A Statewide Evaluation of the Implementation of Evidence-Based Suicide Prevention Guidelines in Juvenile Detention Centers.

This study aimed to explore suicide prevention in juvenile detention centers by conducting a case study of one state. Qualitative data from semistructured interviews were synthesized from 10 juvenile detention centers. Analytical techniques included thematic and content analysis and the integration of quantitative information and qualitative themes to illustrate key differences in suicide prevention practices and center characteristics among facilities with varying frequencies of crisis stabilization calls and critical incidents. Although the use of many suicide prevention practices was reported across the sample, the quality with which those practices were implemented was highly variable. The analysis suggests that facilities with higher-quality implementation of suicide prevention practices may have had leaders who acknowledged that their facility plays a role in suicide prevention. Moreover, preliminary evidence suggests that the quality of suicide prevention implementation may be associated with the number of crisis stabilization calls and critical incidents (i.e., variables related to suicidality) a facility experiences. Clear conceptualization of a juvenile detention center's role in suicide prevention may lead to better outcomes in suicide prevention implementation. High-quality implementation may reduce suicidality exhibited by youths in juvenile detention and save lives.

Equitable suicide prevention for youth impacted by the juvenile legal system.

Suicide is the second leading cause of death for adolescents in the United States. Despite the already alarmingly high rates of suicide attempts among adolescents, youth involved in the juvenile legal system (JLS) are up to three times more likely to have suicide attempts than their peers not impacted by the JLS. This public health crisis is also a matter of health equity, knowing that ethnoracially minoritized youth, mainly Black and Latinx youth, have disproportionate contact with the JLS. In order to disrupt the current elevated rates of suicide among Black and Latinx youth involved in the JLS, there needs to be more concerted efforts to improve assessment and suicide prevention efforts in the JLS. There are various potential touch points of care for suicide prevention and the Sequential Intercept Model (SIM), which outlines community-based responses to the involvement of people with mental and substance use disorders in the criminal justice system, can be used as a strategic planning tool to outline possible equitable interventions across these various touch points. Our purpose is to provide a comprehensive picture of gaps and equitable opportunities for suicide prevention across each intercept of the SIM. We provide recommendations of priorities to promote health equity in suicide prevention for ethnoracially minoritized youth impacted by the JLS.

Harnessing quality improvement and implementation science to support the implementation of suicide prevention practices in juvenile detention.

Suicide is the second leading cause of death among 10- to 25-year-olds, and suicidal behavior is four times more likely among youth who enter juvenile justice settings. The current quality improvement work aimed to improve the use of suicide prevention practices in a behavioral health unit within a juvenile detention center and was informed by the Plan-Do-Study-Act method and the Exploration, Preparation, Implementation, and Sustainment model of evidence-based practice implementation. Aligned with guidelines for suicide prevention in juvenile detention, the quality improvement work resulted in the implementation of universal screening and assessment of behavioral health concerns and the Stanley and Brown Safety Planning Intervention. We review the quality improvement process, provide an overview of the final clinical model, including methods for tailoring and sustainably implementing the Safety Planning Intervention within juvenile detention, and end with a case example and future directions to expand the impact of this work. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Initial Experience with Topical Fluorouracil for Treatment of HIV-Associated Anal Intraepithelial Neoplasia.

Exposure to high-risk strains of human papillomavirus (HPV) promotes cellular dysplasia of the anal canal epithelium, potentially leading to anal intraepithelial neoplasia (AIN), which is in turn a precursor to invasive squamous cell carcinoma of the anus (SCCA). People with HIV infection who engage in anoreceptive intercourse are at heightened risk for acquiring HPV, AIN, and SCCA. Although intravenous 5-fluorouracil (5-FU) is commonly used for treatment of invasive SCCA, there has been little experience with the use of topical 5-FU as therapy for AIN. We retrospectively reviewed records of the first 11 HIV-positive patients treated with topical 5-FU in our anal dysplasia clinic. Six (55%) patients had clinical improvement with reduction in area of dysplasia seen on high-resolution anoscopy (HRA). Three (27%) patients had improvement in AIN pathologic grade. Eight (73%) patients reported mild-to-moderate perianal irritation, which led six to reduce the frequency of 5-FU application. Further study of topical 5-FU for treatment of HIV-associated AIN is warranted.

Tunable photochromism of spirooxazines via metal coordination.

Through the incorporation of a phenanthroline ligand into the oxazine moiety of photochromic spirooxazines, a series of photochromic spirooxazine-phenanthroline metal complexes have been synthesized, resulting in tunable and significantly increased photoresponsivities. Such systems are of interest for the investigation of multifunctional photochromic materials. These novel metal complexes retain their photochromic activity in the complexed state, leading to ligand binding in both the spirooxazine and the photomerocyanine forms during the photoconversion. A significant stabilization of the photomerocyanine form results from metal complexation, as indicated by the shift in thermal equilibrium values (KT = 0.06) upon metal complexation (KT = 0.6-1.2). Photoconversion occurs with first-order kinetics, suggesting the absence of an intermediate state. A third photostationary state is observed in these systems induced by visible irradiation of the thermal equilibrium state, leading to a three-state system. This new class of compounds provides the opportunity to investigate the synergy between changes in electronic structure associated with photoisomerization, and metal-centered functionality.