A National Survey of Problem-Solving Court Staff Perceptions of In-Person versus Virtual Hearings

During the COVID-19 pandemic, problem-solving courts adopted virtual hearings. We conducted an online nationwide survey with a convenience sample of court staff to elicit their perceptions of court participants' attendance, engagement, willingness to talk, and ability to form connection with judges during in-person versus virtual hearings. Sign tests compared ordinal ratings for perceptions of court participant outcomes during in-person versus virtual hearing modalities, and for audiovisual technology versus audio-only technology. The final analysis included 146 staff. Staff felt that during in-person hearings judges could form closer relationships with participants, quality of information exchanged was higher, and participants were more willing to talk. Staff rated attendance as high regardless of the modality. Staff felt participant engagement was higher with audiovisual technology than audio-only technology. Our results suggest that staff have concerns about effects of virtual hearings on court participant engagement and ability to form relationships with judges. Courts should address these potential negative effects of virtual hearings. We are concerned that staff perceived participants more negatively when participants used audio-only versus audiovisual technology, because technology access could be associated with participant demographic characteristics. Further research is needed to examine court participant perceptions and outcomes.

Sitting Less for Success: Reducing Sedentary Behaviors to Increase Kindergarten Achievement

BACKGROUND

Physical activity (PA) improves outcomes, but disadvantaged children typically experience more sedentary behavior (SB). This study explored movement, executive function (EF) health, and academic achievement (AA) for economically disadvantaged kindergarteners.

METHODS

Children in 2 classrooms (n = 16; n = 7) wore wrist-based accelerometers to assess PA/SB during the school day. Independent t-tests and analysis of variance analyzed mean group differences in PA/SB and EF/AA, and correlations explored AA and EF associations.

RESULTS

The movement-based class spent significantly less time in SB compared to the contemporary class (t = 2.552, g = 1.115), made greater reading (t = -2.611) and math (t = .967) gains, and had better EF (t = .012). There were significant negative correlations between SB and math (r = -.534) and reading (r = -.592), but no significant relationships with EF.

IMPLICATIONS FOR SCHOOL HEALTH POLICY, PRACTICE, AND EQUITY

Schools should consider methods to decrease time spent in SB at lower-SES schools, which is financially feasible and less time-consuming than programs to increase PA.

CONCLUSION

Decreased SB time was associated with better AA. More research is needed to determine whether interventions to decrease time spent in SB at school improve academic outcomes in disadvantaged children.

Direct and Indirect Impacts of Voluntary Pre-Kindergarten on Kindergarten Readiness and Achievement

Early Childhood Education (ECE) programs provide skills needed for successful kindergarten strides, especially for students from low socioeconomic backgrounds. While Florida's Voluntary Pre-Kindergarten (VPK) program currently serves most four-year-olds, some educators have questioned the program's quality. The purpose of this study was to investigate the direct and indirect effects of Florida's VPK program on kindergarten readiness and academic achievement for students attending the program in one county's VPK (CVPK) when compared to students who did not attend approved VPK programs in this county. The results suggest that, regardless of socioeconomic status, children who attended CVPK programs were just as prepared and performed equally as well in kindergarten as those who did not attend this program. Unfortunately, we cannot know how the CVPK program compared to specific pre-K alternatives without being able to distinguish program attendance across provider types (i.e., other ECE or no pre-K), which is something we recommend Florida begin tracking and make accessible.

Barriers to medications for opioid use disorder in the court system: provider availability, provider "trustworthiness," and cost

BACKGROUND

Medications for opioid use disorder (MOUD) significantly decrease mortality but courts rarely refer participants with opioid use disorder to MOUD providers. Previous qualitative work suggests routine court referrals to MOUD providers are more likely if court team members perceive providers as "trustworthy." Court team members may also be less likely to refer participants to MOUD if they consider MOUD unaffordable, particularly in Florida, which has not expanded Medicaid. Our aims were to explore court team members' 1) perceptions of availability of local trustworthy MOUD providers, 2) characteristics associated with perceptions of availability of local trustworthy MOUD providers, including beliefs about MOUD efficacy, and 3) perceptions of MOUD affordability.

METHODS

An online survey was distributed to all criminal problem-solving court and dependency court team members in Florida in 2019 and 2020. Likert scale questions assessed respondent agreement with statements about the availability of any MOUD providers, the availability of trustworthy MOUD providers, and the affordability of MOUD for court participants. An open-ended question explored MOUD barriers. Spearman's rho, Friedman, Kruskal Wallis, and Mann-Whitney U tests were used for analyzing quantitative data and iterative categorization for qualitative data.

RESULTS

One hundred fifty-one respondents completed quantitative questions (26% response rate), and 42 completed the qualitative question. Respondents were more likely to agree that local MOUD providers are more available than trustworthy MOUD providers. Perceptions of trustworthy provider availability differed significantly by MOUD type and were associated with MOUD efficacy beliefs. Qualitative results suggest that MOUD providers offering counseling and individualized treatment are more trustworthy.

CONCLUSIONS

Court team MOUD beliefs may influence their perceptions of providers, or negative experiences with providers may influence court team MOUD beliefs. Improving court team perceptions of local MOUD providers may be critical for facilitating court participant treatment access.

Criminal problem-solving and civil dependency court policies regarding medications for opioid use disorder

Background: Criminal problem-solving courts and civil dependency courts often have participants with substance use disorder (SUD), including opioid use disorder (OUD). These courts refer participants to treatment and set treatment-related requirements for court participants to avoid incarceration or to regain custody of children. Medications for opioid use disorder (MOUD) are the most effective treatment for OUD but are underutilized by court system participants. Little is known about variation in court policies for different MOUDs. Also, more information is needed about types of policies for each MOUD, including whether participants may begin MOUD, continue previously begun MOUD, or complete the court program with MOUD. Methods: An online survey was distributed to criminal problem-solving and civil dependency judges in Florida in 2019 and 2020, yielding data from 58 judges (a 24% response rate). We used nonparametric statistics to test hypotheses with ordinal data. A Friedman's test for related samples or Cochran's Q was used to make within-group comparisons between policies and MOUDs. Results: We found considerable policy variation, with more permissive policies for naltrexone than buprenorphine or methadone, and more permissive policies for continuing MOUD than for initiating MOUD or completing a court program with MOUD. For each medication, less than one quarter of judges indicated their court always permits MOUD, with most indicating that MOUD is permitted sometimes or usually. Conclusion: Because respondents rarely chose "never" or "always" for any MOUD policy, most courts appear to be making MOUD decisions on a case-by-case basis. A clearer understanding of this decision-making process is needed. Some court participants may be required to discontinue MOUD before completing a court program, even if they were permitted to start or continue MOUD treatment. Discontinuation of MOUD without medical justification is contrary to the standard of care for individuals with OUD and increases their risk of overdose.

Using Bayesian Correspondence Criteria to Compare Results From a Randomized Experiment and a Quasi-Experiment Allowing Self-Selection

BACKGROUND

Randomized experiments yield unbiased estimates of treatment effect, but such experiments are not always feasible. So researchers have searched for conditions under which randomized and nonrandomized experiments can yield the same answer. This search requires well-justified and informative correspondence criteria, that is, criteria by which we can judge if the results from an appropriately adjusted nonrandomized experiment well-approximate results from randomized experiments. Past criteria have relied exclusively on frequentist statistics, using criteria such as whether results agree in sign or statistical significance or whether results differ significantly from each other.

OBJECTIVES

In this article, we show how Bayesian correspondence criteria offer more varied, nuanced, and informative answers than those from frequentist approaches.

RESEARCH DESIGN

We describe the conceptual bases of Bayesian correspondence criteria and then illustrate many possibilities using an example that compares results from a randomized experiment to results from a parallel nonequivalent comparison group experiment in which participants could choose their condition.

RESULTS

Results suggest that, in this case, the quasi-experiment reasonably approximated the randomized experiment.

CONCLUSIONS

We conclude with a discussion of the advantages (computation of relevant quantities, interpretation, and estimation of quantities of interest for policy), disadvantages, and limitations of Bayesian correspondence criteria. We believe that in most circumstances, the advantages of Bayesian approaches far outweigh the disadvantages.

Comparative Regression Discontinuity: A Stress Test With Small Samples

Compared to the randomized experiment (RE), the regression discontinuity design (RDD) has three main limitations: (1) In expectation, its results are unbiased only at the treatment cutoff and not for the entire study population; (2) it is less efficient than the RE and so requires more cases for the same statistical power; and (3) it requires correctly specifying the functional form that relates the assignment and outcome variables. One way to overcome these limitations might be to add a no-treatment functional form to the basic RDD and including it in the outcome analysis as a comparison function rather than as a covariate to increase power. Doing this creates a comparative regression discontinuity design (CRD). It has three untreated regression lines. Two are in the untreated segment of the RDD-the usual RDD one and the added untreated comparison function-while the third is in the treated RDD segment. Also observed is the treated regression line in the treated segment. Recent studies comparing RE, RDD, and CRD causal estimates have found that CRD reduces imprecision compared to RDD and also produces valid causal estimates at the treatment cutoff and also along all the rest of the assignment variable. The present study seeks to replicate these results, but with considerably smaller sample sizes. The power difference between RDD and CRD is replicated, but not the bias results either at the treatment cutoff or away from it. We conclude that CRD without large samples can be dangerous.

Gender differences in anthropometric predictors of physical performance in older adults

BACKGROUND

Both high body fat and low muscle mass have been associated with physical disability in older adults. However, men and women differ markedly in body composition; men generally have more absolute and relative lean muscle mass and less fat mass than women. It is not known how these anthropometric differences differentially affect physical ability in men and women.

OBJECTIVES

This study examines differences in anthropometric predictors of physical performance in older women and men.

METHODS

Participants were 470 older women and men 72.9 (7.9) years of age. Body composition was measured using dual-energy x-ray absorptiometry. Maximum leg strength and power were measured using a leg press. Muscle quality (MQ) was calculated as relative strength (leg press strength per kilogram of leg muscle mass). Gait speed and chair rise were used to assess mobility performance and functional strength.

RESULTS

Body mass index (BMI), age, and MQ emerged as predictors (P < 0.05) of functional strength and mobility in men and women somewhat differently. After accounting for age and sample, leg MQ was related to chair rise time and gait speed in men but not women. BMI was related to gait speed in both men and women, but BMI was related to chair rise time only in women.

CONCLUSION

Results implicate the prioritized importance of healthy weight and muscle maintenance in older women and men for maintained physical functioning with aging.

Molecular and histological evidence of brown adipose tissue in adult cats

Brown adipose tissue (BAT) can influence glucose, lipid, and energy metabolism in rodents. Active BAT is now known to be present in adult humans, and interventions targeting BAT are being investigated for the treatment of human obesity and disorders of glucose and lipid metabolism. Domestic cats, like humans, are at increasing risk for obesity and diabetes but little is known about the presence and role of BAT in adult cats. The purpose of this study was to determine if brown adipocytes, identifiable by histological features and molecular markers, were present in the fat depots of adult cats. Adipose tissue samples from intrascapular, perirenal, and subcutaneous depots of eleven 8-12 year old cats (6 lean, 5 obese), were analyzed by real-time PCR for brown adipocyte markers uncoupling protein 1 (UCP1) and Type II iodothyronine 5'deiodinase (D2), by histological examination and by immunohistochemistry for UCP1. UCP1 mRNA was detectable in interscapular and subcutaneous depots in all cats, and in the perirenal depot in 10/11 cats. D2 mRNA was detectable in all depots from all cats. Multilocular adipocytes were identified in the interscapular depots of 4/11 cats and these were positive for UCP1 immunoreactivity. The results demonstrate that UCP1-expressing brown adipocytes are present in multiple depots of adult lean and long-term obese cats, even at 8-12 years of age. It is possible that dietary components or pharmacological agents that influence brown fat activity could exert a relevant biological effect in cats.

Pharmacokinetics of pioglitazone in lean and obese cats

Pioglitazone is a thiazolidinedione insulin sensitizer that has shown efficacy in Type 2 diabetes and nonalcoholic fatty liver disease in humans. It may be useful for treatment of similar conditions in cats. The purpose of this study was to investigate the pharmacokinetics of pioglitazone in lean and obese cats, to provide a foundation for assessment of its effects on insulin sensitivity and lipid metabolism. Pioglitazone was administered intravenously (median 0.2 mg/kg) or orally (3 mg/kg) to 6 healthy lean (3.96 ± 0.56 kg) and 6 obese (6.43 ± 0.48 kg) cats, in a two by two Latin Square design with a 4-week washout period. Blood samples were collected over 24 h, and pioglitazone concentrations were measured via a validated high-performance liquid chromatography assay. Pharmacokinetic parameters were determined using two-compartmental analysis for IV data and noncompartmental analysis for oral data. After oral administration, mean bioavailability was 55%, t(1/2) was 3.5 h, T(max) was 3.6 h, C(max) was 2131 ng/mL, and AUC(0-∞) was 15 556 ng/mL · h. There were no statistically significant differences in pharmacokinetic parameters between lean and obese cats following either oral or intravenous administration. Systemic exposure to pioglitazone in cats after a 3 mg/kg oral dose approximates that observed in humans with therapeutic doses.

The importance of covariate selection in controlling for selection bias in observational studies

The assumption of strongly ignorable treatment assignment is required for eliminating selection bias in observational studies. To meet this assumption, researchers often rely on a strategy of selecting covariates that they think will control for selection bias. Theory indicates that the most important covariates are those highly correlated with both the real selection process and the potential outcomes. However, when planning a study, it is rarely possible to identify such covariates with certainty. In this article, we report on an extensive reanalysis of a within-study comparison that contrasts a randomized experiment and a quasi-experiment. Various covariate sets were used to adjust for initial group differences in the quasi-experiment that was characterized by self-selection into treatment. The adjusted effect sizes were then compared with the experimental ones to identify which individual covariates, and which conceptually grouped sets of covariates, were responsible for the high degree of bias reduction achieved in the adjusted quasi-experiment. Such results provide strong clues about preferred strategies for identifying the covariates most likely to reduce bias when planning a study and when the true selection process is not known.

Propensity scores: an introduction and experimental test

Propensity score analysis is a relatively recent statistical innovation that is useful in the analysis of data from quasi-experiments. The goal of propensity score analysis is to balance two non-equivalent groups on observed covariates to get more accurate estimates of the effects of a treatment on which the two groups differ. This article presents a general introduction to propensity score analysis, provides an example using data from a quasi-experiment compared to a benchmark randomized experiment, offers practical advice about how to do such analyses, and discusses some limitations of the approach. It also presents the first detailed instructions to appear in the literature on how to use classification tree analysis and bagging for classification trees in the construction of propensity scores. The latter two examples serve as an introduction for researchers interested in computing propensity scores using more complex classification algorithms known as ensemble methods.

Polyvinylsiloxane dental impression material used to support the pinna after severe injury

This case illustrates the simple, cheap and immediate provision of a splint for the pinna after severe injury using dental polyvinylsiloxane impression material.

Monitoring pudendal nerve function during labor

BACKGROUND

To determine methodology and feasibility of pudendal nerve monitoring during labor and delivery.

METHODS

With Institutional Review Board approval, 13 low-risk, singleton pregnant women were recruited. The latency and amplitude of the perineal branch of the pudendal nerve compound muscle action potential were recorded during the second stage of labor and after delivery. With the first two patients, a wire electrode was used to stimulate the pudendal nerve continuously at the ischial spine. For the remaining 11 patients, a St. Mark's electrode was used to stimulate transvaginally. Aurethral ring electrode on a 14 French foley catheter monitored the response from the urethral sphincter. All patients received prophylactic antibiotics.

EXPERIENCE

Twelve patients delivered vaginally, and one by cesarean. In two patients, continuous wire stimulation showed a gradual decrease in amplitude. Changes were minimal over 15-minute intervals. Wire electrode placement was technically difficult and dislodged easily. With the remaining 11 patients, all had data available for interpretation, and of the 85 potential perineal branch of the pudendal nerve compound muscle action potentials, 53 were obtained. No patients developed cystitis.

CONCLUSION

Intrapartum assessment of pudendal nerve function is feasible. Continuous wire stimulation is technically more difficult and does not provide additional information beyond that available from intermittent stimulation.

Intraclass correlations from a community-based alcohol prevention study: the effect of repeat observations on the same communities

OBJECTIVE

School- and community-based alcohol prevention programs are often evaluated using a group-randomized trial (GRT) design with a single pretest and a single posttest survey. To size such studies properly, investigators need accurate estimates of the variance and intraclass correlation that will be operative in their analyses. Until recently, the only available estimates were based on cross-sectional analyses. A recent report suggests that values from cross-sectional analyses may overestimate the intraclass correlation operative in pretest-posttest analyses. The purpose of this article is to review these issues, present estimates of intraclass correlation for a variety of alcohol-related endpoints based on cross-sectional analyses and to compare those estimates to estimates based on pretest-posttest analyses. We will also show how these estimates can be used to establish optimal sample sizes for GRTs to evaluate school- and community-based alcohol prevention programs.

METHOD

Data were collected from 18 to 20 year olds and high-school seniors as part of an alcohol prevention effort employing a group-randomized trial design with a single pretest and a single posttest survey. Data were analyzed via mixed-model regression methods to estimate components of variance. Those components were then used to compute the intraclass correlations operative in both cross-sectional analyses and in pretest-posttest analyses.

RESULTS

Results indicate that intraclass correlations operative in pretest-posttest analyses are much smaller than are those operative in cross-sectional analyses.

CONCLUSIONS

Our findings indicate that future alcohol-prevention studies employing a group-randomized trial design with a single pretest and single posttest survey may not need to be as large as previously suggested by intraclass correlation estimates based on cross-sectional data. This holds true even if they are analyzed to reflect the extra variation typical of group-randomized trials.

Correlation of intraurethral ultrasonography and needle electromyography of the urethra

OBJECTIVE

To correlate structural intraurethral ultrasound findings with needle electromyography of striated urethral sphincters in young continent nulliparas.

METHODS

Twenty-three nulliparas, each less than 35 years old and without pelvic floor disorders, were recruited at Methodist Hospital in Indianapolis, Indiana, and the University of Louisville in Louisville, Kentucky. Each had concentric needle electromyography of their urethra to localize their striated urethral sphincter. Intraurethral ultrasound was used to identify the needle tip and layer in which it was found, examine the sonographic appearance of periurethral anatomy, and measure the thickness of hypoechoic and outer hyperechoic layers.

RESULTS

Three layers were seen on intraurethral ultrasound: a mildly hyperechoic inner layer, a hypoechoic middle layer, and a hyperechoic outer layer. The concentric needle tip was seen in all subjects and showed motor unit action potentials when located in the outer hyperechoic layer. The mean thickness of the hypoechoic layer was 2.5 mm, and the mean thickness of the outer hyperechoic layer was 2.6 mm.

CONCLUSION

Motor unit action potentials showed that striated muscle was present in the outer hyperechoic layer on intraurethral ultrasound, implying that it contains the striated urethral sphincter.

Fecal incontinence and the menstrual cycle: a case report

Urinary tract dysfunction influenced by the menstrual cycle has been described. This case demonstrates mensturation-influenced fecal incontinence. The patient had difficulty with stool control and rectal hygiene only during the week prior to her period. These symptoms had been present since she had discontinued oral birth control. Progestin levels and anal manometry were obtained during the secretory and luteal phases of her cycle and demonstrated a difference in resting anal tone between phases. Progestin smooth muscle relaxation is presumed to have uncovered an already weakened anal continence mechanism. With reinstitution of oral contraceptive pills the patient's cyclic fecal incontinence resolved.

A pedigree primer

Pedigree-taking skills can promote an understanding of how genetic information relates to a comprehensive family health assessment. The format of the pedigree is used to structure and organize data gathered in the assessment process. The pedigree can assist the nurse and genetics specialist to identify possible patterns of inheritance. This article outlines for the staff nurse the pertinent areas that need to be explored during the assessment process. It discusses common terms and symbols used in the pedigree. Information gathered from the health assessment of an adolescent with Usher's syndrome is used for an example of how the pedigree is constructed.

Nevra in a Greek village: idiom, metaphor, symptom, or disorder?

The folk model for nevra (nerves) in Methana, Greece, is discussed in terms of the contradiction between the ideal of solidarity, central to the local family ideology, and the reality of interpersonal conflict in daily life. Contradictions in values resulting from rapid socioeconomic change are also considered. Nevra, a broad, ambiguous, negotiated concept, expresses a wide range of symptoms and serves as a culturally condoned medium for expression of otherwise unacceptable emotions. The notion of nevra provides a metaphor for social disorder such as interpersonal conflict between close kinfolk and value conflicts between generations. Case studies of social interaction demonstrate the relationship of nevra to various kinds of social disorder as well as to what Western psychiatry labels emotional disorders. Nevra is also related to other idioms of distress: the evil eye, possession by the devil, excessive drinking, and pilgrimages to religious shrines.

Is schizophrenia rare if grain is rare?

If, as hypothesized, neuroactive peptides from grain glutens are the major agents evoking schizophrenia in those with the genotype(s), it should be rare if grain is rare. To test this, we analyzed the results of our clinical examinations (e.g., kuru) and observations of anthropologists on peoples consuming little or no grain. Only two overtly insane chronic schizophrenics were found among over 65,000 examined or closely observed adults in remote regions of Papua New Guinea (PNG, 1950-1967) and Malaita , Solomon Islands (1980-1981), and on Yap , Micronesia (1947-1948). In preneuroleptic Europe over 130 would have been expected. When these peoples became partially westernized and consumed wheat, barley beer, and rice, the prevalence reached European levels. Our findings agree with previous epidemiologic and experimental results indicating that grain glutens are harmful to schizophrenics.

Ovine fetal infection due to Salmonella arizonae

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