{\circ }\) depending on the separation angle. Computation time was less than 0.5 s.

Conclusion

An IM-nail distal locking navigation technique is introduced in this study that leads to more accurate and faster screw placement with a lower consumption of radiation dose and a minimum number of added steps to the operation.

     

Drug Use and Risk for HIV Among Women Arrestees in California

The rate of women entering the criminal justice system, particularly from drug-related crimes, is increasing. This study examined the characteristics and HIV risk behaviors of drug-using women arrestees in 13 California counties (N = 532). The injecting drug users (IDUs) (18%) were compared with the noninjecting drug users. The IDUs were older, more often White than African American, and were more likely to have a history of STDs, previous arrest, and polydrug use. Although the IDUs were at higher risk for HIV from their injection drug use and greater involvement in sex work, a substantial number of non-IDUs also engaged in high-risk sexual behaviors. Only a small percentage of the women sampled tested positive for HIV antibodies, however, the generally high-risk profile of this sample of drug-using women arrestees suggests that they would benefit from interventions that link them with needed treatment and services.