"It's just us sitting there for 23 hours like we done something wrong": Isolation, incarceration, and the COVID-19 pandemic.

For the millions of people incarcerated in United States' prisons and jails during the COVID-19 pandemic, isolation took many forms, including medical isolation for those sick with COVID-19, quarantine for those potentially exposed, and prolonged facility-wide lockdowns. Incarcerated people's lived experience of isolation during the pandemic has largely gone undocumented. Through interviews with 48 incarcerated people and 27 staff at two jails and one prison in geographically diverse locations in the United States, we document the implementation of COVID-19 isolation policies from the perspective of those that live and work in carceral settings. Incarcerated people were isolated from social contact, educational programs, employment, and recreation, and lacked clear communication about COVID-19-related protocols. Being isolated, no matter the reason, felt like punishment and was compared to solitary confinement-with resultant long-term, negative impacts on health. Participants detailed isolation policies as disruptive, detrimental to mental health, and dehumanizing for incarcerated people. Findings point to several recommendations for isolation policy in carceral settings. These include integrating healthcare delivery into isolation protocols, preserving social relationships during isolation, promoting bidirectional communication about protocols and their effect between facility leadership and incarcerated people. Most importantly, there is an urgent need to re-evaluate the current approach to the use of isolation in carceral settings and to establish external oversight procedures for its use during pandemics.

Stakeholder-driven development and implementation of CRICIT: an app to support high-quality data capture and protocol monitoring for outpatient clinical trials with vulnerable populations.

Introduction: Choosing an appropriate electronic data capture system (EDC) is a critical decision for all randomized controlled trials (RCT). In this paper, we document our process for developing and implementing an EDC for a multisite RCT evaluating the efficacy and implementation of an enhanced primary care model for individuals with opioid use disorder who are returning to the community from incarceration. Methods: Informed by the Knowledge-to-Action conceptual framework and user-centered design principles, we used Claris Filemaker software to design and implement CRICIT, a novel EDC that could meet the varied needs of the many stakeholders involved in our study. Results: CRICIT was deployed in May 2021 and has been continuously iterated and adapted since. CRICIT's features include extensive participant tracking capabilities, site-specific adaptability, integrated randomization protocols, and the ability to generate both site-specific and study-wide summary reports. Conclusions: CRICIT is highly customizable, adaptable, and secure. Its implementation has enhanced the quality of the study's data, increased fidelity to a complicated research protocol, and reduced research staff's administrative burden. CRICIT and similar systems have the potential to streamline research activities and contribute to the efficient collection and utilization of clinical research data.

Postpartum contraceptive choice and fulfillment in patients with opioid use disorder.

OBJECTIVE: We examined the differences in postpartum contraception between patients with and without opioid use disorder (OUD). STUDY DESIGN: We conducted a retrospective, single-institution, cohort analysis assessing differences in desired method of postpartum contraception and plan fulfillment. RESULTS: Patients with OUD comprised 200/8654 (2.3%) of our study cohort. After 2:1 matching, method desired (matched odds ratio [mOR] 0.86, 95% confidence interval [CI] 0.60-1.23 for highly vs. moderately effective) and receipt (mOR 0.77, 95% CI 0.53-1.12) of desired method were comparable between groups. CONCLUSION: Patients with and without OUD were similar in their choice and fulfillment of postpartum contraception.

Response to substance use during hospitalization: A survey study of current and ideal policies and practices.

People may use nonprescribed substances during an acute hospitalization. Hospital policies and responses can be stigmatizing, involve law enforcement, and lead to worse patient outcomes, including patient-directed discharge. In the United States, there is currently little data on hospital policies that address the use of substances during hospitalization. In this cross-sectional study, we surveyed clinicians at US hospitals with Accreditation Council of Graduate Medical Education (ACGME)-accredited addiction medicine fellowships about their current practices and policies and what they would include in an ideal policy. We had 77 responses from 55 out of 86 ACGME-addiction medicine fellowships (63.9%). Respondents identified policies at 21.8% of the institutions surveyed. Current responses to inpatient substance use vary, though most do not match what clinicians identify as an ideal response. Our results suggest that the use of nonprescribed substances during a hospitalization may be common, but a majority of hospitals likely do not have patient-centered policies to address this.

Evaluating the effect of acute diesel exhaust particle exposure on P-glycoprotein efflux transporter in the blood-brain barrier co-cultured with microglia.

A growing public health concern, chronic Diesel Exhaust Particle (DEP) exposure is a heavy risk factor for the development of neurodegenerative diseases like Alzheimer's (AD). Considered the brain's first line of defense, the Blood-Brain Barrier (BBB) and perivascular microglia work in tandem to protect the brain from circulating neurotoxic molecules like DEP. Importantly, there is a strong association between AD and BBB dysfunction, particularly in the Aß transporter and multidrug resistant pump, P-glycoprotein (P-gp). However, the response of this efflux transporter is not well understood in the context of environmental exposures, such as to DEP. Moreover, microglia are seldom included in in vitro BBB models, despite their significance in neurovascular health and disease. Therefore, the goal of this study was to evaluate the effect of acute (24 hr.) DEP exposure (2000 µg/ml) on P-gp expression and function, paracellular permeability, and inflammation profiles of the human in vitro BBB model (hCMEC/D3) with and without microglia (hMC3). Our results suggested that DEP exposure can decrease both the expression and function of P-gp in the BBB, and corroborated that DEP exposure impairs BBB integrity (i.e. increased permeability), a response that was significantly worsened by the influence of microglia in co-culture. Interestingly, DEP exposure seemed to produce atypical inflammation profiles and an unexpected general downregulation in inflammatory markers in both the monoculture and co-culture, which differentially expressed IL-1ß and GM-CSF. Interestingly, the microglia in co-culture did not appear to influence the response of the BBB, save in the permeability assay, where it worsened the BBB's response. Overall, our study is important because it is the first (to our knowledge) to investigate the effect of acute DEP exposure on P-gp in the in vitro human BBB, while also investigating the influence of microglia on the BBB's responses to this environmental chemical.

Ecosystem responses of shallow thermokarst lakes to climate-driven hydrological change: Insights from long-term monitoring of periphytic diatom community composition at Old Crow Flats (Yukon, Canada).

Shallow waterbodies are abundant in Arctic and subarctic landscapes where they provide productive wildlife habitat and hold cultural and socioeconomic importance for Indigenous communities. Their vulnerability to climate-driven hydrological and limnological changes enhances a need for long-term monitoring data capable of tracking aquatic ecosystem responses. Here, we evaluate biological and inferred physicochemical responses associated with a rise in rainfall-generated runoff and increasingly positive lake water balances in Old Crow Flats (OCF), a 5600 km2 thermokarst landscape in northern Yukon. This is achieved by analyzing periphytic diatom community composition in biofilms accrued on artificial-substrate samplers at 14 lakes collected mostly annually during 2008-2019 CE. Results reveal that diatom communities at 10 of the 14 lakes converged toward a composition typical of lakes with rainfall-dominated input waters. These include six of nine lakes that were not initially dominated by rainfall input. The shifts in diatom community composition infer rise of lake-water pH and ionic content, and they reveal that northern shallow lake ecosystems are responsive to climate-driven increases in rainfall. Based on data generated during the 12 -year-long monitoring period, we conclude that lakes located centrally within OCF are most vulnerable to rapid climate-driven hydroecological change due to flat terrain, larger lake surface area, and sparse terrestrial vegetation, which provide less resistance to lake expansion, shoreline erosion, and sudden drainage. This information assists the local Indigenous community and natural resource stewardship agencies to anticipate changes to traditional food sources and inform adaptation options.

A competitive, bead-based assay combined with microfluidics for multiplexed toxin detection.

The requirement for rapid, in-field detection of cyanotoxins in water resources necessitates the developing of an easy-to-use and miniaturized system for their detection. We present a novel bead-based, competitive fluorescence assay for multiplexed detection of two types of toxins: microcystin-LR (MC-LR) and okadaic acid (OA). To automate the detection process, a reusable microfluidic device, termed toxin-chip, was designed and validated. The toxin-chip consists of a micromixer where the target toxins were efficiently mixed with a reagent solution, and a detection chamber for magnetic retainment of beads for downstream analysis. Quantum dots (QDs) were used as the reporter molecules to enhance the sensitivity of the assay and the emitted fluorescence signal from QDs was reversely proportional to the amount of toxins in the solution. An image analysis program was also developed to further automate the detection and analysis steps. Two toxins were simultaneously analyzed on a single microfluidic chip, and the device exhibited a low detection limit of 10-4 µg ml-1 for MC-LR and 4 × 10-5 µg ml-1 for OA detection. The bead-based, competitive assay also showed remarkable chemical specificity against potential interfering toxins. We also validated the device performance using natural lake water samples from Sunfish Lake of Waterloo. The toxin-chip holds promise as a versatile and simple quantification tool for cyanotoxin detection, with the potential of detecting more toxins.

DECIDE: Delphi Expert Consensus Statement on Inflammatory Bowel Disease Dysplasia Shared Management Decision-Making.

BACKGROUND AND AIMS: Inflammatory bowel disease colitis-associated dysplasia is managed with either enhanced surveillance and endoscopic resection or prophylactic surgery. The rate of progression to cancer after a dysplasia diagnosis remains uncertain in many cases and patients have high thresholds for accepting proctocolectomy. Individualised discussion of management options is encouraged to take place between patients and their multidisciplinary teams for best outcomes. We aimed to develop a toolkit to support a structured, multidisciplinary and shared decision-making approach to discussions about dysplasia management options between clinicians and their patients. METHODS: Evidence from systematic literature reviews, mixed-methods studies conducted with key stakeholders, and decision-making expert recommendations were consolidated to draft consensus statements by the DECIDE steering group. These were then subjected to an international, multidisciplinary modified electronic Delphi process until an a priori threshold of 80% agreement was achieved to establish consensus for each statement. RESULTS: In all, 31 members [15 gastroenterologists, 14 colorectal surgeons and two nurse specialists] from nine countries formed the Delphi panel. We present the 18 consensus statements generated after two iterative rounds of anonymous voting. CONCLUSIONS: By consolidating evidence for best practice using literature review and key stakeholder and decision-making expert consultation, we have developed international consensus recommendations to support health care professionals counselling patients on the management of high cancer risk colitis-associated dysplasia. The final toolkit includes clinician and patient decision aids to facilitate shared decision-making.

Anatomical Correlation for Focused Assessment With Sonography in Trauma.

When learning the Focused Assessment with Sonography in Trauma (FAST) exam, anatomical orientation can be difficult, especially in the subxiphoid and upper quadrant views. To facilitate understanding in these areas, a novel in-situ cadaver dissection was used to demonstrate anatomy related to the FAST exam. In situ, because the structures remained in normal positions with adjacent organs, layers, and spaces clearly visible from the point of view of the ultrasound probe. These views were then correlated with what was seen on the ultrasound screen. The right upper quadrant and subxiphoid anatomy were viewed in a mirror to match the ultrasound images, and the left upper quadrant was viewed directly from the examiner's position, also matching the view on the ultrasound screen. The in-situ cadaver dissection was developed as a resource to correlate FAST exam ultrasound images in the upper quadrant and subxiphoid regions with related cadaver anatomy.

Termination From Substance Use Disorder Treatment in the United States: Residential and Outpatient Settings.

OBJECTIVE: As rates of noncompletion in substance use treatment remain high and consequences of noncompletion can be severe, research regarding individual and environmental factors associated with specific types of discharge is crucial. The current study used data from the Treatment Episodes Dataset-Discharge (TEDS-D) 2015-2017 in the United States to investigate the impact of social determinants of health on discharge from treatment due to termination by the treatment facility in both outpatient/intensive outpatient and residential treatment settings. METHOD: A multinomial logistic regression was conducted examining the likelihood of discharge due to termination compared with discharge because of dropout or incarceration. RESULTS: Results revealed differences in termination based on treatment setting, race, income, criminal justice referral, and mental health diagnoses, among others. Broadly across settings, people of color were significantly more likely to be terminated from treatment than to drop out compared with their White counterparts. Further, with little exception, individuals with less financial security (i.e., those who were unemployed, those with low/no income, those with no insurance) were less likely to drop out and more likely to be discharged due to termination across treatment settings. CONCLUSIONS: The results of the current study further solidify the need for nuanced examination of the reason individuals do not complete substance use treatment and extend the impact of social determinants of health to involuntary termination from substance use treatment.

The psychological impact of wrongful convictions: Exploring retrospective trajectories of distress in exonerees.

OBJECTIVE: Although an emerging body of research has examined the legal causes of wrongful convictions, there is little research that examines the psychological impact of wrongful convictions. This study aims to understand the psychological experiences of exonerees, with a focus on the role of meaning-making in individuals' reactions to trauma. The study also aims to examine exonerees' self-reported trajectories of distress throughout their experience of being wrongfully convicted and subsequently exonerated. METHOD: A total of 46 exonerees completed an online survey. Measures included: Patient Health Questionnaire-9, Generalized Anxiety Disorder-7, PTSD Checklist for DSM-5, Posttraumatic Growth Inventory, World Assumptions Questionnaire, Meaning in Life Questionnaire, Satisfaction with Life Scale, and a self-reported retrospective trajectory measure. RESULTS: Cluster analysis suggested a four-factor solution: Chronic Distress, Relief and Readjustment, Recovery, and Intense Distress with Minimal Recovery. The Recovery cluster (n = 17; 37.0%) had significantly lower levels of PTSD and anxiety symptoms than the other three groups. The Recovery cluster had higher levels of positive world assumptions and lower levels of searching for meaning than the other three clusters, but there were no differences among clusters in level of meaning made, presence of meaning, depression symptoms, and satisfaction with life. CONCLUSIONS: The results revealed that exonerees with more positive world beliefs (conceptualized as an outcome of meaning-making) have lower rates of PTSD and anxiety. Consistent with the literature, results also suggest that the search for meaning may be indicative of increased distress and less recovery. Clinical and policy implications are discussed. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Phylogenetic risk assessment is robust for forecasting the impact of European insects on North American conifers.

Some introduced species cause severe damage, although the majority have little impact. Robust predictions of which species are most likely to cause substantial impacts could focus efforts to mitigate those impacts or prevent certain invasions entirely. Introduced herbivorous insects can reduce crop yield, fundamentally alter natural and managed forest ecosystems, and are unique among invasive species in that they require certain host plants to succeed. Recent studies have demonstrated that understanding the evolutionary history of introduced herbivores and their host plants can provide robust predictions of impact. Specifically, divergence times between hosts in the native and introduced ranges of a nonnative insect can be used to predict the potential impact of the insect should it establish in a novel ecosystem. However, divergence time estimates vary among published phylogenetic datasets, making it crucial to understand if and how the choice of phylogeny affects prediction of impact. Here, we tested the robustness of impact prediction to variation in host phylogeny by using insects that feed on conifers and predicting the likelihood of high impact using four different published phylogenies. Our analyses ranked 62 insects that are not established in North America and 47 North American conifer species according to overall risk and vulnerability, respectively. We found that results were robust to the choice of phylogeny. Although published vascular plant phylogenies continue to be refined, our analysis indicates that those differences are not substantial enough to alter the predictions of invader impact. Our results can assist in focusing biosecurity programs for conifer pests and can be more generally applied to nonnative insects and their potential hosts by prioritizing surveillance for those insects most likely to be damaging invaders.

The Association Between Civil Legal Needs After Incarceration, Psychosocial Stress, and Cardiovascular Disease Risk Factors.

Many formerly incarcerated people have civil legal needs that can imperil their successful re-entry to society and, consequently, their health. We categorize these needs and assess their association with cardiovascular disease risk factors in a sample of recently released people. We find that having legal needs related to debt, public benefits, housing, or healthcare access is associated with psychosocial stress, but not uncontrolled high blood pressure or high cholesterol, in the first three months after release.

Police Harassment and Violence against Transgender & Gender Diverse Sex Workers in the United States.

Sex workers continue to experience high rates of abuse and violence around the world. However, information regarding police-perpetrated harassment and violence against transgender and gender diverse (TGD) sex workers in the United States remains extremely limited. The current study is the first known examination of police interaction, harassment, and violence among TGD sex workers in the United States using a large nationwide dataset. Data from 23,372 TGD people were used. Results revealed that sex workers were more likely to experience police interaction, harassment, and violence compared to non-sex workers. Among sex workers with police interaction while doing sex work, 89.2% reported experiencing at least one type of harassment and/or violence. Regression analyses revealed that individuals with no reported income and trans women were more likely to experience multiple types of police harassment/violence. Taken together, TGD sex workers continue to experience alarming rates of interaction, harassment, and violence from police in the United States. Urgent, and effective intervention is needed to eliminate police harassment and violence toward TGD sex workers and provide support for TGD sex workers who survive this violence.

Postdeployment Treatment Gap: Symptoms and Treatment Utilization Among Returning National Guard Soldiers.

This study evaluated rates of psychiatric symptoms and mental health treatment utilization among National Guard service members during the post-deployment period. National Guard service members (n=311) completed surveys assessing demographics, beliefs about mental health treatment, emotion regulation strategies, and psychiatric symptoms. Mental health treatment utilization was assessed at 6-month follow-up. Post-deployment, 41.2% of the sample had psychiatric symptoms above the clinical cut-off for at least one symptom measure. This proportion increased at follow-up (53.5%). Alcohol use disorder (AUD) symptoms showed the largest increase (d=0.66), although symptoms of depression and posttraumatic stress disorder (PTSD) also showed small magnitude increases. Among those with elevated symptoms post-deployment (n=128), only 27.8% received mental health treatment at follow-up. Severity of depression, anxiety, and PTSD were higher among those who utilized treatment. The post-deployment period is a vulnerable one. Continued efforts to understand and address barriers to treatment for this population are warranted.

Development and Validation of a Brief Culture-of-Safety Survey.

BACKGROUND: Culture of safety (COS) is recognized as a critical component of patient safety but can be burdensome to measure due to survey length. This project aimed to develop a shortened COS survey with comparable measurement properties to a validated 19-item instrument. METHODS: Item response theory (IRT) was used to reduce items from a 19-item COS survey at a 10-hospital health system. Using a 50% random sample, IRT was applied to evaluate survey question discrimination and information. Concepts from the key questions in each subdomain were reworded into a new abbreviated scale. Cognitive interviews with clinicians were conducted to validate reworded questions for adequacy, clarity, and consistency of interpretation. RESULTS: The 19-item survey was reduced with IRT to 4 items. Cronbach's alpha for the 4-item IRT-derived scale was 0.80 (average inter-item covariance = 0.36) and was comparable to the original scale despite ∼75% reduction in items. Pearson correlation between the 4-item scale and the original scale was > 0.90. The 4-item scale demonstrated convergent validity. Results were replicated in a 50% random validation sample. Cognitive interviews revealed inadequacy of the shortened scale in assessing error-reporting culture. A fifth item was developed and qualitatively validated for this construct. CONCLUSION: Using a mixed methods approach, a lengthy COS survey was condensed and revised to a brief 5-question survey with comparable measurement properties and respondent interpretation. A shorter instrument necessarily loses detailed insight into multiple aspects of safety culture, and organizations should consider trade-offs in choosing to develop a briefer survey.

Sexual minority disparities in opioid and benzodiazepine misuse among adults with opioid use disorder.

BACKGROUND AND OBJECTIVES: Sexual minority individuals demonstrate disparate rates of substance use. Research suggests that bisexual women are vulnerable to substance use disorders when compared to other sexual minority groups. This study explored differences in prevalence of past-year alcohol use disorder (AUD) with and without concurrent past-year opioid and/or benzodiazepine misuse. METHODS: The present study utilized responses from the National Survey on Drug Use and Health (NSDUH) public dataset between the years 2015-2019 (N = 16,002) to examine the association between sexual orientation and concurrent misuse of opioids and/or benzodiazepines among individuals with past-year AUD, stratified by sex. RESULTS: Bisexual females demonstrated higher rates of concurrent opioid and benzodiazepine use compared to all other groups. Although there was no association between sexual orientation and concurrent substance use patterns among males, female respondents with past-year AUD endorsing past-year misuse of opioids and benzodiazepines, both alone and in combination, were more likely to be bisexual compared to heterosexual. Lesbians were less likely to endorse concurrent misuse of opioids and benzodiazepines compared to bisexual females. DISCUSSION AND CONCLUSIONS: In a national sample, bisexual females demonstrated higher odds of risky concurrent substance use patterns. Identifying sexual minority individuals who exhibit elevated risk of co-occurring alcohol, opioid, and/or benzodiazepine misuse is an important step to targeted prevention efforts and allocation of resources to combat rising overdose deaths. SCIENTIFIC SIGNIFICANCE: For the first time, this study explored risky concurrent alcohol, opioid, and benzodiazepine misuse patterns among individuals of different sexual orientations.

The relationship between realization of transgender identity and transition processes with nonsuicidal self-injury in transgender populations.

We hypothesized that transgender and nonbinary (TNB) individuals who reported a longer period of time from realizing they were TNB to beginning their transition will have a longer history of nonsuicidal self-injury (NSSI) and that participants who report higher levels of body investment, fewer years from realization of TNB identity to transition, and more years since NSSI will report lower levels of current anxiety, stress, and depression. We conducted a secondary data analysis of a dataset collected online, which included 217 participants. We conducted multiple regressions to explore the hypotheses. Results revealed that TNB people who had a longer time between realizing their gender identity and beginning a transition had a longer history of NSSI. Exploratory analyses were also conducted to help understand the relationship between NSSI, transition, and body investment on mental health outcomes. Providers are cautioned that the presence of NSSI should not necessarily be a contraindication to transition.

Police and Transgender and Gender Diverse People in the United States: A Brief Note on Interaction, Harassment, and Violence.

Transgender and gender diverse (TGD) people in the United States continue to face dire rates of police violence and harassment. However, little research has examined this phenomenon using large-scale nationwide data. The current study utilized data from the United States Transgender Survey to examine the prevalence and correlates of police interaction, harassment, and violence among TGD people in the United States. Police harassment and violence types examined included reported incidences of (a) officers using the wrong pronouns, (b) officers asking about an individual's transition, (c) verbal harassment, (d) physical attack, (e) forcing sex to avoid arrest, and (f) unwanted sexual contact from an officer. Results from a weighted sample of 22,456 TGD people revealed that 40.3% reported having interacted with the police in the past year. Among those who interacted with the police in the past year, 45.7% reported experiencing at least one incident of police verbal harassment and 6.1% reported at least one incidence of police physical/sexual violence in the past year. Engaging in sex work was one of the most consistent predictors of police interaction, harassment, and violence. Notably, sex workers were approximately 11 times more likely to report being forced to engage in sex with the police to avoid arrest when compared to non-sex workers. Overall, people of color also reported significantly higher rates of police harassment and violence compared to their White counterparts. Additional correlates included income, educational attainment, and participation in other illegal work. Taken together, the findings of the current study highlight the urgent need for additional examination, intervention, and advocacy to eliminate police harassment and violence against members of the TGD community in the United States.