Standardized applications for genetic counseling graduate programs: Opinions of program directors.

Genetic Counseling Graduate Programs (GCGPs) have progressively increased in number and class size, and implementation of the National Matching Services in 2018 was a major step toward streamlining the admissions process. Standardized applications (SAs), which have been incorporated into the admissions process for undergraduate studies as well as several professional graduate programs, could also be considered for GCGPs. In this study, we assessed the opinions of GCGP Program Directors (PDs) regarding the implementation of an SA for GCGP admissions processes. GCGP PDs participated in an anonymous online survey designed to evaluate interest in an SA and assess perceived implementation barriers. The survey collected GCGP and PD demographic information, data on current application components, and PD opinions of an SA. Thirty PDs were included in this study, and just over half (n = 16/30, 53.3%) reported their current application structure would allow for SA implementation. While 40% (n = 12/30) of respondents anticipated an SA would benefit GCGPs, an additional 23.3% (n = 7/30) anticipated no impact to GCGPs. Most respondents (n = 26/30, 86.6%) anticipated that an SA would be beneficial for GCGP applicants. The main perceived benefit to GCGPs was an efficient application process, while perceived benefits to applicants included decreased redundancy and increased application access. Perceived harms to GCGPs included more generic applications, while perceived harms to applicants included increased competition for admission to individual GCGPs. The most common SA implementation barrier cited by respondents was current administrative structures. This study demonstrates that while GCGP leadership largely perceives an SA to be beneficial for applicants, opinions on impact to GCGPs vary. While the majority of respondents perceive implementation of an SA to be feasible, there are implementation barriers that must be addressed. Interestingly, GCGP leadership had mixed perceptions about the structure of a hypothetical SA, and thus overall impact, demonstrating the need for further study.

Diagnosis and treatment of epidural empyema in a pygmy goat.

A mixed-breed pygmy goat was presented for nonambulatory tetraparesis. Neurological examination was consistent with a C6 to T2 myelopathy. Initially, the goat was treated medically. Forty-three days later, magnetic resonance imaging (MRI) revealed an extradural mass compressing the cervical spinal cord. Magnetic resonance attributes of the mass were consistent with a slow-growing, fluid-poor lesion. The spinal cord was surgically decompressed. Epidural empyema secondary to Fusobacterium necrophorum was identified. Postoperative care consisted of anti-inflammatory medication, antimicrobials, and physical therapy. Ability to walk occurred by day 14 after surgery. Despite prolonged recumbency before surgery, the goat was clinically normal, and antimicrobials were discontinued on day 60 after surgery. Key clinical message: Epidural empyema can cause a compressive myelopathy which may result in varying degrees of paresis/paralysis. Clinical resolution and return of normal function occurred following the use of MRI to plan surgical decompression combined with extended use of antimicrobials.

Diagnostic et traitement d'un empyème épidural chez une chèvre pygmée. Une chèvre naine fut présentée pour tétraparésie non-ambulatoire, neuro-localisée au segment C6-T2. Un traitement conservateur fut initialement instauré. Quarante-trois jours plus tard, une IRM révéla une compression sévère de la moelle épinière cervicale par une masse extradurale faiblement liquide et à croissance lente. La moelle épinière fut chirurgicalement décompressée. Un empyème épidural secondaire à Fusobacterium necrophorum fut identifié. Des soins postopératoires à base d'anti-inflammatoires, d'antibiotiques ainsi qu'une rééducation physique furent instaurés. L'animal recouvra la capacité de marcher 14 jours plus tard. Malgré un décubitus prolongé, 60 jours après la chirurgie la chèvre était normale et les antimicrobiens furent interrompus.Message clinique clé :L'empyème épidural peut provoquer une myélopathie compressive pouvant entraîner divers degrés de parésie/ paralysie. La résolution clinique et le retour de la fonction normale sont survenus après l'utilisation de l'IRM pour planifier la décompression chirurgicale combinée à une utilisation prolongée d'antimicrobiens.(Traduit par Karin Gendron et Maëva Barozzi).

Testing a stepped care model for binge-eating disorder: a two-step randomized controlled trial.

BACKGROUND: A stepped care approach involves patients first receiving low-intensity treatment followed by higher intensity treatment. This two-step randomized controlled trial investigated the efficacy of a sequential stepped care approach for the psychological treatment of binge-eating disorder (BED). METHODS: In the first step, all participants with BED (n = 135) received unguided self-help (USH) based on a cognitive-behavioral therapy model. In the second step, participants who remained in the trial were randomized either to 16 weeks of group psychodynamic-interpersonal psychotherapy (GPIP) (n = 39) or to a no-treatment control condition (n = 46). Outcomes were assessed for USH in step 1, and then for step 2 up to 6-months post-treatment using multilevel regression slope discontinuity models. RESULTS: In the first step, USH resulted in large and statistically significant reductions in the frequency of binge eating. Statistically significant moderate to large reductions in eating disorder cognitions were also noted. In the second step, there was no difference in change in frequency of binge eating between GPIP and the control condition. Compared with controls, GPIP resulted in significant and large improvement in attachment avoidance and interpersonal problems. CONCLUSIONS: The findings indicated that a second step of a stepped care approach did not significantly reduce binge-eating symptoms beyond the effects of USH alone. The study provided some evidence for the second step potentially to reduce factors known to maintain binge eating in the long run, such as attachment avoidance and interpersonal problems.

Human rabies despite post-exposure prophylaxis: a systematic review of fatal breakthrough infections after zoonotic exposures.

Post-exposure prophylaxis (PEP) for rabies is widely administered and highly effective. Nevertheless, sporadic breakthrough infections (ie, rabies in people who have started PEP) have been reported. We conducted a systematic review of articles published between Jan 1, 1980 and June 1, 2022 to characterise breakthrough infections. After reviewing 3380 articles from across all continents, we identified 52 articles, which included a total of 122 breakthrough infections. We classified breakthrough infections on the basis of adherence to core practices (ie, wound cleaning and vaccine administration). Of 86 breakthrough infections with data, median time from exposure to symptom onset was 20 days (IQR 16-24). Most (89 [77%] of 115) participants received PEP within 2 days of an exposure. Severe wounds (defined as those involving multiple wound sites or bites to the head, face, or neck) were common (80 [69%] of 116 [with data]). Deviations from core practices were reported in 68 (56%) of 122 cases. Other possible causes for breakthrough infections included errors in the administration of rabies immunoglobulin, delays in seeking health care, and comorbidities or immunosuppression. Cold-chain integrity assessments and potency testing of PEP biologics were only rarely assessed (8 [7%] of 122 cases), neither of which were found to be a cause of breakthrough infections. Timely and appropriate administration of PEP is crucial to prevent rabies, and although people with high-risk exposures or immunosuppression can develop rabies despite adherence to core practices, this occurrence remains exceedingly rare.

Case report: Abomasal ulcer secondary to congenital pyloric and duodenal stenosis in a 3-day-old heifer.

Abomasal ulcers, an economic concern for all calf-raising farms, are usually silent until perforation occurs, at which time management is complicated and often unrewarding. This case study describes perforating ulcer in a 3-day-old Brahman heifer, occurring secondary to a congenital narrowing of the pylorus and proximal duodenum and leading to marked abomasal distention, leakage, and eventual peritonitis and sepsis.

Modulation of Macrophage Redox and Apoptotic Processes to Leishmania infantum during Coinfection with the Tick-Borne Bacteria Borrelia burgdorferi.

Canine leishmaniosis (CanL) is a zoonotic disease caused by protozoan Leishmania infantum. Dogs with CanL are often coinfected with tick-borne bacterial pathogens, including Borrelia burgdorferi in the United States. These coinfections have been causally associated with hastened disease progression and mortality. However, the specific cellular mechanisms of how coinfections affect microbicidal responses against L. infantum are unknown. We hypothesized that B. burgdorferi coinfection impacts host macrophage effector functions, prompting L. infantum intracellular survival. In vitro experiments demonstrated that exposure to B. burgdorferi spirochetes significantly increased L. infantum parasite burden and pro-inflammatory responses in DH82 canine macrophage cells. Induction of cell death and generation of mitochondrial ROS were significantly decreased in coinfected DH82 cells compared to uninfected and L. infantum-infected cells. Ex vivo stimulation of PBMCs from L. infantum-seronegative and -seropositive subclinical dogs with spirochetes and/or total Leishmania antigens promoted limited induction of IFNγ. Coexposure significantly induced expression of pro-inflammatory cytokines and chemokines associated with Th17 differentiation and neutrophilic and monocytic recruitment in PBMCs from L. infantum-seropositive dogs. Excessive pro-inflammatory responses have previously been shown to cause CanL pathology. This work supports effective tick prevention and risk management of coinfections as critical strategies to prevent and control L. infantum progression in dogs.

Possibility of Leishmania Transmission via Lutzomyia spp. Sand Flies Within the USA and Implications for Human and Canine Autochthonous Infection.

Purpose of Review: Leishmaniasis is a leading cause of parasitic death, with incidence rising from decreased resources to administer insecticide and anti-leishmanial treatments due to the COVID-19 pandemic. Leishmaniasis is nonendemic in the United States (U.S.), but enzootic canine populations and potentially competent vectors warrant monitoring of autochthonous disease as a fluctuating climate facilitates vector expansion. Recent studies concerning sand fly distribution and vector capacity were assessed for implications of autochthonous transmission within the U.S. Recent Findings: Climate change and insecticide resistance provide challenges in sand fly control. While most Leishmania-infected dogs in the U.S. were infected via vertical transmission or were imported, autochthonous vector-borne cases were reported. Autochthonous vector-borne human cases have been reported in four states. Further vaccine research could contribute to infection control. Summary: Both cutaneous and visceral leishmaniasis cases in the U.S. are increasingly reported. Prevention measures including vector control and responsible animal breeding are critical to halt this zoonotic disease.

Roles of traditional medicine and traditional healers for rabies prevention and potential impacts on post-exposure prophylaxis: A literature review.

INTRODUCTION: Globally, traditional medicine is widely used to treat a variety of injuries and illnesses, including dog bites, and exposures that are risky for rabies. However, efficacy of most traditional remedies used for rabies prevention or treatment has not been demonstrated in controlled trials or proven in community-based surveys. METHODS: Six databases were searched including the terms rabies, traditional treatment, traditional remedy, traditional therapy, traditional medicine, and medicinal treatment to review traditional remedies used in the prevention and treatment of rabies. In addition, published literature of rabies transmission dynamics was used to estimate statistical likelihood of dog bite victims developing rabies to provide clarity as to why traditional healers have a high apparent success rate when preventing death from rabies in victims bitten by suspected rabid dogs. RESULTS: Literature review yielded 50 articles, including three controlled experiments, that described use of traditional remedies for rabies prevention and treatment. Traditional remedies for rabies ranged from plant- or animal-based products to spiritual rituals; however, only a few controlled mice trials were conducted, and none of these trials demonstrated efficacy in preventing or treating rabies. Risk of dying from rabies after a bite from a dog with unknown rabies status is low, 1.90% (0.05%-29.60%). Therefore, traditional healers had a 98.10% (70.40%-99.95%) apparent success rate in preventing death from suspected rabid dog bites despite inefficaciousness of herbal remedies. CONCLUSION: There was no universal plant species or route of administration that was consistently used for rabies prevention or treatment across countries. No traditional remedy was efficacious in the prevention or treatment of rabies in randomized controlled experiments. Understanding the cultural context under which traditional remedies are used may facilitate collaboration of traditional healers with the modern medical system to ensure timely and appropriate use of proven therapies for prevention and clinical management of rabies.

Assessing COVID-19 Pandemic Risk Perception and Response Preparedness in Veterinary and Animal Care Workers.

Veterinary and animal care workers perform critical functions in biosecurity and public health, yet little has been done to understand the unique needs and barriers these workers face when responding during a pandemic crisis. In this article, we evaluated the perceived risks and roles of veterinary and animal care workers during the COVID-19 pandemic and explored barriers and facilitators in their readiness, ability, and willingness to respond during a pandemic. We deployed a survey targeting US veterinary medical personnel, animal shelter and control workers, zoo and wildlife workers, and other animal care workers. Data were collected on respondents' self-reported job and demographic factors, perceptions of risk and job efficacy, and readiness, ability, and willingness to respond during the pandemic. We found that leadership roles and older age had the strongest association with decreased perceived risk and improved job efficacy and confidence, and that increased reported contact level with others (both coworkers and the public) was associated with increased perceived risk. We determined that older age and serving in leadership positions were associated with improved readiness, willingness, and ability to respond. Veterinary and animal care workers' dedication to public health response, reflected in our findings, will be imperative if more zoonotic vectors of SARS-CoV-2 arise. Response preparedness in veterinary and animal care workers can be improved by targeting younger workers not in leadership roles through support programs that focus on improving job efficacy and confidence in safety protocols. These findings can be used to target intervention and training efforts to support the most vulnerable within this critical, yet often overlooked, workforce.

Epidemiologic, Clinical and Immunological Consequences of Co-Infections during Canine Leishmaniosis.

Canine leishmaniosis (CanL) is a vector-borne, parasitic disease. CanL is endemic in the Mediterranean basin and South America but also found in Northern Africa, Asia, and the U.S. Regions with both competent sand fly vectors and L. infantum parasites are also endemic for additional infectious diseases that could cause co-infections in dogs. Growing evidence indicates that co-infections can impact immunologic responses and thus the clinical course of both CanL and the comorbid disease(s). The aim for this review is to summarize epidemiologic, clinical, and immunologic factors contributing to eight primary co-infections reported with CanL: Ehrlichia spp., Anaplasma spp., Borrelia spp., Babesia spp., Trypanosoma cruzi, Toxoplasma gondii, Dirofilaria immitis, Paracoccidioides braziliensis. Co-infection causes mechanistic differences in immunity which can alter diagnostics, therapeutic management, and prognosis of dogs with CanL. More research is needed to further explore immunomodulation during CanL co-infection(s) and their clinical impact.

The effect of prior thecal puncture on cerebrospinal fluid analytes in normal adult horses.

BACKGROUND: Serial cerebrospinal fluid (CSF) analysis might be required in clinical neurologic disease. The effect of lumbosacral (LS) or cervical (C1-C2) centesis on subsequent CSF cytologic analyses has not been investigated in horses. OBJECTIVE: To evaluate the effect of thecal puncture on subsequent CSF analyses ANIMALS: Ten healthy adult horses. METHODS: Prospective study. Horses were randomly assigned to undergo CSF collection twice, 14 days apart, from either the C1-C2 or LS space. After a 4-month washout period, CSF collection was repeated from the alternate site. Continuous data were analyzed using linear mixed-effects models and count data using mixed-effects negative binomial regression. Statistical significance was set at P < .05. RESULTS: There was no significant effect of collection day (day 0 or day 14) for any CSF analytes, including protein concentration (C1-C2: 45 [95% CI: 33-57] mg/dL day 0 vs 49 [95% CI: 39-62] mg/dL day 14, P = .12; LS: 64 [95% CI: 41-100] mg/dL day 0 vs 83 [95% CI: 53-129] mg/dL day 14, P = .37), or nucleated cell count (C1-C2: 2 [95% CI: 1-4] cells/µL day 0 vs 3 [95% CI: 1-4] cells/µL day 14, P = .65; LS: 3 [95% CI: 2-5] cells/µL day 0 vs 5 [95% CI: 3-8] cells/µL day 14, P = .10). There was no significant difference in EPM titer or EPM serum : CSF ratio between days 0 and 14. CONCLUSIONS AND CLINICAL IMPORTANCE: Repeat thecal puncture from the LS or C1-C2 space 2 weeks apart does not appear to impact CSF analytes.

Comparison of 2 collection methods for cerebrospinal fluid analysis from standing, sedate adult horses.

BACKGROUND: Cerebrospinal fluid (CSF) analysis is an important component of the evaluation of horses with neurologic disease. Lumbosacral (LS) centesis is routine, but CSF is also collected from the space between the first and second cervical vertebrae (C1-C2). OBJECTIVES: To compare collection times, CSF cytology results, and equine protozoal myelitis (EPM) titers of CSF collected from the C1-C2 and LS sites. ANIMALS: Fifteen university-owned adult horses with no evidence of neurologic disease, and 9 horses with signs of neurologic disease: 3 university-owned and 6 client-owned. METHODS: Prospective study. Cerebrospinal fluid collection from the LS space and C1-C2 space of each horse was performed in randomized order. Continuous data were analyzed using mixed-effects linear models and count data using mixed-effects negative binomial regression. Statistical significance was set at P < .05. RESULTS: Cerebrospinal fluid collected from the C1-C2 site had a significantly lower mean protein concentration (49 [95% CI: 43-55.8] mg/dL C1-C2 versus 52.1 [95% CI: 45.7-59.3] mg/dL LS; P = .03) and red blood cell count (6 [95% CI: 2-16] cells/µL versus 33 [95% CI: 13-81] cells/µL; P = .02). Collection time, total nucleated cell count, EPM titers, and serum:CSF EPM titer ratios were not significantly different between collection sites. CONCLUSIONS AND CLINICAL IMPORTANCE: Cerebrospinal fluid from the C1-C2 space provides an acceptable alternative to LS CSF collection with decreased likelihood of clinically important blood contamination of samples.

Simian Immunodeficiency Virus-Infected Memory CD4+ T Cells Infiltrate to the Site of Infected Macrophages in the Neuroparenchyma of a Chronic Macaque Model of Neurological Complications of AIDS.

Simian immunodeficiency virus (SIV)-infected nonhuman primates can serve as a relevant model for AIDS neuropathogenesis. Current SIV-induced encephalitis (SIVE)/neurological complications of AIDS (neuroAIDS) models are generally associated with rapid progression to neuroAIDS, which does not reflect the tempo of neuroAIDS progression in humans. Recently, we isolated a neuropathogenic clone, SIVsm804E-CL757 (CL757), obtained from an SIV-infected rhesus macaque (RM). CL757 causes a more protracted progression to disease, inducing SIVE in 50% of inoculated animals, with high cerebral spinal fluid viral loads, multinucleated giant cells (MNGCs), and perivascular lymphocytic cuffing in the central nervous system (CNS). This latter finding is reminiscent of human immunodeficiency virus (HIV) encephalitis in humans but not generally observed in rapid progressor animals with neuroAIDS. Here, we studied which subsets of cells within the CNS were targeted by CL757 in animals with neurological symptoms of SIVE. Immunohistochemistry of brain sections demonstrated infiltration of CD4+ T cells (CD4) and macrophages (MΦs) to the site of MNGCs. Moreover, an increase in mononuclear cells isolated from the brain tissues of RMs with SIVE correlated with increased cerebrospinal fluid (CSF) viral load. Subset analysis showed a specific increase in brain CD4+ memory T cells (Br-mCD4), brain-MΦs (Br-MΦs), and brain B cells (Br-B cells). Both Br-mCD4s and Br-MΦs harbored replication-competent viral DNA, as demonstrated by virus isolation by coculture. However, only in animals exhibiting SIVE/neuroAIDS was virus isolated from Br-MΦs. These findings support the use of CL757 to study the pathogenesis of AIDS viruses in the central nervous system and indicate a previously unanticipated role of CD4s cells as a potential reservoir in the brain.IMPORTANCE While the use of combination antiretroviral therapy effectively suppresses systemic viral replication in the body, neurocognitive disorders as a result of HIV infection of the central nervous system (CNS) remain a clinical problem. Therefore, the use of nonhuman primate models is necessary to study mechanisms of neuropathogenesis. The neurotropic, molecular clone SIVsm804E-CL757 (CL757) results in neuroAIDS in 50% of infected rhesus macaques approximately 1 year postinfection. Using CL757-infected macaques, we investigate disease progression by examining subsets of cells within the CNS that were targeted by CL757 and could potentially serve as viral reservoirs. By isolating mononuclear cells from the brains of SIV-infected rhesus macaques with and without encephalitis, we show that immune cells invade the neuroparenchyma and increase in number in the CNS in animals with SIV-induced encephalitis (SIVE). Of these cells, both brain macrophages and brain memory CD4+ T cells harbor replication-competent SIV DNA; however, only brain CD4+ T cells harbored SIV DNA in animals without SIVE. These findings support use of CL757 as an important model to investigate disease progression in the CNS and as a model to study virus reservoirs in the CNS.

Potential of phytoceuticals to affect antibiotic residue detection tests in cow milk in a randomised trial.

Mastitis is a costly disease for dairy farmers. Some dairy farmers use herbal products, or phytoceuticals, to treat mastitis. Phytoceuticals have not been approved for this use by the United States Food and Drug Administration, and have not been tested to determine how they impact antibiotic residue detection testing. The current study tested the potential for phytoceuticals to cause positive results on two milk antibiotic residue screening tests, the Delvotest P and Charm SL Beta-lactam test, or to interfere with the detection of antibiotics by these tests. The three phytoceuticals tested were labelled for intramammary, topical or intravulvar administration. Testing was performed in vitro using the products diluted in milk obtained from healthy organic dairy cows. Phytoceuticals were tested at concentrations ranging from 1.5 per cent to 100 per cent. Concentration levels were replicated at least twice on each milk antibiotic residue screening test. The Delvotest P is based on detection of bacterial inhibitors and no positive results were obtained for any product at concentrations less than 50 per cent. The Charm SL Beta-lactam test uses a receptor for the detection of beta-lactam antibiotics and no concentration of phytoceuticals caused an interference with these tests. Based on dilution of the products in bovine milk at physiologically achievable levels, phytoceutical products tested at levels expected after treatment do not cause positive test results for the Delvotest P nor do they interfere with the Charm SL Beta-lactam test in detection of various antibiotics.

An evaluation of immediate roadside prohibitions for drinking drivers in British Columbia: findings from roadside surveys.

OBJECTIVE: The purpose was to determine the impact of new immediate roadside prohibitions (IRPs) for drinking drivers introduced in British Columbia in September 2010 as assessed by random roadside surveys of alcohol and drug use among nighttime drivers. METHODS: Two roadside surveys were conducted prior to and following the introduction of IRPs. Drivers were randomly selected from the traffic stream in 5 cities and asked to provide a breath sample to determine alcohol content and a sample of oral fluid to be tested for the presence of psychoactive drugs. The survey was conducted between the hours of 9:00 p.m. and 3:00 a.m. on Wednesday through Saturday nights in June 2010 and again in June 2012. RESULTS: Driving after drinking decreased significantly following the introduction of IRPs. In particular, the percentage of drivers with blood alcohol concentrations (BACs) over 80 mg/dL decreased by 59 percent; drivers with BACs of at least 50 mg/dL decreased by 44 percent. The decreases in drinking and driving were not restricted to specific subgroups of drivers but were universal across age groups, sex, and communities. The results also revealed a changing pattern of drinking of driving. For example, the typical pattern of increased drinking and driving on weekend nights was not observed and the prevalence of drinking drivers on the road during late night hours was less than half that found in 2010. The prevalence of drug use by drivers in 2012 did not change from the levels reported in 2010. CONCLUSIONS: The IRP program combined immediate short-term roadside suspensions with vehicle impoundment and monetary penalties to enhance the swiftness, certainty, and perceived severity of sanctions for drinking and driving. The introduction of these measures was associated with a substantial reduction in the prevalence of driving with a BAC over 50 mg/dL and driving with a BAC over 80 mg/dL.

A roadside survey of alcohol and drug use among drivers in British Columbia.

OBJECTIVE: The purpose was to determine the prevalence of alcohol and drug use among a random sample of nighttime drivers. METHODS: Drivers were randomly selected from the traffic stream in three cities in British Columbia and asked to provide a breath sample to determine alcohol content and a sample of oral fluid to be tested for the presence of psychoactive drugs. The survey was conducted between the hours of 9:00 p.m. and 03:00 a.m. on Wednesday through Saturday nights in June 2008. RESULTS: Of the 1533 vehicles selected, 89 percent of drivers provided a breath sample and 78 percent provided a sample of oral fluid. Key findings include: 10.4 percent of drivers tested positive for drug use. 8.1 percent of drivers had been drinking. 15.5 percent of drivers tested positive for alcohol, drugs, or both. Cannabis and cocaine were the drugs most frequently detected in drivers. Alcohol use among drivers was most common on weekends and during late-night hours; drug use was more evenly distributed across all survey nights and times. Alcohol use was most common among drivers aged 19 to 24 and 25 to 34; drug use was more evenly distributed across all age groups. Though driving after drinking has decreased substantially since previous surveys, the number of drivers with elevated alcohol levels (over 80 mg/dL) was higher than in the past. CONCLUSIONS: The finding that drug use is more common than alcohol use among drivers highlights the need for a unique and separate societal response to the use of drugs by drivers commensurate with the extent of safety risks posed to road users. The observed differences between driving after drug use and driving after drinking have implications for enforcement and prevention.

A meta-analytic review of school-based prevention for cannabis use.

This investigation used meta-analytic techniques to evaluate the effectiveness of school-based prevention programming in reducing cannabis use among youth aged 12 to 19. It summarized the results from 15 studies published in peer-reviewed journals since 1999 and identified features that influenced program effectiveness. The results from the set of 15 studies indicated that these school-based programs had a positive impact on reducing students' cannabis use (d = 0.58, CI: 0.55, 0.62) compared to control conditions. Findings revealed that programs incorporating elements of several prevention models were significantly more effective than were those based on only a social influence model. Programs that were longer in duration (≥15 sessions) and facilitated by individuals other than teachers in an interactive manner also yielded stronger effects. The results also suggested that programs targeting high school students were more effective than were those aimed at middle-school students. Implications for school-based prevention programming are discussed.

Toward a more parsimonious approach to drug recognition expert evaluations.

OBJECTIVE: The purpose of this study is to statistically identify the set of drug-related cues from Drug Evaluation and Classification (DEC) evaluations that significantly predict the substance used by suspected drug-impaired drivers. METHODS: Data from 742 completed Canadian DEC evaluations of central nervous system (CNS) stimulant, narcotic analgesic, and cannabis cases were analyzed using a multinomial logistic regression procedure. RESULTS: Nine clinical indicators from the DEC evaluations significantly enhanced the prediction of drug category, including pulse rate, condition of the eyes and eyelids, lack of convergence, hippus, reaction to light, rebound dilation, systolic blood pressure, and the presence of injection sites. CONCLUSIONS: The findings from this study will facilitate the process of identifying the correct category of drug ingested by focusing on critical signs and symptoms of drug influence. This work will have direct and immediate relevance to the training of drug recognition experts (DREs) by providing the foundation for an innovative, statistically based approach to drug classification decisions by DREs.