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Behavioral health treatment disparities by race and ethnicity are well documented across the criminal legal system. Despite criminal legal settings such as drug treatment courts (DTCs) increasingly adopting evidence-based programs (EBPs) to improve care, there is a dearth of research identifying strategies to advance equitable implementation of EBPs and reduce racial/ethnic treatment disparities. This paper describes an innovative approach to identify community- and provider-generated strategies to support equitable implementation of an evidence-based co-occurring mental health and substance use disorder intervention, called Maintaining Independence and Sobriety through Systems Integration, Outreach and Networking-Criminal Justice (MISSION-CJ), in DTCs.
Guided by the Health Equity Implementation Framework, qualitative interviews and surveys will assess factors facilitating and hindering equitable implementation of MISSION-CJ in DTCs among 30 Black/African American and/or Hispanic/Latino persons served and providers. Concept mapping with sixty Black/African American and/or Hispanic/Latino persons served and providers will gather community- and provider-generated strategies to address identified barriers. Finally, an advisory board will offer iterative feedback on the data to guide toolkit development and inform equitable implementation of MISSION-CJ within DTCs.
The paper illustrates a protocol of a study based in community-engaged research and implementation science to understand multilevel drivers of racial/ethnic disparities in co-occurring disorder treatment and identify opportunities for intervention and improvements within criminal legal settings.
School-based CalFresh Healthy Living (CFHL) (California’s SNAP-Ed) interventions adapted to new learning environments necessitated by COVID-19. We examined the impact of these interventions on student diet and physical activity (PA) outcomes.
Quasi-experimental, two-group, pre-post.
California public schools with ≥50 % of students Free and Reduced Price Meal-eligible (nintervention = 47; ncomparison = 17).
Fourth- and fifth-grade students who completed the online Eating and Activity Tool for Students at pre and post (nintervention = 1087; ncomparison = 846 students).
Intervention students reported a significantly greater increase in consumption frequency of total fruit (by 0·16 times/d; P = 0·032), driven primarily by a greater increase in 100 % fruit juice (by 0·11 times/d; P = 0·007). Intervention students reported a significantly greater increase in total vegetable consumption frequency (by 0·45 times/d; P < 0·001) than comparison students. Specifically, intervention students reported increased, whereas comparison students reported decreased, consumption frequencies for starchy vegetables (0·05 v. −0·10 times/d, P < 0·001), salad/green vegetables (0·01 v. −0·11 times/d, P = 0·005) and beans (0·04 v. −0·03 times/d, P = 0·025). Consumption frequency of other vegetables decreased in both groups (−0·01 v. −0·09 times/d) but decreased more among comparison students (P = 0·048). No differences in pre-post change in PA outcomes were detected.
Findings suggest that despite COVID-19-related challenges necessitating programme modifications, CFHL interventions played a role in protecting student consumption of fruit and vegetables during the 2020–2021 school year. Therefore, it appears that school-based CFHL interventions can be a viable means of safeguarding student nutrition at a time when access to nutritious food and PA opportunities are hindered.
Common mental disorders are highly prevalent among Syrian refugees. Problem Management Plus (PM+) is a brief, transdiagnostic, non-specialist helper delivered, psychological intervention targeting psychological distress. This single-blind pilot randomised controlled trial (RCT) on PM+ delivered by peer-refugees examined trial procedures in advance of a definitive RCT, evaluated PM+ 's acceptability and feasibility, and investigated its likely effectiveness and cost-effectiveness among Syrian refugees in the Netherlands.
Adult Syrian refugees (N = 60) with elevated psychological distress (Kessler Psychological Distress Scale (K10) score >15) and reduced pychosocial functioning (WHO Disability Assessment Schedule 2.0 (WHODAS) score >16) were randomised into PM+ in addition to care as usual (CAU) (PM+/CAU; n = 30) or CAU alone (n = 30). Primary outcomes were symptoms of depression and anxiety (Hopkins Symptom Checklist; HSCL-25) at 3-month follow-up. Secondary outcomes were pychosocial functioning (WHO Disability Assessment Schedule; WHODAS 2.0), symptoms of posttraumatic stress disorder (PTSD) (PTSD Checklist for DSM 5; PCL-5) and self-identified problems (Psychological Outcomes Profiles; PSYCHLOPS). Changes in service utilisation and time out of employment and/or adult education were estimated (adapted version of the Client Service Receipt Inventory; CSRI). Semi-structured interviews on the implementation of PM+ were conducted with stakeholders (i.e. six PM+ participants, five non-specialist helpers and five key informants).
Recruitment, randomization and blinding procedures were successful. PM+ was generally perceived positively by stakeholders, especially regarding the intervention strategies, accommodation of the intervention and the helpers. Two serious adverse events not attributable to the trial were reported. At 3-month follow-up, the HSCL-25 total score was significantly lower for the PM+/CAU group (n = 30) than CAU group (n = 30) (p = 0.004; d = 0.58). Significant differences in favour of PM+/CAU were also found for WHODAS psychosocial functioning (p = 0.009, d = 0.73), PCL-5 symptoms of PTSD (p = 0.006, d = 0.66) and PSYCHLOPS self-identified problems (p = 0.005, d = 0.81). There were no significant differences in mean health service costs (p = 0.191) and the mean costs of lost productive time (p = 0.141). This suggests PM+ may potentially be cost-effective with an incremental cost from a health system perspective of €5047 (95% CI €0–€19 773) per additional recovery achieved.
Trial procedures and PM+ delivered by non-specialist peer-refugee helpers seemed acceptable, feasible and safe. Analyses indicate that PM+ may be effective in improving mental health outcomes and psychosocial functioning, and potentially cost-effective. These results support the development of a definitive RCT with a larger sample of refugees and a longer follow-up period.
The dairy cow model ‘Molly’ is a mixed discrete event-continuous system model that simulates feeding, metabolism and lactation of dairy cows. Decades of model development have resulted in a valuable tool in dairy science. Due to the deprecation of the ACSL (Advanced Continuous Simulation Language) programming language, Molly has been translated into C++. This paper describes the translation process and discusses the advantages of the new implementation, one of which is the ability to run Molly within RStudio, a popular integrated development environment (IDE) for data science.
Wind-driven snow redistribution can increase the spatial heterogeneity of snow accumulation on ice caps and ice sheets, and may prove crucial for the initiation and survival of glaciers in areas of marginal glaciation. We present a snowdrift model (Snow_Blow), which extends and improves the model of Purves, Mackaness and Sugden (1999, Journal of Quaternary Science 14, 313–321). The model calculates spatial variations in relative snow accumulation that result from variations in topography, using a digital elevation model (DEM) and wind direction as inputs. Improvements include snow redistribution using a flux routing algorithm, DEM resolution independence and the addition of a slope curvature component. This paper tests Snow_Blow in Antarctica (a modern environment) and reveals its potential for application in palaeoenvironmental settings, where input meteorological data are unavailable and difficult to estimate. Specifically, Snow_Blow is applied to the Ellsworth Mountains in West Antarctica where ablation is considered to be predominantly related to wind erosion processes. We find that Snow_Blow is able to replicate well the existing distribution of accumulating snow and snow erosion as recorded in and around Blue Ice Areas. Lastly, a variety of model parameters are tested, including depositional distance and erosion vs wind speed, to provide the most likely input parameters for palaeoenvironmental reconstructions.
To assess produce availability, quality and price in a large sample of food stores in low-income neighbourhoods in California.
Cross-sectional statewide survey.
Between 2011 and 2015, local health departments assessed store type, WIC (Supplemental Nutrition Program for Women, Infants, and Children)/SNAP (Supplemental Nutrition Assistance Program) participation, produce availability, quality and price of selected items in stores in low-income neighbourhoods. Secondary data provided reference chain supermarket produce prices matched by county and month. t Tests and ANOVA examined differences by store type; regression models examined factors associated with price.
Large grocery stores (n 231), small markets (n 621) and convenience stores (n 622) in 225 neighbourhoods.
Produce in most large groceries was rated high quality (97 % of fruits, 98 % of vegetables), but not in convenience stores (25 % fruits, 14 % vegetables). Small markets and convenience stores participating in WIC and/or SNAP had better produce availability, variety and quality than non-participating stores. Produce prices across store types were, on average, higher than reference prices from matched chain supermarkets (27 % higher in large groceries, 37 % higher in small markets, 102 % higher in convenience stores). Price was significantly inversely associated with produce variety, adjusting for quality, store type, and SNAP and WIC participation.
The study finds that fresh produce is more expensive in low-income neighbourhoods and that convenience stores offer more expensive, poorer-quality produce than other stores. Variety is associated with price and most limited in convenience stores, suggesting more work is needed to determine how convenience stores can provide low-income consumers with access to affordable, high-quality produce. WIC and SNAP can contribute to the solution.
With now over 50 million people worldwide with dementia (Prince et al., 2013), there are almost certainly well over 100 million people with cognitive concerns and many of these will attend their health professional keen to know what is going on. We need those without intensive training in this field to be more confident and correct in their diagnosis when such a concerned person turns up. Many simple diagnostic tests have been proposed and some assessed – these include the walk and talk (divided attention) test (those who stop when asked a question while walking may be cognitively impaired) (Lamoth et al., 2011), the clock drawing test (Brodaty and Moore, 1997), the “handbag” sign (those clutching their personal possessions are more likely to be cognitively impaired) and the “hippopotamus sign” (calling the rhinoceros, in those tests that include this, a hippopotamus). Simple screening tests have been extensively validated and are important to the clinician in formulating a diagnosis (Lorentz et al., 2002). The “head-turning” and the “attended with/alone” signs are frequently observed, and many clinicians assessing such individuals would be well aware of them and probably even unknowingly factor them into their diagnosis. In this issue, Pinar Soysal and colleagues (Soysal et al., 2017) have evaluated these signs and, in those older people attending with cognitive concerns, found they had quite good diagnostic value. They were not very specific but showed good sensitivity and negative predictive value. Indeed, at the recent Alzheimer's Association International Conference in London there were several posters evaluating “soft but simple” signs although not all performed as expected – one group found gait actually sped up in those with cognitive impairment that were asked a question.
Stranded in Jamaica for a year in AD 1503, Christopher Columbus and crew became reliant on the Taíno village of Maima for provisions. Recent archaeological survey and excavations at this site document a sizeable hillside settlement established early in the White Marl period of Jamaican culture history with continued occupation up to Spanish contact. Beginning by 13th to 14th century AD, the people at Maima expanded their settlement capacity across the hillslope through construction of house terraces and platforms employing large volumes of limestone rock and gravel fill. Archaeological excavation on these features has exposed at least one circular, center-pole Taíno house with a surprisingly limited floor space. A review of Jamaican archaeology suggests both hillside terracing and small house form is characteristic of Jamaican Taíno village configuration more broadly. This pattern stands in contrast to other areas of Taíno settlement in the Caribbean, and to the small number of Spanish chronicles in which Taíno villages and houses are described.
Clearly defined distal tephras are rare in rockshelter sediment records. Crvena Stijena, a Palaeolithic site in Montenegro, contains one of the longest (> 20 m) rockshelter sediment records in Europe with deposits ranging in age from Middle Pleistocene to mid-Holocene. A distinctive tephra is clearly exposed within the well stratified record approximately 6.5 m below the present land surface. We present geochemical data to confirm that this tephra is a distal equivalent of the Campanian Ignimbrite deposits and a product of the largest Late Pleistocene eruption in Europe. Originating in the Campanian volcanic province of southwest Italy, this tephra has been independently dated to 39.3 ka. It is a highly significant chronostratigraphic marker for southern Europe. Macrostratigraphic and microstratigraphic observations, allied with detailed particle size data, show that the tephra layer is in a primary depositional context and was transported into the rockshelter by aeolian processes. This site is unique because the tephra forms an abrupt boundary between the Middle and Upper Palaeolithic records. Before they can be used as chronostratigraphic markers in rockshelter and cave-mouth environments, it is essential to establish the stratigraphic integrity of distal tephras and the mechanisms and pathways involved in their transport and deposition.
Outcrops of an ash bed at several localities in northern California and western Nevada belong to a single air-fall ash layer, the informally named Rockland ash bed, dated at about 400,000 yr B.P. The informal Rockland pumice tuff breccia, a thick, coarse, compound tephra deposit southwest of Lassen Peak in northeastern California, is the near-source equivalent of the Rockland ash bed. Relations between initial thickness of the Rockland ash bed and distances to eruptive source suggest that the eruption was at least as great as that of the Mazama ash from Crater Lake, Oregon. Identification of the Rockland tephra allows temporal correlation of associated middle Pleistocene strata of diverse facies in separate depositional basins. Specifically, marine, littoral, estuarine, and fluvial strata of the Hookton and type Merced formations correlate with fluvial strata of the Santa Clara Formation and unnamed alluvium of Willits Valley and the Hollister area, in northwestern and west-central California, and with lacustrine beds of Mohawk Valley, fluvial deposits of the Red Bluff Formation of the eastern Sacramento Valley, and fluvial and glaciofluvial deposits of Fales Hot Spring, Carson City, and Washoe Valley areas in northeastern California and western Nevada. Stratigraphic relations of the Rockland ash bed and older tephra layers in the Great Valley and near San Francisco suggest that the southern Great Valley emerged above sea level about 2 my ago, that its southerly outlet to the ocean was closed sometime after about 2 my ago, and that drainage from the Great Valley to the ocean was established near the present, northerly outlet in the vicinity of San Francisco Bay about 0.6 my ago.
Detailed morpho- and lithostratigraphic investigations, allied with radiometric dating, in the Voidomatis basin, Epirus, northwest Greece, have identified four Quaternary terraced alluvial fills that range from middle Pleistocene to historic in age. Major-periods of alluviation during the late Quaternary were associated with valley glaciation (ca. 26,000–20,000 yr B.P.) and subsequent deglaciation (ca. 20,000–15,000 yr B.P.) in the Pindus Mountains during Late Würmian times, and more recently linked to overgrazing sometime before the 11th century AD. The late Quaternary alluvial stratigraphy of the Voidomatis River is more complex than the “Older Fill” and “Younger Fill” model outlined previously, and it is suggested that these terms should no longer form the basis for defining alluvial stratigraphic units in the Mediterranean Basin.
The Australian Imaging, Biomarkers and Lifestyle (AIBL) Flagship Study of Ageing is a prospective study of 1,112 individuals (211 with Alzheimer's disease (AD), 133 with mild cognitive impairment (MCI), and 768 healthy controls (HCs)). Here we report diagnostic and cognitive findings at the first (18-month) follow-up of the cohort. The first aim was to compute rates of transition from HC to MCI, and MCI to AD. The second aim was to characterize the cognitive profiles of individuals who transitioned to a more severe disease stage compared with those who did not.
Eighteen months after baseline, participants underwent comprehensive cognitive testing and diagnostic review, provided an 80 ml blood sample, and completed health and lifestyle questionnaires. A subgroup also underwent amyloid PET and MRI neuroimaging.
The diagnostic status of 89.9% of the cohorts was determined (972 were reassessed, 28 had died, and 112 did not return for reassessment). The 18-month cohort comprised 692 HCs, 82 MCI cases, 197 AD patients, and one Parkinson's disease dementia case. The transition rate from HC to MCI was 2.5%, and cognitive decline in HCs who transitioned to MCI was greatest in memory and naming domains compared to HCs who remained stable. The transition rate from MCI to AD was 30.5%.
There was a high retention rate after 18 months. Rates of transition from healthy aging to MCI, and MCI to AD, were consistent with established estimates. Follow-up of this cohort over longer periods will elucidate robust predictors of future cognitive decline.
Luminescence methods were used to date a palaeoenvironmental coastal exposure on Stronsay, Orkney. The section consists of glacial sediments that are overlain by intercalated peats and windblown sands, implying varying past environmental conditions. Rapid luminescence characterisation was undertaken using screening methods in combination with quantitative dating of selected samples, providing information on depositional processes and chronology. A temporal discontinuity between the glacial sediments and later peats encompasses the period associated with an important Mesolithic site located inland, and implies erosional episodes. The onset of blanket bog formation on Stronsay dates to 3760±330 yrs BP, consistent with observations elsewhere in Orkney and northern Scotland. Periods of enhanced aeolian activity on Stronsay occurred in the late Bronze Age (2700±265 yrs BP) and at the beginning of the Little Ice Age (650±75 yrs BP). Recent periods of sand deposition in the 19th and 20th centuries (AD 1865±20 and 1960±5) correspond to periods of known historic storminess. These results add to an expanding catalogue of data on sand movements throughout the Holocene in Orkney, and set a framework to interpret the evolution of nearby archaeological and natural landscapes from prehistoric to modern times.