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The comparative effectiveness of Core versus Core+Enhanced implementation strategies in a randomized controlled trial to improve substance use treatment receipt among justice-involved youth
Background
Most justice-involved youth are supervised in community settings, where assessment and linkage to substance use (SU) treatment services are inconsistent and fragmented. Only 1/3 of youth with an identified SU need receive a treatment referral and even fewer initiate services. Thus, improving identification and linkage to treatment requires coordination across juvenile justice (JJ) and behavioral health (BH) agencies. The current study examines the comparative effectiveness of two bundled implementation intervention strategies for improving SU treatment initiation, engagement, and continuing care among justice-involved youth supervised in community settings. Exploration, Preparation, Implementation, Sustainment (EPIS) served as the conceptual framework for study design and selection/timing of implementation intervention components, and the BH Services Cascade served as the conceptual and measurement framework for identifying and addressing gaps in service receipt.
Methods
Part of a larger Juvenile-Justice Translational Research on Interventions for Adolescents in the Legal System (JJ-TRIALS) Cooperative, this study involved a multisite, cluster-randomized control trial where sites were paired then randomly assigned to receive Core (training teams on the BH Services Cascade and data-driven decision making; supporting goal selection) or Core+Enhanced (external facilitation of implementation teams) intervention components. Youth service records were collected from 20 JJ community supervision agencies (in five states) across five study phases (baseline, pre-randomization, early experiment, late experiment, maintenance). Implementation teams comprised of JJ and BH staff collaboratively identified goals along the BH Cascade and used data-driven decision-making to implement change.
Results
Results suggest that Core intervention components were effective at increasing service receipt over time relative to baseline, but differences between Core and Core+Enhanced conditions were non-significant. Time to service initiation was shorter among Core+Enhanced sites, and deeper Cascade penetration occurred when external facilitation (of implementation teams) was provided. Wide variation existed in the degree and nature of change across service systems.
Conclusions
Findings demonstrate the criticality of early EPIS phases, demonstrating that strategies provided during the formative exploration and preparation phases produced some improvement in service receipt, whereas implementation-focused activities produced incremental improvement in moving youth farther along the Cascade.
Journal Article
The Oxford handbook of historical phonology
Presents a comprehensive and critical overview of historical phonology as it stands today. Scholars from around the world consider and advance research in every aspect of the field. In doing so they demonstrate the continuing vitality of one of the oldest sub-disciplines of linguistics.
Book
Management of Glucocorticoid-Induced Hyperglycemia
Glucocorticoids are potent immunosuppressive and anti-inflammatory drugs used for various systemic and localized conditions. The use of glucocorticoids needs to be weighed against their adverse effect of aggravating hyperglycemia in persons with diabetes mellitus, unmask undiagnosed diabetes mellitus, or precipitate glucocorticoid-induced diabetes mellitus appearance. Hyperglycemia is associated with poor clinical outcomes, including infection, disability after hospital discharge, prolonged hospital stay, and death. Furthermore, clear guidelines for managing glucocorticoid-induced hyperglycemia are lacking. Therefore, this consensus document aims to develop guidance on the management of glucocorticoid-induced hyperglycemia. Twenty expert endocrinologists, in a virtual meeting, discussed the evidence and practical experience of real-life management of glucocorticoid-induced hyperglycemia. The expert group concluded that we should be proactive in terms of diagnosis, management, and post-steroid care. Since every patient has different severity of underlying disease, clinical stratification would help understand patient profiles and determine the treatment course. Patients at home with pre-existing diabetes who are already on oral or injectable therapy can continue the same as long as they are clinically stable and eating adequately. However, depending on the degree of hyperglycemia, modification of doses may be required. Initiating basal bolus with correction regimen is recommended for patients in non-intensive care unit settings. For patients in intensive care unit, variable rate intravenous insulin infusion could be temporarily used, but under supervision of diabetes inpatient team, and patients can be transitioned to subcutaneous insulin once stable baseline assessment and continual evaluation are crucial for day-to-day decisions concerning insulin doses. Glycemic variability should be carefully monitored, and interventions to treat patients should also aim at achieving and maintaining euglycemia. Rational use of glucose-lowering drugs is recommended and treatment regimen should ensure maximum safety for both patient and provider. Glucovigilance is required as the steroids taper during transition, and insulin dosage should be reduced subsequently. Increased clinical and economic burden resulting from corticosteroid-related adverse events highlights the need for effective management. Therefore, these recommendations would help successfully manage GC-induced hyperglycemia and judiciously allocate resources.
Journal Article
The longest con : how grifters, swindlers, and frauds hijacked American conservatism
\"A sardonic chronicle of how conservatism turned into a racketeering enterprise - and why Donald Trump became the living emblem of the American right's moral decay. The Longest Con tells the fascinating story of the partisan con artists who have corrupted conservative politics in our time, creating a toxic phenomenon that culminated in the election of Donald Trump, a bumptious fraud whose checkered career and tawdry retinue, including his presidential cabinet, have featured almost every variety of scam. But long before he appeared, Trump's path to power was blazed by the motley horde of swindlers and quacks who preceded him. From the \"professional anti-communists\" (whose tactics even J. Edgar Hoover despised) to the \"populist\" grifters of the Tea Party movement and the religious charlatans of the \"prosperity gospel\" (who provided a pious front for Trump), the right-wing ripoff has remained remarkably consistent, even as personalities change and new technologies emerge: Stir up anger and resentment, demonize political opponents, promise vengeance, and collect donations from the gullible. It's a highly lucrative game that any unscrupulous charlatan can play, as many have - and they are named in these pages. In an unsparing and often comic narrative, Joe Conason explores the right's long, steep descent into a movement whose principal aim is not to protect freedom or defend the Constitution, but merely to line the pockets of pretenders and blowhards whose malevolent tactics now endanger the nation\"-- Provided by publisher.
Book
Key works in critical pedagogy : Joe L. Kincheloe
\"Key Works in Critical Pedagogy: Joe L. Kincheloe comprises sixteen papers written within a twenty-year period in which Kincheloe inspired legions of educators with his incisive analyses of education. Kincheloe was a prolific thinker and writer who produced an enormous number of books and chapters and journal articles. In a career cut short by his untimely death, Kincheloe led the way with an approach to research and pedagogy that incorporated multiperspectival approaches that examined a wide range of topics including schooling, cultural studies, research bricolage, kinderculture, Christotainment, and capitalism. In these works Kincheloe used accessible, elegantly produced language to capture his emotional yet scholarly ways of engaging with the world. He was a champion of the disenfranchised and his writing consistently examined social life from the perspective of participants who were often treated harshly because of their marginalization. The articles in this book were selected to encompass Kincheloe's impressive scholarly career and to draw attention to the necessity for educators to take a critical stance with respect to the enactment of education to reproduce disadvantage. Among the theoretical frameworks included in the works are critical pedagogy, research, hermeneutics, phenomenology, cultural studies, and post-formal thought. Key Works in Critical Pedagogy is a comprehensive introduction to the scholarly contributions of one of the foremost educational researchers of our time. The selected chapters and associated scholarly review essays constitute a reference resource for researchers, educators, students of education -- and all of those with an interest in adopting a deeper view of ways in which policies and practices shape education and social life to produce privilege and disadvantage simultaneously in ways that are often hidden from view. The critical perspective that permeates these works constitute ways of thinking and being in the world that others can adopt as a framework for analyzing their engagement in education as researchers, teacher educators, policymakers, students, parents of students, and members of the community at large. Responding to each of Kincheloe's chapters is a scholar/teacher who is intimately familiar with the works, theories, and epistemologies of this unique scholar.\"--Publisher's website.
Book
Organizational Context and Individual Adaptability in Promoting Perceived Importance and Use of Best Practices for Substance Use
This study examines associations among organizational context, staff attributes, perceived importance, and use of best practices among staff in community-based, juvenile justice (JJ) agencies. As part of the National Institute on Drug Abuse’s
Juvenile Justice—Translational Research on Interventions for Adolescents in the Legal System
(JJ-TRIALS) study, 492 staff from 36 JJ agencies were surveyed about the perceived importance and use of best practices within their organization in five substance use practice domains: screening, assessment, standard referral, active referral, and treatment support. Structural equation models indicated that supervisory encouragement and organizational innovation/flexibility were associated with greater individual adaptability. Adaptability (willingness to try new ideas, use new procedures, adjust quickly to change), was positively correlated with importance ratings. Importance ratings were positively associated with reported use of best practices. Organizational climates that support innovation likely affect use of practices through staff attributes and perceptions of the importance of such services.
Journal Article
Deathstroke, the Terminator. Volume 2, Sympathy for the devil
\"Deathstroke, the break-out villain from the 1980s sensation THE NEW TEEN TITANS and current star of the hit TV series \"Arrow,\" stars in his own graphic novel series! In this new collection, Deathstroke must train the new Vigilante while he recovers from his own recent injuries. Plus, after being captured by Superman, Deathstroke must escape the Justice League of America. Collects DEATHSTROKE THE TERMINATOR #10-13 and DEATHSTROKE THE TERMINATOR ANNUAL #1\"-- Provided by publisher.
Book
A structural model of treatment program and individual counselor leadership in innovation transfer
Background
A number of program-level and counselor-level factors are known to impact the adoption of treatment innovations. While program leadership is considered a primary factor, the importance of leadership among clinical staff to innovation transfer is less known. Objectives included explore (1) the influence of two leadership roles, program director and individual counselor, on recent training activity and (2) the relationship of counselor attributes on training endorsement.
Methods
The sample included 301 clinical staff in 49 treatment programs. A structural equation model was evaluated for key hypothesized relationships between exogenous and endogenous variables related to the two leadership roles.
Results
The importance of organizational leadership, climate, and counselor attributes (particularly counseling innovation interest and influence) to recent training activity was supported. In a subset of 68 counselors who attended a developer-led training on a new intervention, it was found that training endorsement was higher among those with high innovation interest and influence.
Conclusions
The findings suggest that each leadership level impacts the organization in different ways, yet both can promote or impede technology transfer.
Journal Article