Diverting people who use drugs from the criminal justice system: A systematic review of police-based diversion measures.

BACKGROUND: Previous reviews of the effectiveness of measures to divert those who use drugs from the criminal justice system have focused mainly on post-conviction or post-sentence programs and report mixed results. The present systematic review synthesizes evidence on the effectiveness of police-based diversion measures in reducing criminal offenses and other harms related to drug use and then summarizes evidence from qualitative studies to identify facilitators and barriers associated with the implementation of such measures. METHODS: Eight databases were searched to find evaluations of police-based diversion measures for drug-related offenders. Twenty-seven studies were identified. The vote-count method and the Maryland Scientific Method Scale were used to assess the impact of police-based diversion measures. Themes related to barriers or conditions facilitating the implementation of these measures were extracted from qualitative studies. RESULTS: Evidence from quantitative studies indicates that in general police-based diversion measures are effective in preventing criminal offending and show promising results for improving participants' health and diminishing social costs as well as costs associated with processing drug-related offenses. There was insufficient evidence to draw conclusions about the effect of police-based diversion measures on drug use, drug accessibility, or changes in participants' socioeconomic conditions. Findings from qualitative studies suggest that program acceptance by police officers, constructive intersectoral collaboration, clear eligibility criteria, and timely access to services seem to facilitate the implementation and delivery of police-based diversion measures. CONCLUSION: Police-based diversion measures can be effective in preventing drug-related criminal offenses and harm. Additional research is needed to evaluate their effect on participants' socioeconomic conditions and drug use as well as drug accessibility.

A diffusion cell adapted to nuclear imaging instruments for the measurement of molecular release and pharmacokinetics across membranes.

Diffusion cells are routinely used in pharmacology to measure the permeation of pharmaceutical compounds and contaminants across membranes (biological or synthetic). They can also be used to study drug release from excipients. The device is made of a donor (DC) and an acceptor (AC) compartment, separated by a membrane. Usually, permeation of molecules across membranes is measured by sampling from the AC at different time points. However, this process disturbs the equilibrium of the cell. Furthermore, analytical techniques used in association with diffusion cells sometimes lack either accuracy, sensitivity, or both. This work reports on the development of nuclear imaging - compatible diffusion cells. The cell is made of a polymer transparent to high-energy photons typically detected in positron emission tomography (PET). It was tested in a finite-dose set-up experiment with a pre-clinical PET system. Porous cellulose membranes (3.5, 25 and 300 kDa), a common excipient in pharmacology, as well as for dialysis membranes, were used as test membranes. The radioisotope 89Zr chelated with deferoxamine B (DFO; 0.65 kDa), was used as an imaging probe (7-10 MBq; 0.2-0.3 nMol 89Zr-DFO). In medicine, DFO is also commonly used for iron removal treatments and pharmacological formulations often require the association of this molecule with cellulose. Permeation profiles were obtained by measuring the radioactivity in the DC and AC for up to 2 weeks. The kinetic profiles were used to extract lag time, influx, and diffusion coefficients of DFO across porous cellulose membranes. A sensitivity threshold of 0.005 MBq, or 3.4 fmol of 89Zr-DFO, was revealed. The lag time to permeation (τ) measured in the AC compartment, was found to be 1.33, 0.5, and 0.19 h with 3.5, 25, and 300 kDa membranes, respectively. Diffusion coefficients of 3.65 × 10-6, 8.33 × 10-6, and 4.74 × 10-5 cm2 h-1 where revealed, with maximal pseudo steady-state influx values (Jpss) of 6.55 × 10-6, 1.76 × 10-5, and 1.29 × 10-5 nmol cm-2 h-1. This study confirms the potential of the technology for monitoring molecular diffusion and release processes at low concentrations, high sensitivities, in real time and in a visual manner.

The utility of multi-stack alignment and 3D longitudinal image registration to assess bone remodeling in rheumatoid arthritis patients from second generation HR-pQCT scans.

BACKGROUND: Medical imaging plays an important role in determining the progression of joint damage in rheumatoid arthritis (RA). High resolution peripheral quantitative computed tomography (HR-pQCT) is a sensitive tool capable of evaluating bone microarchitecture and erosions, and 3D rigid image registration can be used to visualize and quantify bone remodeling over time. However, patient motion during image acquisition can cause a "stack shift" artifact resulting in loss of information and reducing the number of erosions that can be analyzed using HR-pQCT. The purpose of this study was to use image registration to improve the number of useable HR-pQCT scans and to apply image-based bone remodeling assessment to the metacarpophalangeal (MCP) joints of RA patients. METHODS: Ten participants with RA completed HR-pQCT scans of the 2nd and 3rd MCP joints at enrolment to the study and at a 6-month follow-up interval. At 6-months, an additional repeat scan was acquired to evaluate reliability. HR-pQCT images were acquired in three individual 1 cm acquisitions (stacks) with a 25% overlap. We completed analysis first using standard evaluation methods, and second with multi-stack registration. We assessed whether additional erosions could be evaluated after multi-stack registration. Bone remodeling analysis was completed using registration and transformation of baseline and follow-up images. We calculated the bone formation and resorption volume fractions with 6-month follow-up, and same-day repositioning as a negative control. RESULTS: 13/57 (23%) of erosions could not be analyzed from raw images due to a stack shift artifact. All erosions could be volumetrically assessed after multi-stack registration. We observed that there was a median bone formation fraction of 2.1% and resorption fraction of 3.8% in RA patients over the course of 6 months. In contrast to the same-day rescan negative control, we observed median bone formation and resorption fractions of 0%. CONCLUSIONS: Multi-stack image registration is a useful tool to improve the number of useable scans when analyzing erosions using HR-pQCT. Further, image registration can be used to longitudinally assess bone remodeling. These methods could be implemented in future studies to provide important pathophysiological information on the progression of bone damage.