Substance use among pregnant women in NSW prisons.

INTRODUCTION AND AIMS: Little is published about pregnant women in custody. Existing data on the prevalence of substance use among incarcerated pregnant women or their needs are scant. This study sought to determine the prevalence and characteristics of women with substance use histories who present to prison pregnant in New South Wales (NSW), Australia. DESIGN AND METHODS: A retrospective review of prison medical health records was completed for pregnant women entering New South Wales custodial settings between January 2020 and June 2021. RESULTS: We identified 158 prison receptions among 141 pregnant women (median age 28 years [IQR 25-33 years]), 42 % identified as Aboriginal or Torres Strait Islander. Eighty four percent of the women (n = 119) reported recent use of one or more than one substance and 36 % had injected drugs. The most commonly used substances were (meth)amphetamine (60 %), cannabis (40 %) and opioids (28 %). We found discrepancies between drug problems self-reported at reception screening on entry to prison and self-reported drug use collected during the subsequent drug and alcohol specialist assessment while incarcerated. Most (88 %) women described their current pregnancy as unplanned and half (52 %) were unaware they were pregnant before incarceration. CONCLUSIONS: These findings highlight the high prevalence of substance use in incarcerated pregnant women and that many women are unaware of their pregnancy prior to incarceration. Findings emphasize the importance of timely and appropriate drug and alcohol assessment and treatment to minimize harm for both the mother and foetus and also underscore the urgent need for enhanced access to contraception for these women.

Alcohol relapse prevention health care after alcohol withdrawal in New South Wales prisons, Australia: A patient file review.

INTRODUCTION: People who enter custody have complex health issues and comorbidities may include alcohol use disorders. We investigated clinical service provision and comorbidities recorded among individuals with a likely alcohol withdrawal syndrome within prison in New South Wales, Australia. METHODS: For this clinical case series review, electronic medical data were used to identify 50 people entering custody between August and November 2018 who likely had a treated alcohol withdrawal syndrome. We aimed for a 3:2 ratio of men and women, and a 1:1 ratio of Aboriginal and non-Aboriginal individuals. Data were extracted using a purposefully designed tool which included current alcohol withdrawal management, comorbidities and alcohol relapse prevention approaches used or recommended. RESULTS: Thirty-eight men and 12 women, of whom 22 were Aboriginal, were included. Twenty-nine individuals (58%) reported a history of medical comorbidities. Thirty-five (70%) reported using other substances and over half (60%) had a diagnosis of mental health disorders. Fourteen (28%) individuals had a record of receiving brief intervention and five (10%) of motivational interviewing. Twenty-three individuals (46%) were referred to and seen by drug and alcohol clinicians. Only seven (14%) of the sample had pre-release community care plans. DISCUSSION AND CONCLUSIONS: Individuals treated for an alcohol withdrawal syndrome in New South Wales prisons have a high prevalence of medical comorbidities and other substance use. Clinical interventions focused on alcohol withdrawal management, and relapse prevention interventions were not recorded for most individuals. Service innovation and expansion are needed to increase the provision of post-withdrawal management.

Health and correctional staff acceptability of depot buprenorphine in NSW prisons.

BACKGROUND: Provision of opioid agonist treatment (OAT) in custodial settings is resource-intensive and may be associated with diversion, non-medical use, and violence. A clinical trial of a new OAT, depot buprenorphine (the UNLOC-T study), provided the opportunity to obtain health and correctional staff perspectives regarding this treatment prior to widespread roll-out. METHODS: Sixteen focus groups with 52 participants were conducted, including 44 health staff (nurses, nurse practitioners, doctors, and operational staff) and eight correctional staff. RESULTS: Key challenges to providing OAT identified as potentially being addressed by depot buprenorphine included 1) patient access, 2) OAT program capacity, 3) treatment administration procedures, 4) medication diversion and other safety issues and, 5) impact on other service delivery. CONCLUSIONS: The introduction of depot buprenorphine into correctional settings was considered to have the potential to increase safety for patients, improve staff / patient relations and advance patient health outcomes via expanded treatment coverage and efficiencies gained through enhanced health service delivery. Support was almost universal from both correctional and health staff participating in this study. These findings build on emerging research regarding the positive impact of more flexible OAT programs and could be used to engage support for the implementation of depot buprenorphine from staff in other secure settings.

Treatment of opioid dependence with depot buprenorphine (CAM2038) in custodial settings.

BACKGROUND AND AIMS: Opioid agonist treatment is effective but resource intensive to administer safely in custodial settings, leading to significant under-treatment of opioid dependence in these settings world-wide. This study assessed the safety of subcutaneous slow-release depot buprenorphine in custody. DESIGN: Open-label, non-randomized trial. SETTING: Correctional centres in New South Wales, Australia. PARTICIPANTS: Sixty-seven men and women, aged ≥ 18 years of various security classifications with a diagnosis of moderate to severe DSM-5 opioid use disorder currently serving a custodial sentence of ≥ 6 months were recruited between November 2018 and July 2019. Patients not in opioid agonist treatment at recruitment commenced depot buprenorphine; patients already stable on oral methadone treatment were recruited to the comparison arm. INTERVENTION AND COMPARATOR: Depot buprenorphine (CAM2038 weekly for 4 weeks then monthly) and daily oral methadone. MEASUREMENTS: Safety was assessed by adverse event (AE) monitoring and physical examinations at every visit. Participants were administered a survey assessing self-reported diversion and substance use at baseline and weeks 4 and 16. FINDINGS: Retention in depot buprenorphine treatment was 92.3%. Ninety-four per cent of patients reported at least one adverse event, typically mild and transient. No diversion was identified. The prevalence of self-reported non-prescribed opioid use among depot buprenorphine patients decreased significantly between baseline (97%) and week 16 (12%, odds ratio = 0.0035, 95% confidence interval = 0.0007-0.018, P < 0.0001). CONCLUSIONS: This first study of depot buprenorphine in custodial settings showed treatment retention and outcomes comparable to those observed in community settings and for other opioid agonist treatment used in custodial settings, without increased risk of diversion.

Combined Electric and Acoustic Stimulation (EAS) in Children: Investigating Benefit Afforded by Bilateral Versus Unilateral Acoustic Hearing.

PURPOSE: Electric and acoustic stimulation (EAS) with preserved hearing in the implanted ear provides benefit for speech understanding, spatial hearing, and quality of life in adults. However, there is limited research on EAS outcomes in children. The aims of this study were to estimate the magnitude of EAS-related benefit on speech understanding in children with preserved acoustic hearing and to determine what role acoustic interaural time difference (ITD) sensitivity may have on said EAS benefit. METHODS: Six children with acoustic hearing preservation and 20 children with normal hearing (NH) were recruited to participate. Speech recognition was assessed via an eight-loudspeaker array with speech presented from one loudspeaker at 0 degree and restaurant noise from all other loudspeakers (45-315 degrees). ITD thresholds were measured for a 250-Hz signal presented acoustically via insert earphones. RESULTS: Only one EAS listener demonstrated significant benefit from bilateral acoustic hearing as compared with acoustic hearing from a single ear. ITD thresholds were poor in the range of 302 to 1000+ ms and were considerably poorer than ITD thresholds for the NH group. CONCLUSION: These data suggest that children with acoustic hearing preservation may not exhibit initial EAS benefit for speech recognition in semi-diffuse noise; however, because none exhibited a decrement in performance with bilateral acoustic stimulation, EAS fittings are recommended to provide binaural acoustic access allowing for EAS adaptation to binaural cues over time. Future research should address the emergence of EAS benefit, binaural cue sensitivity, and the role of EAS experience in children and adults.

Feasibility and acceptability of take-home naloxone for people released from prison in New South Wales, Australia.

INTRODUCTION AND AIMS: To assess the feasibility and acceptability of a take-home naloxone program for people with a history of opioid use released from prison in New South Wales, Australia. DESIGN AND METHODS: Cross-sectional interviews with people with a history of opioid use who were recently released from prison (n = 105), and semi-structured interviews with key clinical and operational staff of Justice Health and Forensic Mental Health Network and Corrective Services NSW (n = 9). RESULTS: Among people with a history of opioid use who had recently left prison, there was very high awareness of the elevated risk of overdose following release from prison (95%) and the potential for naloxone to reverse an opioid overdose (97%). Participants considered that their personal risk of overdose was low, despite ongoing opioid use being common. Participants were largely supportive of take-home naloxone, but the majority (83%) stated that proactively obtaining naloxone would be a low priority for them following release. Key informants were supportive of introducing naloxone training and supply and identified barriers to implementation, including adequate resourcing, identifying the population for training, and developing an appropriate model of training and implementation. DISCUSSION AND CONCLUSION: There was widespread support for naloxone training in custody and distribution at release among people recently released from prison and key stakeholders in health-care provision and prisons administration. As proactively accessing naloxone is a low priority for patients, naloxone supply at release may be more effective than programs that refer releasees to local pharmacies, but developing a sustainable supply model requires consideration of several barriers.

Effect of Microphone Configuration and Sound Source Location on Speech Recognition for Adult Cochlear Implant Users with Current-Generation Sound Processors.

BACKGROUND: Microphone location has been shown to influence speech recognition with a microphone placed at the entrance to the ear canal yielding higher levels of speech recognition than top-of-the-pinna placement. Although this work is currently influencing cochlear implant programming practices, prior studies were completed with previous-generation microphone and sound processor technology. Consequently, the applicability of prior studies to current clinical practice is unclear. PURPOSE: To investigate how microphone location (e.g., at the entrance to the ear canal, at the top of the pinna), speech-source location, and configuration (e.g., omnidirectional, directional) influence speech recognition for adult CI recipients with the latest in sound processor technology. RESEARCH DESIGN: Single-center prospective study using a within-subjects, repeated-measures design. STUDY SAMPLE: Eleven experienced adult Advanced Bionics cochlear implant recipients (five bilateral, six bimodal) using a Naída CI Q90 sound processor were recruited for this study. DATA COLLECTION AND ANALYSIS: Sentences were presented from a single loudspeaker at 65 dBA for source azimuths of 0°, 90°, or 270° with semidiffuse noise originating from the remaining loudspeakers in the R-SPACE array. Individualized signal-to-noise ratios were determined to obtain 50% correct in the unilateral cochlear implant condition with the signal at 0°. Performance was compared across the following microphone sources: T-Mic 2, integrated processor microphone (formerly behind-the-ear mic), processor microphone + T-Mic 2, and two types of beamforming: monaural, adaptive beamforming (UltraZoom) and binaural beamforming (StereoZoom). Repeated-measures analyses were completed for both speech recognition and microphone output for each microphone location and configuration as well as sound source location. A two-way analysis of variance using mic and azimuth as the independent variables and output for pink noise as the dependent variable was used to characterize the acoustic output characteristics of each microphone source. RESULTS: No significant differences in speech recognition across omnidirectional mic location at any source azimuth or listening condition were observed. Secondary findings were (1) omnidirectional microphone configurations afforded significantly higher speech recognition for conditions in which speech was directed to ± 90° (when compared with directional microphone configurations), (2) omnidirectional microphone output was significantly greater when the signal was presented off-axis, and (3) processor microphone output was significantly greater than T-Mic 2 when the sound originated from 0°, which contributed to better aided detection at 2 and 6 kHz with the processor microphone in this group. CONCLUSIONS: Unlike previous-generation microphones, we found no statistically significant effect of microphone location on speech recognition in noise from any source azimuth. Directional microphones significantly improved speech recognition in the most difficult listening environments.

Intraoperative Electrically Evoked Compound Action Potential (ECAP) Measurements in Traditional and Hearing Preservation Cochlear Implantation.

BACKGROUND: In current practice, the status of residual low-frequency acoustic hearing in hearing preservation cochlear implantation (CI) is unknown until activation two to three weeks postoperatively. The intraoperatively measured electrically evoked compound action potential (ECAP), a synchronous response from electrically stimulated auditory nerve fibers, is one of the first markers of auditory nerve function after cochlear implant surgery and such may provide information regarding the status of residual low-frequency acoustic hearing. PURPOSE: This study aimed to evaluate the relationship between intraoperative ECAP at the time of CI and presence of preoperative and postoperative low-frequency acoustic hearing. RESEARCH DESIGN: A retrospective case review. STUDY SAMPLE: Two hundred seventeen adult ears receiving CI (42 Advanced Bionics, 82 Cochlear, and 93 MED-EL implants). INTERVENTIONS: Intraoperative ECAP and CI. DATA COLLECTION AND ANALYSIS: ECAP measurements were obtained intraoperatively, whereas residual hearing data were obtained from postoperative CI activation audiogram. A linear mixed model test revealed no interaction effects for the following variables: manufacturer, electrode location (basal, middle, and apical), preoperative low-frequency pure-tone average (LFPTA), and postoperative LFPTA. The postoperative residual low-frequency hearing status was defined as preservation of unaided air conduction thresholds ≤90 dB at 250 Hz. Electrode location and hearing preservation data were analyzed individually for both the ECAP threshold and ECAP maximum amplitude using multiple t-tests, without assuming a consistent standard deviation between the groups, and with alpha correction. RESULTS: The maximum amplitude, in microvolts, was significantly higher throughout apical and middle regions of the cochlea in patients who had preserved low-frequency acoustic hearing as compared with those who did not have preserved hearing (p = 0.0001 and p = 0.0088, respectively). ECAP threshold, in microamperes, was significantly lower throughout the apical region of the cochlea in patients with preserved low-frequency acoustic hearing as compared with those without preserved hearing (p = 0.0099). Basal electrode maximum amplitudes and middle and basal electrode thresholds were not significantly correlated with postoperative low-frequency hearing. CONCLUSIONS: Apical and middle electrode maximum amplitudes and apical electrode thresholds detected through intraoperative ECAP measurements are significantly correlated with preservation of low-frequency acoustic hearing. This association may represent a potential immediate feedback mechanism for postoperative outcomes that can be applied to all CIs.

Determination of ochratoxin A in cocoa beans using immunoaffinity column cleanup with high-performance liquid chromatography.

A method was developed and validated for the determination of ochratoxin A (OTA), a fungal metabolite, in cocoa beans of high fat content. The sample was extracted by blending with a 1% sodium bicarbonate solution (pH 10) followed by ultrasonication, and the sample was defatted by treatment with a flocculant. The defatted sample was purified using immunoaffinity column chromatography, and OTA was detected using HPLC with fluorescence detection. The method was fully optimized, validated, and quality controlled using spike recovery analyses, with recoveries of 89-105% over spiking ranges of 320-2.5 ng/g with CV of analyses generally <10% over 4 consecutive years and an LOQ of 0.66 ng/g in cocoa bean samples. This method overcomes the problems posed by the high fat contents of cocoa and chocolate samples with a high degree of reliability.

The quality of life of elderly women who underwent radiofrequency ablation to treat breast cancer.

The purpose of this article is to explore the effects of radiofrequency ablation (RFA), an investigational treatment for breast cancer, on the quality of life of elderly women. For this descriptive phenomenological study, the authors interviewed 12 White women (aged 60-81 years) 4 months to 1 year after treatment and analyzed these interviews for common themes. They asked questions regarding the lived experience of RFA treatment and its effects on quality of life. Analyses focused on the effects of deciding to have the RFA treatment and the treatment itself. They found quality of life improved because the women felt empowered by (a) their decision to have the procedure, (b) knowing that the procedure might kill the tumor, (c) and feeling that they were contributing to cancer research. The level of support received from the medical team, family and friends, and other cancer survivors also improved participant quality of life.

Quality of life of patients who have undergone the Nuss procedure for pectus excavatum: Preliminary findings.

BACKGROUND/PURPOSE: The current project is a preliminary qualitative exploration of changes in quality of life of patients who have undergone the Nuss Procedure. The current study explores quality of life after surgical repair from the perspectives of both the patients and the parent(s) of the younger participants. METHODS: This research constitutes the first segment in a mixed-method longitudinal design. The author conducted semistructured interviews based on the Keith and Schalock's quality of life model. Five youth who have undergone the Nuss Procedure and the parent(s) of the 4 younger participants were included in the study for a total of 10 participants. Textual analysis has been carried out using Atlas.ti, a qualitative data analysis program that facilitates such activities as selecting, coding, and comparing textual segments. RESULTS: Results based on these preliminary data indicate that the patients interviewed had significant improvement in overall quality of life, which they attributed to the surgery. Specific examples of patients' expressions of improved self-confidence and renewed interest in physical activity are given. CONCLUSIONS: The Nuss Procedure is a minimally invasive surgical option for correcting pectus excavatum deformities that may make important contributions to patients' self-perceptions and quality of life. The participants in the current study expressed satisfaction with both the physical results of the surgery and with how it improved their overall quality of life. The authors recommend further prospective longitudinal research that assesses pre- and postsurgery psychosocial status and the maintenance of perceived quality of life changes.