Automated direct deconditioning of a childhood phobia

The authors present a procedure for the treatment of childhood phobias. Involving aspects of deconditioning, systematic desensitization and reinforced practice, it is referred to as automated direct deconditioning. The application of the procedure to a fear of loud noises in an 11-yr-old boy is described. Treatment was self-administered by the child in his home. Following relaxation in a darkened room, he listened to increasingly longer portions of a tape recording in which feared sounds were systematically superimposed upon selections of his favorite music. Participation in the sessions was reinforced by the child's parents. Within 24 sessions, over an 8-day period, the phobia was eliminated. The advantages of the procedure and its possibilities for other childhood phobias are discussed.     

A comparison of the OnTrak Testcup-5 to laboratory urinalysis among arrestees

Research studies that collect urine specimens to measure recent drug use have traditionally sent the specimens to laboratories for analysis. A new method of urinalysis-instant urine testing-may offer a quicker, equally accurate alternative to laboratory assays. To date, however, no studies have explored the efficacy of instant urine technology with individuals under criminal justice supervision. To address this limitation, the authors administered a single instant urine test-the OnTrak Testcup-5-to 136 adult male arrestees surveyed through Maryland's Substance Abuse Need for Treatment among Arrestees (SANTA) study. The specimens were subsequently shipped to an independent laboratory for reanalysis. Analyses indicate high agreement between the two techniques for marijuana, cocaine, and heroin. Potential uses for the OnTrak Testcup-5 are discussed.     

Correlates of treatment follow-up difficulty

This study examines the correlates of treatment follow-up difficulty utilizing data from the District of Columbia Treatment Initiative (DCI). Findings indicate that (1) treatment completion is positively associated with a successful follow-up; (2) age and number of prior arrests are related to follow-up difficulty; (3) persons easiest to reach were more likely to be employed at follow-up; (4) persons difficult to locate were more likely to be using cocaine and to be arrested post-discharge; and (5) cocaine use at follow-up might be underestimated and employment at follow-up might be overestimated in findings derived from less than 80% of the target sample.     

A physician's perseverance uncovers problems in a key nephrology study

The Normal Hematocrit Cardiac Trial, published in 1998, was a foundational study testing erythropoietin analog treatment to normal hematocrit targets. It served as a warning that erythropoietin replacement was not a panacea. Its large size gave it disproportionate weighting in evidence reviews and guideline development and thereby impacted treatment decisions. Coyne shows that the published results did not completely and clearly represent the study's actual results. We discuss the implications and make recommendations to prevent such occurrences.     

Concordance of three measures of cocaine use in an arrestee population: hair, urine, and self-report.

This article reports on the comparison of self-reported cocaine use with urinalysis outcomes and radioimmunoassay of hair samples for cocaine. The data is based on a voluntary sample of approximately 300 arrestees, tested and interviewed anonymously. The study reports high rates of request compliance for both urine and hair samples, and affirms a relatively high degree of underreporting of cocaine use. Radioimmunoassay of hair appears to detect considerably larger degrees of cocaine use than are detected by urinalysis. The differential rates of detection between hair and urine are less dramatic in subjects who appear to be high rate users.     

The relationship between physical and sexual abuse and illicit drug use: a replication among a new sample of youths entering a juvenile detention center

The relationship between child physical and sexual abuse and illicit drug use are little understood and underinvestigated. Our previous study of this association found that a sample of detained youths' physical and sexual abuse experiences were related significantly and positively to their use of illicit drugs. Data gathered from a new sample of detained juveniles, interviewed 3 years after our first study, relating to this issue were examined and our previous findings were replicated.     

Examination of the relationships among drug use, emotional/psychological problems, and crime among youths entering a juvenile detention center

Urine testing and confidential interviews of youths entering a juvenile detention center in a southeastern city produced some striking results in regard to their drug use, delinquent behavior, and emotional/psychological problems. Recent users of marijuana/hashish and cocaine had higher rates of referral to juvenile court for property and drug offenses than nonusers. The results suggest that interviewing and urine testing of youthful detainees for drug use at the point of entry into secure detention is a promising method for screening youngsters with histories of delinquent behavior. Implications of these findings are drawn.     

Transdiaphragmatic implantation of the automatic implantable cardioverter defibrillator

A new surgical approach for implantation of the automatic implantable cardioverter defibrillator without thoracotomy was used in 12 patients, aged 46 to 72 years. Preimplantation arrhythmia was ventricular tachycardia in 7 patients and ventricular fibrillation in 5 patients. The mean ejection fraction was 19%. Six patients were at high risk for general anesthesia for a variety of medical problems, and 2 patients had had a previous cardiac operation. Epidural anesthesia was used in 8 patients without intubation. The surgical approach used a longitudinal epigastric extraperitoneal incision with access to the heart through an incision made in the central tendon of the diaphragm. Two patches and two epicardial sensing leads were placed in all patients. All patients but one could be defibrillated with 20 J or less. There was no operative mortality and minimal morbidity. There were two late deaths due to heart failure. Thus, the transdiaphragmatic approach provides an excellent exposure for automatic implantable cardioverter defibrillator implantation, avoids general anesthesia and thoracotomy, and can be used after a previous cardiac operation.