Experiences and perceptions of conditional cash incentive provision and cessation among people with HIV for care engagement: A qualitative study.

Background: Consistent engagement in HIV treatment is needed for healthy outcomes, yet substantial loss-to-follow up persists, leading to increased morbidity, mortality and onward transmission risk. Although conditional cash transfers (CCTs) address structural barriers, recent findings suggest that incentive effects are time-limited, with cessation resulting in HIV care engagement deterioration. We explored incentive experiences, perceptions, and effects after cessation to investigate potential mechanisms of this observation. Methods: This qualitative study was nested within a larger trial, AdaPT-R (NCT02338739), focused on HIV care engagement in western Kenya. A subset of participants were purposively sampled from AdaPT-R participants: adults with HIV who had recently started ART, received CCTs for one year, completed one year of follow-up without missing a clinic visit, and were randomized to either continue or discontinue CCTs for one more year of follow-up. In-depth interviews were conducted by an experienced qualitative researcher using a semi-structed guide within a month of randomization. Interviews were conducted in the participants' preferred language (Dholuo, Kiswahili, English). Data on patient characteristics, randomization dates, and clinic visit dates to determine care lapses were extracted from the AdaPT-R database. A codebook was developed deductively based on the guide and inductively refined based on initial transcripts. Transcripts were coded using Dedoose software, and thematic saturation was identified. Results: Of 38 participants, 15 (39%) continued receiving incentives, while 23 (61%) were discontinued from receiving incentives. Half were female (N = 19), median age was 30 years (range: 19-48), and about three-quarters were married or living with partners. Both groups expressed high intrinsic motivation to engage in care, prioritized clinic attendance regardless of CCTs and felt the incentives expanded their decision-making options. Despite high motivation, some participants reported that cessation of the CCTs affected their ability to access care, especially those with constrained financial situations. Participants also expressed concerns that incentives might foster dependency. Conclusions: This study helps us better understand the durability of financial incentives for HIV care engagement, including when incentives end. Together with the quantitative findings in the parent AdaPT-R study, these results support the idea that careful consideration be exercised when implementing incentives for sustainable engagement effects.

Adaptive Strategies for Retention in Care among Persons Living with HIV.

BACKGROUND: Optimizing retention in human immunodeficiency virus (HIV) treatment may require sequential behavioral interventions based on patients' response. METHODS: In a sequential multiple assignment randomized trial in Kenya, we randomly assigned adults initiating HIV treatment to standard of care (SOC), Short Message Service (SMS) messages, or conditional cash transfers (CCT). Those with retention lapse (missed a clinic visit by ≥14 days) were randomly assigned again to standard-of-care outreach (SOC-Outreach), SMS+CCT, or peer navigation. Those randomly assigned to SMS or CCT who did not lapse after 1 year were randomly assigned again to either stop or continue the initial intervention. Primary outcomes were retention in care without an initial lapse, return to the clinic among those who lapsed, and time in care; secondary outcomes included adjudicated viral suppression. Average treatment effect (ATE) was calculated using targeted maximum likelihood estimation with adjustment for baseline characteristics at randomization and certain time-varying characteristics at rerandomization. RESULTS: Among 1809 participants, 79.7% of those randomly assigned to CCT (n=523/656), 71.7% to SMS (n=393/548), and 70.7% to SOC (n=428/605) were retained in care in the first year (ATE: 9.9%; 95% confidence interval [CI]: 5.4%, 14.4% and ATE: 4.2%; 95% CI: -0.7%, 9.2% for CCT and SMS compared with SOC, respectively). Among 312 participants with an initial lapse who were randomly assigned again, 69.1% who were randomly assigned to a navigator (n=76/110) returned, 69.5% randomly assigned to CCT+SMS (n=73/105) returned, and 55.7% randomly assigned to SOC-Outreach (n=54/97) returned (ATE: 14.1%; 95% CI: 0.6%, 27.6% and ATE: 11.4%; 95% CI: -2.2%, 24.9% for navigator and CCT+SMS compared with SOC-Outreach, respectively). Among participants without lapse on SMS, continuing SMS did not affect retention (n=122/180; 67.8% retained) versus stopping (n=151/209; 72.2% retained; ATE: -4.4%; 95% CI: -16.6%, 7.9%). Among participants without lapse on CCT, those continuing CCT had higher retention (n=192/230; 83.5% retained) than those stopping (n=173/287; 60.3% retained; ATE: 28.6%; 95% CI: 19.9%, 37.3%). Among 15 sequenced strategies, initial CCT, escalated to navigator if lapse occurred and continued if no lapse occurred, increased time in care (ATE: 7.2%, 95% CI: 3.7%, 10.7%) and viral suppression (ATE: 8.2%, 95% CI: 2.2%, 14.2%), the most compared with SOC throughout. Initial SMS escalated to navigator if lapse occurred, and otherwise continued, showed similar effect sizes compared with SOC throughout. CONCLUSIONS: Active interventions to prevent retention lapses followed by navigation for those who lapse and maintenance of initial intervention for those without lapse resulted in best overall retention and viral suppression among the strategies studied. Among those who remained in care, discontinuation of CCT, but not SMS, compromised retention and suppression. (Funded by National Institutes of Health grants R01 MH104123, K24 AI134413, and R01 AI074345; ClinicalTrials.gov number, NCT02338739.).

Urban biodiversity: Cuterebriasis in free-ranging Robinson's mouse opossum (Marmosa robinsoni) in the suburbs of Barranquilla, Colombia.

The tropical dry forest is one of the world's most threatened ecosystems and is the habitat of the Robinson's Mouse Opossum (Marmosa robinsoni), a small marsupial within the Didelphidae family. This study aimed to describe cases of cuterebriases in free-ranging M. robinsoni by examining individuals caught in live animal traps. Sherman traps were deployed in four different sites over three different periods in five days. All animals passed through biometry, weighing, sampling parasites, and sampling feces. Only animals captured in the study site located close to the city were anesthetized and examined. The evaluation included blood samples and a clinical examination. Animals received anesthesia under physical restraint by intramuscular injections of ketamine and xylazine. For anesthetic reversion, the protocol was Yohimbine administered before release. In total, 8% (5/60) of all captured animals had fly larvae extracted from wounds. The molecular Barcode of the mitochondrial Cytochrome Oxidase I gene showed no match with any recognized species of Cuterebra. The animals weighed from 35 to 80 g and had lesions in the scapular region with parasites under their skin in sizes ranging from 1.3 to 2.2 cm. The animals with parasites were in good physical condition without evidence of disturbances in health conditions. This is compatible with literature, reporting little effect on population dynamics of other host species infected with Cuterebra larvae. The study included 24 animals captured in three areas far from any city, which showed no evidence of cuterebrid infection, suggesting that proximity to the city could increase exposure to cuterebriasis. There are reports of cuterebrids in M. robinsoni in Brazil; however, this is the first report of cuterebriasis in M. robinsoni in Colombia.

Adapt for Adolescents: Protocol for a sequential multiple assignment randomized trial to improve retention and viral suppression among adolescents and young adults living with HIV in Kenya.

BACKGROUND: Adolescents and young adults living with HIV (AYAH) aged 14-24 years in Africa experience substantially higher rates of virological failure and HIV-related mortality than adults. We propose to utilize developmentally appropriate interventions with high potential for effectiveness, tailored by AYAH pre-implementation, in a sequential multiple assignment randomized trial (SMART) aimed at improving viral suppression for AYAH in Kenya. METHODS: Using a SMART design, we will randomize 880 AYAH in Kisumu, Kenya to either youth-centered education and counseling (standard of care) or electronic peer navigation in which a peer provides support, information, and counseling via phone and automated monthly text messages. Those with a lapse in engagement (defined as either a missed clinic visit by ≥14 days or HIV viral load ≥1000 copies/ml) will be randomized a second time to one of three higher-intensity re-engagement interventions: This study will evaluate which interventions and which dynamic sequence of interventions improve sustained viral suppression and HIV care engagement in AYAH at 24 months post-enrollment and assess the cost-effectiveness of successful strategies. DISCUSSION: The study utilizes promising interventions tailored to AYAH while optimizing resources by intensifying services only for those AYAH who need more support. Findings from this innovative study will offer evidence for public health programming to end the HIV epidemic as a public health threat for AYAH in Africa. TRIAL REGISTRATION: Clinicaltrials.govNCT04432571, registered June 16, 2020.

Efficient and robust approaches for analysis of sequential multiple assignment randomized trials: Illustration using the ADAPT-R trial.

Personalized intervention strategies, in particular those that modify treatment based on a participant's own response, are a core component of precision medicine approaches. Sequential multiple assignment randomized trials (SMARTs) are growing in popularity and are specifically designed to facilitate the evaluation of sequential adaptive strategies, in particular those embedded within the SMART. Advances in efficient estimation approaches that are able to incorporate machine learning while retaining valid inference can allow for more precise estimates of the effectiveness of these embedded regimes. However, to the best of our knowledge, such approaches have not yet been applied as the primary analysis in SMART trials. In this paper, we present a robust and efficient approach using targeted maximum likelihood estimation (TMLE) for estimating and contrasting expected outcomes under the dynamic regimes embedded in a SMART, together with generating simultaneous confidence intervals for the resulting estimates. We contrast this method with two alternatives (G-computation and inverse probability weighting estimators). The precision gains and robust inference achievable through the use of TMLE to evaluate the effects of embedded regimes are illustrated using both outcome-blind simulations and a real-data analysis from the Adaptive Strategies for Preventing and Treating Lapses of Retention in Human Immunodeficiency Virus (HIV) Care (ADAPT-R) trial (NCT02338739), a SMART with a primary aim of identifying strategies to improve retention in HIV care among people living with HIV in sub-Saharan Africa.

Estimators for the value of the optimal dynamic treatment rule with application to criminal justice interventions.

Given an (optimal) dynamic treatment rule, it may be of interest to evaluate that rule - that is, to ask the causal question: what is the expected outcome had every subject received treatment according to that rule? In this paper, we study the performance of estimators that approximate the true value of: (1) an a priori known dynamic treatment rule (2) the true, unknown optimal dynamic treatment rule (ODTR); (3) an estimated ODTR, a so-called "data-adaptive parameter," whose true value depends on the sample. Using simulations of point-treatment data, we specifically investigate: (1) the impact of increasingly data-adaptive estimation of nuisance parameters and/or of the ODTR on performance; (2) the potential for improved efficiency and bias reduction through the use of semiparametric efficient estimators; and, (3) the importance of sample splitting based on the cross-validated targeted maximum likelihood estimator (CV-TMLE) for accurate inference. In the simulations considered, there was very little cost and many benefits to using CV-TMLE to estimate the value of the true and estimated ODTR; importantly, and in contrast to non cross-validated estimators, the performance of CV-TMLE was maintained even when highly data-adaptive algorithms were used to estimate both nuisance parameters and the ODTR. In addition, we apply these estimators for the value of the rule to the "Interventions" study, an ongoing randomized controlled trial, to identify whether assigning cognitive behavioral therapy (CBT) to criminal justice-involved adults with mental illness using an ODTR significantly reduces the probability of recidivism, compared to assigning CBT in a non-individualized way.

The optimal dynamic treatment rule superlearner: considerations, performance, and application to criminal justice interventions.

The optimal dynamic treatment rule (ODTR) framework offers an approach for understanding which kinds of patients respond best to specific treatments - in other words, treatment effect heterogeneity. Recently, there has been a proliferation of methods for estimating the ODTR. One such method is an extension of the SuperLearner algorithm - an ensemble method to optimally combine candidate algorithms extensively used in prediction problems - to ODTRs. Following the ``causal roadmap," we causally and statistically define the ODTR and provide an introduction to estimating it using the ODTR SuperLearner. Additionally, we highlight practical choices when implementing the algorithm, including choice of candidate algorithms, metalearners to combine the candidates, and risk functions to select the best combination of algorithms. Using simulations, we illustrate how estimating the ODTR using this SuperLearner approach can uncover treatment effect heterogeneity more effectively than traditional approaches based on fitting a parametric regression of the outcome on the treatment, covariates and treatment-covariate interactions. We investigate the implications of choices in implementing an ODTR SuperLearner at various sample sizes. Our results show the advantages of: (1) including a combination of both flexible machine learning algorithms and simple parametric estimators in the library of candidate algorithms; (2) using an ensemble metalearner to combine candidates rather than selecting only the best-performing candidate; (3) using the mean outcome under the rule as a risk function. Finally, we apply the ODTR SuperLearner to the ``Interventions" study, an ongoing randomized controlled trial, to identify which justice-involved adults with mental illness benefit most from cognitive behavioral therapy to reduce criminal re-offending.

AI Estimation of Gestational Age from Blind Ultrasound Sweeps in Low-Resource Settings.

BACKGROUND: Ultrasound is indispensable to gestational age estimation and thus to quality obstetrical care, yet high equipment cost and the need for trained sonographers limit its use in low-resource settings. METHODS: From September 2018 through June 2021, we recruited 4695 pregnant volunteers in North Carolina and Zambia and obtained blind ultrasound sweeps (cineloop videos) of the gravid abdomen alongside standard fetal biometry. We trained a neural network to estimate gestational age from the sweeps and, in three test data sets, assessed the performance of the artificial intelligence (AI) model and biometry against previously established gestational age. RESULTS: In our main test set, the mean absolute error (MAE) (±SE) was 3.9±0.12 days for the model versus 4.7±0.15 days for biometry (difference, -0.8 days; 95% confidence interval [CI], -1.1 to -0.5; P<0.001). The results were similar in North Carolina (difference, -0.6 days; 95% CI, -0.9 to -0.2) and Zambia (-1.0 days; 95% CI, -1.5 to -0.5). Findings were supported in the test set of women who conceived by in vitro fertilization (MAE of 2.8±0.28 vs. 3.6±0.53 days for the model vs. biometry; difference, -0.8 days; 95% CI, -1.7 to 0.2) and in the set of women from whom sweeps were collected by untrained users with low-cost, battery-powered devices (MAE of 4.9±0.29 vs. 5.4±0.28 days for the model vs. biometry; difference, -0.6; 95% CI, -1.3 to 0.1). CONCLUSIONS: When provided blindly obtained ultrasound sweeps of the gravid abdomen, our AI model estimated gestational age with accuracy similar to that of trained sonographers conducting standard fetal biometry. Model performance appears to extend to blind sweeps collected by untrained providers in Zambia using low-cost devices. (Funded by the Bill and Melinda Gates Foundation.).

Attitudes towards and experiences with economic incentives for engagement in HIV care and treatment: Qualitative insights from a randomized trial in Kenya.

Growing literature has shown heterogenous effects of conditional cash incentives (CCIs) on HIV care retention. The field lacks insights into reasons why incentives impact various patients in different ways-differences that may be due to variations in psychological and social mechanisms of effect. A deeper understanding of patients' perceptions and experiences of CCIs for retention may help to clarify these mechanisms. We conducted a qualitative study embedded in the ADAPT-R trial (NCT#02338739), a sequential multiple assignment randomized trial (SMART) that evaluated economic incentives to support retention in HIV care among persons living with HIV (PLHIV) initiating antiretroviral therapy in Kenya. Participants who attended their scheduled clinic visits received an incentive of approximately $4 each visit. Interviews were conducted between July 2016 and June 2017 with 39 participants to explore attitudes and experiences with economic incentives conditional on care engagement. Analyses revealed that incentives helped PLHIV prioritize care-seeking by alleviating transport barriers and food insecurity: "I decided to forgo [work] and attend clinic […] the voucher relieved me". Patients who borrowed money for care-seeking reported feeling relieved from the burden of indebtedness to others: "I borrow with confidence that I will pay after my appointment." Incentives fostered their autonomy, and enabled them to support others: "I used the money to buy some clothes and Pampers for the children." Participants who were intrinsically motivated to engage in care ("my life depends on the drugs, not the incentive"), and those who mistrusted researchers, reported being less prompted by the incentive itself. For patients not already prioritizing care-seeking, incentives facilitated care engagement through alleviating transport costs, indebtedness and food insecurity, and also supported social role fulfillment. Conditional cash incentives may be an important cue to action to improve progression through the HIV treatment cascade, and contribute to better care retention.

Frecuencia de helmintos gastrointestinales en roedores sinantrópicos capturados en el Zoológico de Barranquilla

RESUMEN Objetivo. El objetivo del presente trabajo fue describir la frecuencia y caracterización de parásitos gastrointestinales en roedores sinantrópicos capturados en el Zoológico de Barranquilla. Materiales y métodos. Para la captura de los roedores se utilizaron trampas Tomahawk con ayuda de cebos no tóxicos, y posteriormente los individuos capturados fueron sacrificados mediante la inhalación de ¡soflurano. El diagnóstico e identificación de parásitos en el contenido intestinal fue realizado mediante las técnicas de examen directo en NaCl (0.9%), flotación Sheather modificada y sedimentación Ritchie modificada. Resultados. Un total de 34 roedores (Rattus rattus) fueron capturados, en los cuales la frecuencia de infección fue de 82.4% (IC 95% = 68.8-95.8%, 28/34). Los parásitos descritos con mayor frecuencia fueron los nematodos (63.2%, IC 95% = 49.2-77.2%, 31/49), seguido de los protozoos (20.4%, IC 95% = 8.7-32.1%, 10/49) y cestodos (16.3%, IC 95% =5.6-27%, 8/49), con diferencias significativas entre los tres grupos (x2=20.7, p<0.0l). Dentro de los nematodos, la familia encontrada con mayor frecuencia fue la Strongylidae (24/31), seguida de la Ascarididae (4/31), Ancylostomatidae (1/31), Oxyuridae (1/31) y Trichostrongylidae (1/31); para el caso de los protozoos, fueron la Eimeriidae (6/10) y Entamoebidae (4/10), mientras para los cestodos fue la Hymenolepididae (8/8). Conclusiones. La especie R. rattus fue la única especie de roedor sinantrópico capturada en el Zoológico de Barranquilla, la cual al encontrarce infectada con diversas especies de parásitos gastrointestinales, debe ser considerada un factor de riesgo para la transmisión de estos parásitos hacia personas y otros animales en el zoológico.

ABSTRACT Objective. The aim of this work was to characterize and describe the frequency of the gastrointestinal parasites in synanthropic rodents captured at the Barranquilla Zoo. Materials and methods. The rodents were captured using Tomahawk traps with the help of non-toxic bait and subsequently sacrificed by isoflurane inhalation. The diagnosis and identification of parasites in the intestinal contents was performed using direct examination in NaCl (0.9%), modified Sheather's flotation, and modified Ritchie's sedimentation techniques. Results. A total of 34 rodents (Rattus rattus) were captured, with an infection frequency of 82.4% (95% CI = 68.8%-95.8%, 28/34). The most prevalent parasites were nematodes (63.2%, 95% CI = 49.2%-77.2%, 31/49), followed by protozoans (20.4%, 95% CI = 8.7%-32.1%, 10/49) and cestodes (16.3%, 95% CI = 5.6%-27%, 8/49), with significant differences between the three groups (x2 = 20.7, p<0.01). Among the nematodes, Strongylidae was the most prevalent family (24/31), followed by Ascarididae (4/31), Ancylostomatidae (1/31), Oxyuridae (1/31), and Trichostrongylidae (1/31); for the protozoans, the most prevalent families were Eimeriidae (6/10) and Entamoebidae (4/10), and for the cestodes, the only family found was the Hymenolepididae (8/8) family. Conclusions. The R. rattus species was the only species of synanthropic rodents caught in the Barranquilla Zoo; because it was infected with various species of gastrointestinal parasites, it should be considered a risk factor for the transmission of these parasites to humans and other animals in the zoo.

Using Positive Emotion Training With Maltreated Youths to Reduce Anger Bias and Physical Aggression.

Maltreated youths often overinterpret anger in others' emotional expressions, particularly expressions that are ambiguous, and this "anger bias" is associated with aggressive behavior. In the current experiment, we tested the effect of an emotion-training intervention on anger bias and subsequent aggression. Eighty-four youths, ages 8 to 17, who had been removed from home because of maltreatment and had screened positive for aggressive tendencies, served as participants. Over 4 days, youths completed positive emotion training, a computerized program in which youths classify emotional expressions. Youths in the treatment condition received feedback to encourage their recognition of happiness over anger in ambiguous expressions. Physical aggression up to 1 week posttraining was assessed on the basis of self- and staff reports. The intervention was effective in reducing youths' anger bias and somewhat so in reducing aggression-the latter of-which occurred infrequently, limiting power. Results offer direction for developmental research and cost-effective interventions for maltreated youths at risk for aggression and future justice-system involvement.

Comparing Costs of Traditional and Specialty Probation for People With Serious Mental Illness.

OBJECTIVE: Specialty mental health probation reduces the likelihood of rearrest for people with mental illness, who are overrepresented in the justice system. This study tested whether specialty probation was associated with lower costs than traditional probation during the two years after placement in probation. METHODS: A longitudinal, matched study compared costs of behavioral health care and criminal justice contacts among 359 probationers with mental illness at prototypic specialty or traditional agencies. Compared with traditional officers, specialty officers supervised smaller caseloads, established better relationships with supervisees, and participated more in treatment. Participants and officers were interviewed, and administrative databases were integrated to capture service use and criminal justice contacts. Unit costs were attached to these data to estimate costs incurred by each participant over two years. Cost differences were estimated by using machine-learning algorithms combined with targeted maximum-likelihood estimation (TMLE), a double-robust estimator that accounts for associations between confounders and both treatment assignment and outcomes. RESULTS: Specialty probation cost $11,826 (p<.001) less per participant than traditional probation, with overall savings of about 51%. Specialty and traditional probation did not differ in criminal justice costs because the additional costs for supervision of specialty caseloads were offset by reduced recidivism. However, for behavioral health care, specialty probation cost an estimated $14,049 (p<.001) less per client than traditional probation. Greater outpatient costs were more than offset by reduced emergency, inpatient, and residential costs. CONCLUSIONS: Well-implemented specialty probation yielded substantial savings-and should be considered in justice reform efforts for people with mental illness.

Prenatal buprenorphine exposure and neonatal neurobehavioral functioning.

AIMS: Assessments of effects of prenatal opioid exposure on the neonate have consisted principally of evaluations of neonatal abstinence syndrome (NAS) to determine the need for pharmacotherapy. The purpose of this study was to comprehensively evaluate the effects of gestational maternal buprenorphine maintenance on newborn neurobehavioral functioning. STUDY DESIGN: Maternal substance use history and psychosocial demographics that can contribute to the neurobehavioral functioning of the infant were explored. Infants were assessed using the NICU Network Neurobehavioral Scale (NNNS) to measure their neurologic and behavioral functioning and signs of stress/abstinence on days 3, 14 and 30 of life. SUBJECTS: Participants were 41 pregnant buprenorphine-maintained women and their infants. RESULTS: Maternal buprenorphine dose at delivery was negatively correlated with infant quality of movement and self-regulation, and positively correlated with the central nervous system parameters of stress/abstinence at day 3 of life. As maternal buprenorphine dose increased, the mean morphine dose that the infant required for NAS treatment significantly increased. No differences were found when comparing the NNNS domain scores between infants who required pharmacotherapy for NAS versus those who did not at day 3 of life. CONCLUSIONS: Buprenorphine exposure during pregnancy can alter neonatal neurobehavioral and physiological responses to stimuli. A systematic evaluation of the newborn's functional domains above NAS assessment alone is crucial to address the challenges created by neurobehavioral dysregulation associated with substance exposure, improve caregiver/infant interaction and developmental trajectory. Comprehensive pre/postnatal treatment of buprenorphine-maintained mothers can lead to healthier outcomes for the dyad.

Comparing Public Safety Outcomes for Traditional Probation vs Specialty Mental Health Probation.

Importance: Probation is a cornerstone of efforts to reduce mass incarceration. Although it is understudied, specialty probation could improve outcomes for the overrepresented group of people with mental illness. Objective: To test whether specialty probation yields better public safety outcomes than traditional probation. Design, Setting, and Participants: A longitudinal observational study with group matching on age, sex, race/ethnicity, probation time, and offense at 2 urban agencies that exemplify specialty and traditional probation. Enrollment began October 19, 2005; follow-up data were complete January 26, 2013. Participants were 359 diverse probationers with serious mental health problems and functional impairment. Probationers and officers were assessed 3 times (for probationers, 6-month retention, 315 of 359 [88%]; 12-month retention 304 of 359 [85%]) and follow-up records were obtained. Machine learning algorithms were combined with a targeted maximum likelihood estimation, a double robust estimator that accounts for associations between confounders and both treatment assignment and outcomes. Statistical analysis was conducted from January 1, 2016 to May 5, 2017. Interventions: Specialty probationers were assigned to small, homogeneous caseloads supervised by experts. Prior data indicate that specialty officers had better relationships with probationers, participated more in probationers' treatment, and relied more on positive compliance strategies than traditional officers. Main Outcomes and Measures: Violence during 1 year, determined by probationer report, officer report, and records, and rearrest during a period of 2 to 5 years, according to Federal Bureau of Investigation records. Results: Participants were 183 specialty (73.8% of 248 eligible) and 176 traditional (56.6% of 311 eligible) probationers (205 men and 154 women; mean [SD] age, 36.9 [10.6]). Although specialty probation had no significant effect on violence (odds ratio, 0.97; 95% CI, 0.69-1.36), the odds of rearrest were 2.68 times higher for traditional probationers than for specialty probationers (95% CI, 1.86-3.84; P < .001). At 2 years, estimated probabilities of rearrest were 28.6% for specialty probationers and 51.8% for traditional probationers. Survival analyses indicate that arrest effects endured up to 5 years. Conclusions and Relevance: Although it did not specifically reduce violence, well-implemented specialty probation appears to be effective in reducing general recidivism. Reform efforts for people with mental illness could leverage probation-a ubiquitous and revitalized node of the justice system.

Looking to the eyes influences the processing of emotion on face-sensitive event-related potentials in 7-month-old infants.

Previous studies in infants have shown that face-sensitive components of the ongoing electroencephalogram (the event-related potential, or ERP) are larger in amplitude to negative emotions (e.g., fear, anger) versus positive emotions (e.g., happy). However, it is still unclear whether the negative emotions linked with the face or the negative emotions alone contribute to these amplitude differences. We simultaneously recorded infant looking behaviors (via eye-tracking) and face-sensitive ERPs while 7-month-old infants viewed human faces or animals displaying happy, fear, or angry expressions. We observed that the amplitude of the N290 was greater (i.e., more negative) to angry animals compared to happy or fearful animals; no such differences were obtained for human faces. Eye-tracking data highlighted the importance of the eye region in processing emotional human faces. Infants that spent more time looking to the eye region of human faces showing fearful or angry expressions had greater N290 or P400 amplitudes, respectively.

Calidad de vida relacionada con la salud en pacientes con diagnóstico de hipertensión arterial leve / Quality of life related to health and its relation in patients with diagnostic of slight arterial hypertension

El propósito de esta investigación fue evaluar las dimensiones de la calidad de vida relacionadas con la salud en 282 pacientes con hipertensión arterial leve de la ciudad de Medellín, Colombia. Se utilizó el Cuestionario de Calidad de Vida en Hipertensión Arterial (CHAL). Los resultados evidenciaron un cierto deterioro en la calidad de vida de estos pacientes en lo que concierne al estado de ánimo y principalmente en sus manifestaciones somáticas.

The purpose of this investigation was to evaluate the extent of quality of life related to health in 282 patients with slight arterial hypertension from the city of Medellin, Colombia. The questionnaire Quality of Life Hypertension (CHAL) was used. The results demonstrated an important deterioration in the quality of life of these patients at level of the state mind and mainly in his somatic manifestations.

Comparación de dos pilares protésicos para un implante único anterior / Clinical report: comparation between two prosthetic abutments for an anterior single-tooth implant

Existe en la actualidad una alta demanda no sólo funcional sino estética por parte de los pacientescomo de los profesionales. Por eso los implantes brindan hoy la oportunidad de conseguir ambosresultados. La ausencia de simetría y armonía gingival pone el resultado estético del implanteen riesgo. Sin embargo no depende sólo de la intacta oseintegración que haya con el huesosubyacente y de la capacidad de carga funcional, sino también de la integración armónica de lacorona en el arco dental. En el segmento anterior, los implantes necesitan altos requerimientosquirúrgicos y protésicos. Para lograrlos, se debe tener mucho cuidado en el proceso que ademásde ser exigente y cuidadoso, obliga a tener en cuenta que no debe haber cambio en el huesoo en el tejido blando subyacente. En dos pacientes del posgrado de Rehabilitación del CES, secomparó la utilización de dos pilares protésicos Nobel biocare diferentes (un pilar Easy abutmenty un pilar Procera personalizado de circonio), colocados sobre implantes groovy de igual tamaño(4.3 x 13mm), cuyos principales resultados fueron: una mejor cicatrización del tejido blando sobreel pilar (Easy Abutment), proporcionando una mejor estabilidad en el margen óseo cortical, unmenor costo del procedimiento tanto quirúrgico como de laboratorio, en la utilización del pilar EasyAbutment, sin embargo el resultado final estético y funcional dejó satisfechos a ambos pacientes,aunque el margen gingival libre en ambos casos migró apicalmente 0.5mm...

Currently, patients and professionals highly demand not only functional but also aestheticallyharmonious implants. The lack of gingival symmetry and harmony risk the aesthetic result of theimplant. Nevertheless, this result depends not only on the intact integration with the underlyingbone and the capacity of functional load, but also on the harmonic integration of the crown inthe dental arch. In the anterior segment implants are subject to precise surgical and prostheticrequirements. Achieving an ideal aesthetic result in the replacement of a single tooth with animplant in the anterior zone is a highly demanding and careful process, in which bony or soft tissuedefects are unacceptable. This article reports two patients who attended the Oral RehabilitationPosgraduate Program at CES University Dental School; two different Nobel Biocare prostheticabutments were compared -Easy Abutment and a Zircon Personalized Procera Abutment-, placedon groovy implants of the same size. Results indicated that with the Easy Abutment there wasbetter soft tissue healing process, improved stability of the bony cortical margin and lower surgicaland laboratory costs. The final aesthetic and functional results however were satisfactory for bothpatients, although the gingival margin free in both cases migrated apically 0.5mm...