Linkage facilitation for opioid use disorder in criminal legal system contexts: a primer for researchers, clinicians, and legal practitioners

At the intersection of drug policy, the opioid crisis, and fragmented care systems, persons with opioid use disorder (OUD) in the United States are significantly vulnerable to contact with the criminal legal system (CLS). In CLS settings, provision of evidence-based treatment for OUD is variable and often secondary to punitive approaches. Linkage facilitation at every touch point along the CLS Sequential Intercept Model has potential to redirect persons with OUD into recovery-oriented systems of care, increase evidence-based OUD treatment connections, and therefore reduce CLS re-exposure risk. Research in this area is still nascent. Thus, this narrative review explores the state of the science on linkage facilitation across the varied CLS contexts, including general barriers, facilitators, and opportunities for using linkage facilitation for OUD treatment and related services. Following the CLS Sequential Intercept Model, the specific CLS contexts examined include community services, police encounters, the courts (pre- and post-disposition), incarceration (pre-trial detention, jail, and prison), reentry (from jails, prisons, and unified systems), and community supervision (probation and parole). Examples of innovative linkage facilitation interventions are drawn from the Justice Community Opioid Innovation Network (JCOIN). Areas for future research and policy change are highlighted to advance the science of linkage facilitation for OUD services in the CLS

Recovery housing and on-the-ground research priorities: a scoping study through the lens of community based participatory research

IntroductionThough communities have featured recovery housing (RH) for several decades, the base of evidence for best practices continues to grow – especially evidence needed by, and known to, those who operate and receive these services. The Initiative for Justice and Emerging Adult Populations (JEAP) engaged with three community boards (CBs) – consisting of young adults with experience in recovery from substance use issues, people who have a history of criminal legal system involvement and recovery, and payers and provider of substance use services and harm reduction – to understand on-the-ground priorities for research into recovery support services.MethodsJEAP engaged with the CBs using community-based participatory research, resulting in 12 overarching categories of research priorities, including RH. Each category contains a general problem statement, as well as testable research questions stemming from the priorities identified by the CBs. It remains to be seen, though, if research has answered them. This study used these research questions as the basis for an adapted scoping study, querying extant literature on these research priorities.ResultsThese efforts resulted Our search found 132 peer-reviewed studies of RH since 1984, 111 of these pertaining to the CB’s research questions. These, however, were heavily weighted toward those providing fewer services and supervision (80%), and the research questions focused on RH operations (57%), though more recent efforts have investigated populations served (37%).DiscussionThough many RH studies fell within JEAP research questions, the literature has yet to reach an overarching consensus on best practices within each. Given the high degree of variation between types of RH programs and between geographic locations, such consensus may not be feasible or even desirable. Key elements of effective RH operations are discussed providing useful information for both researchers and practitioners to consider, as well as recommendations for future research

Real-world assessment of intravitreal dexamethasone implant (0.7 mg) in patients with macular edema: The CHROME study

© 2015 Lam et al.Background: The purpose of this study was to evaluate the real-world use, efficacy, and safety of one or more dexamethasone intravitreal implant(s) 0.7 mg (DEX implant) in patients with macular edema (ME). Methods: This was a retrospective cohort study of patients with ME secondary to retinal disease treated at ten Canadian retina practices, including one uveitis center. Best-corrected visual acuity (BCVA), central retinal thickness (CRT), intraocular pressure (IOP), glaucoma and cataract surgery, and safety data were collected from the medical charts of patients with ≥3 months of follow-up after the initial DEX implant.Results: One hundred and one patient charts yielded data on 120 study eyes, including diagnoses of diabetic ME (DME) (n=34), retinal vein occlusion (RVO, n=30; branch in 19 and central in 11), and uveitis (n=23). Patients had a mean age of 60.9 years, and 73.3% of the study eyes had ME for a duration of ≥12 months prior to DEX implant injection(s). Baseline mean (± standard error) BCVA was 0.63±0.03 logMAR (20/86 Snellen equivalents) and mean CRT was 474.4±18.2 μm. The mean number of DEX implant injections was 1.7±0.1 in all study eyes; 44.2% of eyes had repeat DEX implant injections (reinjection interval 2.3–4.9 months). The greatest mean peak changes in BCVA lines of vision occurred in study eyes with uveitis (3.3±0.6, P0.05). Significant decreases in CRT were observed: -255.6±43.6 µm for uveitis, -190.9±23.5 µm for DME, and -160.7±39.6 µm for RVO (P<0.0001 for all cohorts). IOP increases of ≥10 mmHg occurred in 20.6%, 24.1%, and 22.7% of DME, RVO, and uveitis study eyes, respectively. IOP-lowering medication was initiated in 29.4%, 16.7%, and 8.7% of DME, RVO, and uveitis study eyes, respectively. Glaucoma surgery was performed in 1.7% of all study eyes and cataract surgery in 29.8% of all phakic study eyes receiving DEX implant(s). onclusion: DEX implant(s) alone or combined with other treatments and/or procedures resulted in functional and anatomic improvements in long-standing ME associated with retinal disease.Link_to_subscribed_fulltex

Unusual manifestation of Erdheim-Chester disease

<p>Abstract</p> <p>Background</p> <p>Erdheim-Chester disease (ECD) is a rare multisystem non-Langerhans cell histiocytosis that is characterized histologically by xanthogranulomatous infiltrates and radiologically by symmetrical sclerosis of long bones. The xanthomatous process is characterized by prominent foamy histiocytes staining positive for CD68, occasionally for PS100 and negative for S100 and CD1a. Gastroenterological involvement is exceedingly rare.</p> <p>Case Presentation</p> <p>This case report describes the case of a 69-year-old man who presented otherwise well to the gastroenterology department with unspecific abdominal symptoms, nausea, vomiting and weight loss. ECD involving the gastrointestinal tract was confirmed clinically, radiologically and histologically.</p> <p>Conclusion</p> <p>Gastroenterological manifestation of ECD is rare but should be considered in the differential diagnosis in patients presenting with evidence of multi-organ disease and typical radiological features of Erdheim-Chester disease elsewhere.</p

Activation of the MAPK pathway is a common event in uveal melanomas although it rarely occurs through mutation of BRAF or RAS

In contrast to cutaneous melanoma, there is no evidence that BRAF mutations are involved in the activation of the mitogen-activated protein kinase (MAPK) pathway in uveal melanoma, although there is increasing evidence that this pathway is activated frequently in the latter tumours. In this study, we performed mutation analysis of the RAS and BRAF genes in a panel of 11 uveal melanoma cell lines and 19 primary uveal melanoma tumours. In addition, Western blot and immunohistochemical analyses were performed on downstream members of the MAPK pathway in order to assess the contribution of each of these components. No mutations were found in any of the three RAS gene family members and only one cell line carried a BRAF mutation (V599E). Despite this, mitogen-activated protein kinase/extracellular signal-regulated kinase kinase (MEK), ERK and ELK were constitutively activated in all samples. These data suggest that activation of the MAPK pathway is commonly involved in the development of uveal melanoma, but occurs through a mechanism different to that of cutaneous melanoma

Supporting linkage facilitators working with persons with opioid use disorder: challenges, advances, and future directions

This narrative review explores the evolving role of linkage facilitation (LF) in supporting persons with opioid use disorder (OUD) including both the organizational strategies to initiate and sustain LF services and strategies to support the LF workforce. Drawing on expert consensus and iterative review by an interdisciplinary author team, we synthesized relevant literature from diverse fields using a narrative review approach. Organizational strategies include: ensure leadership support, engage community partners and tailor services, consult with those already delivering LF services, provide adequate pay and career advancement opportunities, establish role clarification, and create official documentation of LF services. Strategies to support the LF workforce include: ensure comprehensive training and continuing education, provide robust supervision, encourage self-care, and establish quality/fidelity standards. Recommendations for advancing the profession include enhancing training for both LFs and supervisors, establishing centralized resource libraries, and tailoring support for diverse OUD-affected populations. This review advocates for the development of best practice guidelines, practical evaluation tools, and a collaborative resource-sharing hub to ensure long-term LF workforce sustainability and improved outcomes for those served