The Attitudes of Females in Drug Court Toward Additional Safeguards in HIV Prevention Research

This article examines the attitudes of 97 women from the St. Louis City Drug Court who previously participated in an HIV prevention study. Data from the previous study indicated that the women met multiple criteria for vulnerability in research. Federal regulations require that such participants be provided with “additional safeguards.” The survey explored the following questions: (1) What are participants’ attitudes toward commonly proposed additional safeguards for vulnerable participants in research, and (2) Are attitudes toward safeguards related to participants’ previous compliance with an HIV prevention protocol? Preferences regarding safeguards in research were not significantly related to participants’ compliance in the previous study. Most participants wanted researchers to take extra measures not only to provide consent information, but to ensure that they are not high on drugs, that they understand relevant information, and that they retain consent information at each visit. Most participants wanted researchers themselves, and not a third party, to assume this responsibility.     

Does readiness to change predict reduced crack use in human immunodeficiency virus prevention?

This study examines crack cocaine (crack) use, readiness to change, and gender in a sample of 923 men and women randomized to standard human immunodeficiency virus (HIV) education (standard intervention [SI]) or peer-delivered intervention (enhanced intervention [EI]). Four levels of crack use characterized frequency of use in the past 30 days; readiness was assessed on three levels (precontemplation, contemplation, and preparation/action). Differences between intervention groups on crack use and readiness by gender were examined from baseline to 3-month follow-up. Overall, participants reduced their crack use from baseline, with those in the EI showing greater improvement than those in the SI. A small proportion of participants improved readiness; those who improved were more likely to improve their crack use. No significant gender differences were found. These findings suggest that the readiness construct does not fully capture the dynamics of change among out-of-treatment crack users. Further research is needed to fully comprehend the dynamics of change among this group.     

Breaking the Blue Wall of Silence: Risk Factors for Experiencing Police Sexual Misconduct Among Female Offenders

Objectives. We assessed the prevalence of and risk factors for trading sex with a police officer among women recruited from drug courts in St Louis, Missouri.Methods. In 2005 to 2008, we recruited women into an HIV intervention study, which surveyed participants about multiple sociodemographic, lifestyle, and risk factors. Regression analyses assessed risk factors for trading sex, a form of police sexual misconduct (PSM).Results. Of the 318 participants, 78 (25%) reported a lifetime history of PSM. Among women who experienced PSM, 96% had sex with an officer on duty, 77% had repeated exchanges, 31% reported rape by an officer, and 54% were offered favors by officers in exchange for sex; 87% said officers kept their promise. Only 51% of these respondents always used a condom with an officer. Multivariable models identified 4 or more arrests (adjusted odds ratio [AOR] = 2.8; 95% confidence interval [CI] = 1.29, 5.97), adult antisocial personality (AOR = 9.0; 95% CI = 2.08, 38.79), and lifetime comorbid cocaine and opiate use (AOR = 2.9 [1.62, 5.20]) as risk factors; employment (AOR = 0.4; 95% CI = 0.22, 0.77) lowered the risk of PSM.Conclusions. Community-based interventions are critical to reduce risk of abuse of vulnerable women by police officers charged with protecting communities.Female offenders represent a growing population of high-risk, vulnerable women in the United States. The number of women who are incarcerated or under correctional supervision increased from approximately 600 000 in 1990 to just more than 1.3 million in 2009.1 Many women involved in the criminal justice system experience stressful life events, suffer from mental disorders, and struggle with substance use problems.2,3Stressful and traumatic life events are common experiences for female offenders. Childhood physical or sexual abuse is such an event and is reported by a large proportion of female offenders4–6; according to the Bureau of Justice Statistics, 37% of women in state prisons, 23% of women in federal prisons, 37% of women in jail, and 28% of female probationers were victims of physical or sexual abuse as a minor. These rates exceed the range of 6% to 14% for men in respective facilities and estimates of 12% to 17% for women in the general adult population.5 Household dysfunction during childhood (e.g., family violence, parental separation or divorce, foster care or adoption placement) is more common among female offenders than women in the general population.6 In addition, the prevalence of other stressful life events, such as adolescent pregnancy and motherhood, among criminal justice samples is higher than national rates.6–8In addition to their experiences with stressful life events, female offenders have high rates of mental health problems, which have been reported among drug court participants,2,9–11 jail detainees,3 felons entering prison,12 prisoners,4,13,14 and offenders in prison substance abuse treatment programs.15,16 Comorbidities, particularly mental disorders and substance use disorders, are common in this population.14,17–19 For example, Teplin et al. found that more than 80% of jail detainees met criteria for 1 or more lifetime psychiatric disorders.3 Lifetime prevalence was highest for substance abuse or dependence (70.2%), posttraumatic stress disorder (33.5%), and major depressive episode (16.9%). Another study among drug-dependent female inmates in a substance abuse treatment program reported rates of 43% and 32% for antisocial personality and depression, respectively.15 Interestingly, the pattern of comorbidity differed such that women with a greater number of drug dependencies had higher rates of antisocial personality and depression than did women dependent on fewer drugs. Studies on gender differences among drug court populations have shown that female drug court participants are more likely than their male counterparts to have mental health problems; specifically, women are more likely than men to report feelings of depression and anxiety11 and to require referrals for mental health issues.2 Women who took more risks were also more likely to engage in gambling.20 Finally, the rate of female offenders’ mental disorder diagnoses exceeds that of the general population, with population prevalence estimates of 6% to 16% for major depressive disorder17,18 and less than 1% for antisocial personality disorder.21Police sexual violence, including rape, has been explored in a few studies in the criminological literature. Methods of these studies varied and included assessing police officers’ perspectives22 and reviewing publicly available records.23 In a study of 40 St Louis, Missouri–area police officers, 11 incidents of firsthand knowledge of a “sexual shakedown” were reported; this involved a demand for sexual services from an unwilling citizen who yielded to perceived police authority. However, these 11 incidents represented only a very small proportion of the 8306 total incidents of firsthand knowledge of police sexual misconduct (PSM). The most common type of PSM was nonsexual contact, such as a sexually motivated traffic stop, with 3481 reported incidents.22To understand the complex environmental factors that could affect behavioral change associated with an HIV prevention field trial focused on female offenders, we convened a series of focus groups at a St Louis correctional facility. Quite serendipitously, women shared with us that the sexual abuse experienced as a child with male relatives extended into their adulthood with other men in authority, specifically police officers.24To better understand the life events that affect female drug court participants, we added structured questions to focus on PSM, a neglected area of study masked by a “blue wall of silence”: an unwritten rule among some groups of police officers whereby officers ignore one another’s misconduct.22,23,25 We compared the experiences of female drug court participants who reported they had traded sex for favors with a police officer with those who did not and assessed sociodemographic characteristics, stressful life events, psychiatric history, and substance use as risk factors for this behavior.     

Anterior cervical interbody fusion with rhBMP-2 and tantalum in a goat model.

BACKGROUND CONTEXT: Tricortical autogenous iliac crest has long served as the gold standard for arthrodesis after cervical discectomy. The added morbidity resulting from bone graft harvest may be eliminated by the use of a biocompatible synthetic bone graft substitute with osteoconductive abilities, and when used with an osteoinductive agent, such as recombinant bone morphogenic protein (rhBMP)-2, it may facilitate arthrodesis similar to autograft. PURPOSE: To determine by radiographic and histologic analysis whether tantalum with and without rhBMP-2 can facilitate bony ingrowth and arthrodesis in an animal model. STUDY DESIGN/SETTING: Single-level anterior cervical discectomy and fusion was performed using a tantalum bone graft substitute with and without rhBMP-2 in a previously established goat model for anterior cervical fusion. METHODS: Eight goats underwent single-level anterior cervical discectomy and stabilization with a porous tantalum implant. There were four goats in each experimental group. Group A underwent anterior cervical stabilization with tantalum alone, whereas in Group B rhBMP-2 was added to the tantalum implant. The goats were sacrificed at 12 weeks, and their cervical spines were removed for histologic and radiological analysis. RESULTS: Only one of four goats in Group A had any bony ingrowth into the tantalum. Three of four goats in Group B demonstrated bony ingrowth. The average extent of bony ingrowth at the perimeter of the tantalum in Group A was 2.5% compared with 12.5% in Group B. Similarly, the volume of bony ingrowth within the tantalum was 2.5% in Group A and 10% in Group B. The difference was not statistically significant. CONCLUSIONS: The data in this pilot study suggest that tantalum may function as a synthetic osteoconductive bone graft substitute. The addition of rhBMP-2 may facilitate osteoinduction within a synthetic osteoconductive implant. The sample size in this study was too small for statistical significance. The present animal model as used in this study was inadequate for cervical arthrodesis where rigid implant fixation is desired.     

Do tooth-supported zirconia restorations present more technical failures related to fracture or loss of retention? Systematic review and meta-analysis

Clinical Oral Investigations - This systematic review was performed to determine the main cause of technical failure of tooth-supported zirconia crowns and fixed partial dentures (FPDs),...     

Predictors of obstructive sleep apnea

Background

A patient’s condition, such as obesity, plays a key role in the pathophysiology of obstructive sleep apnea (OSA). This study focuses on morphometric data that might be associated with the apnea–hypopnea index (AHI) and could therefore be used to predict OSA in order to better select patients for cardiorespiratory polysomnography (PSG).

Methods

Data of 110 patients with suspected OSA in the sleep center outpatient department were analyzed retrospectively. The data included morphometric measurements such as neck, waist, and hip circumference; weight; body size; age; and Epworth Sleepiness Scale (ESS). The results of the patients’ overnight polygraphy, the AHI, completed the data.

Results

Neck and waist circumference can predict the AHI (p < 0.01). Power of prediction was higher for both factors among male (p < 0.01) compared to female patients (p = 0.05). In the case of neck circumference, the threshold value is 40 cm. Neck circumferences of more than 40 cm are strongly associated with a higher AHI (p < 0.001).

Conclusion

It was possible to confirm the roles of waist and neck circumference as important parameters for a prediction model. Nevertheless, these parameters alone are not precise enough to completely neglect factors such as anatomic morphology in order to predict OSA and its severity.

     

Partnership and empowerment program: a model for patient-centered, comprehensive, and cost-effective care

The Partnership and Empowerment Program model offers a comprehensive, patient-centered, and cost-effective template for coordinating care for underinsured and uninsured patients with cancer. Attention to effective coordination, including use of internal and external resources, may result in decreased costs of care and improved patient compliance and health outcomes.     

Enhanced delivery of topically-applied formulations following skin pre-treatment with a hand-applied, plastic microneedle array

The purpose of this work is to characterize microchannels created by polymeric microneedles, applied by hand, and to demonstrate enhanced delivery of topically applied formulations of lidocaine hydrochloride and methylprednisolone sodium succinate (MPSS). 3M's Microstructured Transdermal System (MTS) arrays were applied to domestic swine to demonstrate reliability of penetration, depth of penetration and durability of the structures to repeat application and high force. Tissue levels of lidocaine and MPSS following topical application with and without microneedle pretreatment were determined by HPLC-MS analysis following digestion of biopsies. Almost all microneedles penetrate the stratum corneum upon hand force application. The depth of penetration varies from <100μm to nearly 150μm depending on the application force and the firmness of the underlying tissue. The arrays show excellent durability to repeated in-vivo application, with less than 5% of the structures evidencing even minimal tip bending after 16 applications. Under extreme force against a rigid surface, the microneedles bend but do not break. A lidocaine hydrochloride formulation applied topically in-vivo showed ~340% increase in local tissue levels when the MTS arrays were used to twice pre-treat the skin prior to applying the drug. Local delivery of a topically applied formulation of MPSS was over one order of magnitude higher when the application site was twice pre-treated with the MTS array. 3M's MTS array (marketed as 3M(TM) Microchannel Skin System) provides repeatable and robust penetration of the stratum corneum and epidermis and enhances delivery of some formulations such as lidocaine hydrochloride.     

Ergebnisse der Behandlung des Brustkrebses durch die partielle Mastektomie

Zusammenfassung Die Verfasser führten in der Zeit von 1950–1960 118 partielle Mastektomien beim Brustkrebs in vier verschiedenen Arten und Weisen durch, zusammen mit axillärer Blockdissektion und Strahlentherapie. Die Ergebnisse der 5–10–15jährigen Überlebenszeit vergleichen sie mit denen der gleichermaßen selektierten, aber radikal operierten 217 Patientinnen. Sie stellen fest, daß in der 5- und 10jährigen Überlebenszeit wesentliche Unterschiede nicht bestehen, aber die Zahl der 15 Jahre Überlebenden, besonders die des Stadiums 11, ist wesentlich höher nach der Radikaloperation. Der Grund hierfür ist wahrscheinlich der, daß nach partieller Mastektomie die Zahl der Lokalrezidive doppelt so hoch ist und nach deren Sanierung die Kranken nicht 15 Jahre erleben. Die partielle Mastektomie ist kein Routineeingriff in der Behandlung des Brustkrebses. Sie kann dann in Frage kommen, wenn die Patientin die Radikaloperation ablehnt. Die partielle Mastektomie sollte das Thema von kontrollierter klinischer Forschung sein.

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Results of the therapy of the carcinoma of the breast by partial mastectomy

Summary Between 1950 and 1960, 118 partial mastectomies in the treatment of early breast cancer have been carried out in four different techniques with block dissection and radiotherapy. The 5–10–15 year survivals were compared to a similar selection of 217 patients with radical operations. No significant differences could be found between the 5 and 10 year survival rates, but the number of patients living longer than 15 years is much higher following radical operation chiefly in the cases with stage 11. It is probably caused by the double frequency of local recidives following partial mastectomy, and after their treatment no patients survived to the 15th year. Partial mastectomy is no routine procedure. It is carried out when the patient refuses radical operation. The partial mastectomy should be the subject of a controlled clinical study.

     

Geertz' Interpretive Theory and care management: visualizing nurses' social practice

This paper presents a theoretical reflection on hospital nursing care management and Geertz' Interpretive Theory of Culture. We discuss some significant elements of culture in management, based on the theoretical reference frameworks of nursing, administration and anthropology. In these, the importance of cultural diversity is highlighted as an innovative resource to expand the vision of human integrity, valuing divergences, respect and sharing, which are important for nurses in the construction of their social practice.