The effectiveness of trauma-informed youth justice: a discussion and review.

Youth justice services around the world are under increasing pressure to find new and more effective ways of working with young people. One way forward is to implement a more compassionate approach to service delivery that embraces the idea of 'trauma-informed practice'. And yet, substantial variation has been observed in how a trauma-informed approach has been defined and understood by practitioners, with idiosyncratic implementation evident across different systems and only limited evidence that this results in reductions in subsequent re-offending. In this paper we argue that the success of efforts to work in more trauma-informed ways cannot be judged using recidivism data alone and that there is a need to identify key indicators of the effectiveness of any trauma- informed approach. We present the case for implementing trauma-informed youth justice and outline key features of the approach. We then present a logic model that articulates key components and identifies short- and longer-term outcomes that can be measured to assess the overall performance of a service. The article concludes with a discussion of the current evidential status of trauma-informed youth justice, identifying areas of current strength and those where further work is needed to develop the evidence base, including the need to demonstrate the hypothesized association between short-term trauma-informed practice outcomes and the longer-term goal of preventing re-offending.

Obstetric and perioperative management of patients with factor XI deficiency: a retrospective observational study.

Factor XI (FXI) deficiency is an autosomal inherited, milder bleeding disorder that may predispose to a potential risk of life-threatening bleeding during childbirth or surgery. Unfortunately, data regarding obstetric and perioperative management of this condition are scarce, with limited cases reviewed in the last decade. Therefore, the present study aimed to expand this database and identify factors associated with increased bleeding risk. We performed a retrospective chart review of patients with FXI deficiency who underwent childbirth or other surgical procedures between August 2011 and April 2021 within a single academic health system and identified 198 patients who underwent 252 procedures, including 143 vaginal deliveries, 63 cesarean deliveries, and 46 other surgical procedures. Thirty-three of the 252 procedures resulted in bleeding complications. On multivariable logistic regression analysis, personal history of bleeding was the strongest predictor of perioperative or obstetric bleeding (odds ratio [OR], 5.92; P = .001). Higher FXI levels were correlated with lower odds of bleeding (OR, 0.72 with every 10 U/dL increase in FXI level; P = .05). On receiver operative characteristic analysis, FXI level of >40 U/dL predicted a lower bleeding risk with reasonable specificity (75%) but lacked sensitivity (47%). A family history of bleeding, ethnicity, genotype, preprocedural partial thromboplastin time, and platelet levels were not associated with bleeding risk. There were no cases of epidural or spinal hematoma associated with neuraxial anesthesia. FXI levels remain stable during pregnancy and repeated measurements may not be necessary.

Ankle-brachial index use in peripheral vascular interventions for claudication.

OBJECTIVE: The ankle-brachial index (ABI) has been recommended as the first-line noninvasive test to establish a diagnosis of peripheral arterial disease in patients with claudication (grade 1, level A evidence). The ABI can also be used to monitor disease progression and assess the benefits of treatment after peripheral vascular intervention (PVI). The Upper Midwest Region of the Vascular Quality Initiative has a unique balance of participation from vascular surgeons, interventional radiologists, and cardiologists performing PVI. We sought to identify the use of ABI and assess the functional outcomes of patients who had undergone PVI for claudication. METHODS: We conducted a review of the Upper Midwest Region of the Vascular Quality Initiative to identify PVI performed for claudication from native artery atherosclerotic occlusive disease in nondiabetic patients from 2010 to 2020. Patients who had undergone PVI with infection, tissue loss, rest pain, bypass graft stenosis, or aneurysmal disease were excluded. The primary outcomes included the ABI, ambulation status, and functional status before and after PVI. RESULTS: A total of 3787 patients (58.0% male, 42.0% female; mean age, 68.4 years) who had undergone 3830 procedures were identified. Of the 3787 patients, 2665 (69.5%) had had the ABI measured: 1803 (47.1%) before PVI only, 190 (4.9%) after PVI only, and 862 (22.5%) before and after PVI. In addition, 975 patients (25.5%) had never had the ABI performed. Statistical analysis of the entire cohort found no change in ambulation status (P = .33-.95 for all comparisons) or functional status (P = .42-.61 for all comparisons) regardless of the use of the ABI. However, a significant number of patients who had never had the ABI measured had decreased from full functional status before PVI to only being functional with light work after PVI (P = .015). CONCLUSIONS: Despite the grade 1, level A evidence, ABI had been used before and after PVI for only 22.5% of the patients who had undergone PVI for claudication. In addition, we found overall functional status had decreased significantly after PVI for those patients who had never had an ABI performed. Accurately identifying patients with claudication due to PAD using the ABI remains critically important before PVI. Given the lack of overall improvement in ambulation after PVI found in the present study, identifying the patients who will benefit from PVI to treat claudication remains elusive.

Access to chlamydia testing in remote and rural Scotland.

INTRODUCTION: The aim of this study was to assess access to sexual health care in remote and rural settings using Chlamydia testing as a focus by measuring the extent of Chlamydia testing and positivity across the Scottish Highlands in relation to the Scottish Index of Multiple Deprivation Quintile (SIMD) and Urban Rural 8-fold index (UR8). METHODS: Tests processed through Raigmore Hospital in Inverness, the main testing laboratory for microbiology tests in North and West and South and Mid Highlands, were studied. Where people are tested in relation to where they live was assessed, as well as the type of test they opt for. Also assessed was the rate of positivity in male and female patients in rural compared with urban settings using the Scottish Government UR8 and in relation to the SIMD. RESULTS: 9644 results were analysed. 77.2% of the results were for females and 22.4% for males. 8.1% of the results were positive and 84.4% were negative. There were proportionately more positive tests from the sexual health sources than from general practice. The proportion of men who had positive tests was almost double that for women (12.7% vs 6.6%) although men made up only 27.9% of the total number of tests. There was no significant difference in positivity when compared with UR8 index or SIMD. 37.7% of people living in the most rural areas (UR8 7-8) had their test performed in a more urban setting (UR8 1-6), and 20.4% people had their test performed in a very urban setting (UR8 1-2). Of these tests, there was a tendency for UR8 7-8 patients to be more likely to have a positive test if tested in an urban setting. CONCLUSIONS: These results are similar to previous results in other countries that suggest that Chlamydia positivity is similar in rural and urban settings. A large proportion of people living in more rurally classified areas, and perhaps those with a higher risk, have their test in a central setting, suggesting that they may be bypassing local resources to get a test. The reason for this is not clear. The results also show that men are more likely to have their test in a genitourinary setting as well as have proportionately more positive results. These results support the case for customising sexual health services to the most rural areas and suggest that providing an anonymous testing service in these areas might be beneficial, especially for men.

Preliminary outcomes of implementing cognitive processing therapy for posttraumatic stress disorder across a national veterans' treatment service.

BACKGROUND: Posttraumatic stress disorder (PTSD) is a significant problem for military veterans. There is an international imperative to improve access to effective treatments, but more research is needed to ascertain the extent to which treatments found to be efficacious in research settings translate to successful national implementation efforts. METHOD: This study reports the clinical outcomes for the first 100 clients treated following the implementation of cognitive processing therapy (CPT) across a national community-based veterans' mental health service that commenced in May 2012. The implementation included training and ongoing clinical supervision, leadership support, and updates to the service's data collection and intake system to support the delivery of CPT. The service implemented an intake screen (the Primary Care PTSD) that was used to allocate clients who screened positive for PTSD to CPT-trained therapists. An outcome measure for PTSD (the PTSD Checklist) was incorporated into the services' computerized records system. Clients who received CPT were assessed pretreatment and posttreatment. RESULTS: Statistically significant and clinically large improvements were found for self-reported PTSD (effect size = 1.01, P < .001). In addition, the study obtained high levels of treatment fidelity in the delivery of the CPT treatment. CONCLUSIONS: There is relatively little published research supporting the effectiveness of evidence-based PTSD treatments following national implementation efforts. This is the first study to systematically report CPT treatment outcomes from a national implementation effort, using service-based outcome monitoring data. Results indicate that when administered as part of routine clinical practice, CPT achieves large clinically significant improvements for PTSD comparable with those found in randomized controlled trials.

Stability of extemporaneously prepared oxandrolone oral suspensions.

PURPOSE: The stability of extemporaneously prepared oxandrolone oral suspensions was studied. METHODS: Oxandrolone oral suspension (1 mg/mL) was prepared using oxandrolone tablets, Ora-Plus, and either Ora-Sweet or Ora-Sweet SF. Three identical samples of each formulation were prepared and stored in 2-oz amber plastic bottles with child-resistant caps at room temperature (23-25 °C). After thorough but gentle shaking by hand to prevent foaming, a 1-mL sample was withdrawn from each of the six bottles, diluted with mobile phase to an expected concentration of 200 µg/mL, and assayed in duplicate by injecting 5 µL into the high-performance liquid chromatography system immediately after preparation and at 7, 14, 35, 60, and 90 days. The samples were examined for any change in color or pH on each day of analysis. The stability of the suspensions was determined by calculating the percentage of the initial oxandrolone concentration remaining on each test day. Stability was defined as the retention of at least 90% of the initial oxandrolone concentration. RESULTS: At least 98% of the original oxandrolone concentration remained in both formulations at the end of the 90-day study period. There was no appreciable change in odor, taste, color, or pH. Both suspensions remained white in color and sweet with no aftertaste throughout the study period. The oxandrolone was easily resuspended with gentle shaking. CONCLUSION: Extemporaneously prepared suspensions of oxandrolone 1 mg/mL in 1:1 mixtures of Ora-Plus and either Ora-Sweet or Ora-Sweet SF were stable for at least 90 days when stored in 2-oz amber plastic bottles at room temperature.

Public health framing of news regarding childhood obesity in the United States.

Five U.S. newspapers were searched for stories regarding childhood obesity. Of the 201 stories appearing in 1996, 2001, or 2006, 97 incorporated a public health frame (i.e., connects problem to the larger social and environmental context; exposes risk factors; includes information regarding preventatives and correctives). Significant risk factors were identified as unhealthy eating practices, lack of physical activity, and ads for junk food directed at children. Prevalent categories of preventatives and correctives focused on changes in diet, particularly in the home or in areas controlled by parents. Offered less frequently were suggestions regarding increases in physical activity. Consistent with previous research, the majority of both preventatives and correctives focused on individual-level as opposed to societal-level factors. Implications of these findings for the framing of news regarding childhood obesity are discussed.

Local and regional factors influence the structure of treehole metacommunities.

BACKGROUND: Abiotic and biotic factors in a local habitat may strongly impact the community residing within, but spatially structured metacommunities are also influenced by regional factors such as immigration and colonization. We used three years of monthly treehole census data to evaluate the relative influence of local and regional factors on our study system. RESULTS: Every species responded to at least one of three local environmental factors measured: water volume, leaf litter mass, and presence of a top predator. Several species were affected by water volume, and a non-exclusive group of species were influenced by leaf litter mass. Relative abundance of Aedes triseriatus was higher in treeholes with higher volumes of water, and relative abundances of three out of six other species were lower in treeholes with higher volumes of water. Leaf litter mass positively affected densities of Aedes triseriatus and relative abundance of several dipteran species. The density of the top predator, Toxorhynchites rutilus, affected the relative abundance of the two most common species, A. triseriatus and Culicoides guttipennis. Treeholes with T. rutilus had an average of two more species than treeholes without T. rutilus. We found little evidence of synchrony between pairs of treeholes, either spatially or temporally. There were high levels of spatial and temporal turnover, and spatial turnover increased with distance between patches. CONCLUSION: The strong effects of water volume, leaf litter mass, and presence of a top predator, along with the high temporal turnover strongly suggest that species presence and density are determined by local factors and changes in those factors over time. Both low water volume and high predator densities can eliminate populations in local patches, and those populations can recolonize patches when rain refills or predators exit treeholes. Population densities of the same species were not matched between pairs of treeholes, suggesting variation in local factors and limited dispersal. Distance effects on spatial turnover also support limitations to dispersal in the metacommunity, and we conclude that the weight of evidence favors a strong influence of local factors relative to regional factors.