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Justen M, Edelman EJ, Chawarski M, Coupet E, Cowan E, Lyons M, Owens P, Martel S, Richardson L, Rothman R, Whiteside L, O'Connor PG, Zahn E, D'Onofrio G, Fiellin DA, Hawk KF. Perspectives on and experiences of emergency department-initiated buprenorphine among clinical pharmacists: A multi-site qualitative study. J Subst Use Addict Treat 2023; 155:209058. [PMID: 37149149 DOI: 10.1016/j.josat.2023.209058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Revised: 01/05/2023] [Accepted: 05/01/2023] [Indexed: 05/08/2023]
Abstract
INTRODUCTION Clinical pharmacists are well positioned to enhance efforts to promote emergency department (ED)-initiated buprenorphine to treat opioid use disorder (OUD). Among clinical pharmacists in urban EDs, we sought to characterize barriers and facilitators for ED-initiated buprenorphine to inform future implementation efforts and enhance access to this highly effective OUD treatment. METHODS This study was conducted as a part of Project ED Health (CTN-0069, NCT03023930), a multisite effectiveness-implementation study aimed at promoting ED-initiated buprenorphine that was conducted between April 2017 and July 2020. Data collection and analysis were grounded in the Promoting Action on Research Implementation in Health Services (PARIHS) framework to assess perspectives on the relationship between 3 elements: evidence for buprenorphine, the ED context, and facilitation needs to promote ED-initiated buprenorphine. The study used an iterative coding process to identify overlapping themes within these 3 domains. RESULTS The study conducted eight focus groups/interviews across four geographically disparate EDs with 15 pharmacist participants. We identified six themes. Themes related to evidence included (1) varied levels of comfort and experience among pharmacists with ED-initiated buprenorphine that increased over time and (2) a perception that patients with OUD have unique challenges that require guidance to optimize ED care. With regards to context, clinical pharmacists identified: (3) their ability to clarify scope of ED care in the context of unique pharmacology, formulations, and regulations of buprenorphine to ED staff, and that (4) their presence promotes successful program implementation and quality improvement. Participants identified facilitation needs including: (5) training to promote practice change and (6) ways to leverage already existing pharmacy resources outside of the ED. CONCLUSION Clinical pharmacists play a unique and critical role in the efforts to promote ED-initiated buprenorphine. We identified 6 themes that can inform pharmacist-specific interventions that could aid in the successful implementation of this practice.
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Affiliation(s)
- Marissa Justen
- Yale School of Medicine, 333 Cedar St, New Haven, CT 06510, United States of America.
| | - E Jennifer Edelman
- Yale School of Medicine, Department of Internal Medicine, Edward S. Harkness, Building A, 4th floor 367 Cedar Street, New Haven, CT 06510, United States of America
| | - Marek Chawarski
- Yale School of Medicine, Department of Psychiatry, 300 George St #901, New Haven, CT 06511, United States of America
| | - Edouard Coupet
- Yale School of Medicine, Department of Emergency Medicine, 464 Congress Ave, Suite 260, New Haven, CT 06519, United States of America
| | - Ethan Cowan
- Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Pl, New York, NY 10029, United States of America
| | - Michael Lyons
- University of Cincinnati College of Medicine, 3230 Eden Ave, Cincinnati, OH 45267, United States of America
| | - Patricia Owens
- Yale School of Medicine, Department of Emergency Medicine, 464 Congress Ave, Suite 260, New Haven, CT 06519, United States of America
| | - Shara Martel
- Yale School of Medicine, Department of Emergency Medicine, 464 Congress Ave, Suite 260, New Haven, CT 06519, United States of America
| | - Lynne Richardson
- Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Pl, New York, NY 10029, United States of America
| | - Richard Rothman
- John Hopkins University School of Medicine, 733 N Broadway, Baltimore, MD 21205, United States of America
| | - Lauren Whiteside
- University of Washington School of Medicine, 1959 NE Pacific St, Seattle, WA 98195, United States of America
| | - Patrick G O'Connor
- Yale School of Medicine, Department of Internal Medicine, Edward S. Harkness, Building A, 4th floor 367 Cedar Street, New Haven, CT 06510, United States of America
| | - Evan Zahn
- Yale New Haven Hospital, 20 York Street, New Haven, CT 06510, United States of America
| | - Gail D'Onofrio
- Yale School of Medicine, Department of Emergency Medicine, 464 Congress Ave, Suite 260, New Haven, CT 06519, United States of America
| | - David A Fiellin
- Yale School of Medicine, Department of Internal Medicine, Edward S. Harkness, Building A, 4th floor 367 Cedar Street, New Haven, CT 06510, United States of America; Yale School of Medicine, Department of Emergency Medicine, 464 Congress Ave, Suite 260, New Haven, CT 06519, United States of America
| | - Kathryn F Hawk
- Yale School of Medicine, Department of Emergency Medicine, 464 Congress Ave, Suite 260, New Haven, CT 06519, United States of America
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Harsono D, Deng Y, Chung S, Barakat LA, Friedland G, Villanueva M, Yager JE, Justen M, Edelman EJ. Prevalence and Correlates of Physical Inactivity Among Individuals with HIV During the First COVID-19 Wave: A Cross-sectional Survey. AIDS Behav 2023:10.1007/s10461-023-04170-5. [PMID: 37824037 DOI: 10.1007/s10461-023-04170-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/08/2023] [Indexed: 10/13/2023]
Abstract
Physical activity is associated with improved health outcomes among people with HIV (PWH). In the recent pandemic context, policies designed to mitigate COVID-19 transmission may result in an increase in sedentary lifestyle and decreased physical activity. In this study, we aimed to characterize self-reported physical activity and factors associated with physical inactivity during the first wave of the COVID-19 pandemic among a sample of PWH engaged in care. We also described whether psychological coping strategies measured by the Brief COPE differed based on physical activity levels. Among 260 surveyed PWH in two HIV clinics in the US Northeast, 28.5% (n = 74) met the criteria for being physically active according to the Centers for Disease Control and Prevention (CDC)'s physical activity guidelines. Receiving care in New Haven, CT, presence of a detectable HIV viral load, every day tobacco use, and unhealthy alcohol use were associated with physical inactivity. Problem-focused coping, emotion-focused coping, and avoidance-focused coping strategies were found to be protective against physical inactivity. In adjusted analysis, only problem-focused coping continued to be significantly associated with lower odds of reporting physical inactivity. Efforts are urgently needed to promote physical activity among PWH, including among those without problem-focused coping strategies.
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Affiliation(s)
- Dini Harsono
- Center for Interdisciplinary Research on AIDS, Yale School of Public Health, 135 College St, Suite 200, New Haven, CT, 06510, USA.
| | - Yanhong Deng
- Yale Center for Analytical Sciences, Yale School of Public Health, New Haven, CT, USA
| | - Sangyun Chung
- Yale Center for Analytical Sciences, Yale School of Public Health, New Haven, CT, USA
| | - Lydia A Barakat
- AIDS Care Program, Section of Infectious Disease, Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Gerald Friedland
- Center for Interdisciplinary Research on AIDS, Yale School of Public Health, 135 College St, Suite 200, New Haven, CT, 06510, USA
- AIDS Care Program, Section of Infectious Disease, Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT, USA
| | - Merceditas Villanueva
- Center for Interdisciplinary Research on AIDS, Yale School of Public Health, 135 College St, Suite 200, New Haven, CT, 06510, USA
- AIDS Care Program, Section of Infectious Disease, Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Jessica E Yager
- Center for Interdisciplinary Research on AIDS, Yale School of Public Health, 135 College St, Suite 200, New Haven, CT, 06510, USA
- SUNY Downstate Health Sciences University, Brooklyn, NY, USA
| | | | - E Jennifer Edelman
- Center for Interdisciplinary Research on AIDS, Yale School of Public Health, 135 College St, Suite 200, New Haven, CT, 06510, USA
- Section of General Internal Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
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Yang DH, Justen M, Lee D, Kim H, Boatright D, Desai M, Tiyyagura G. Experiences with Racism Among Asian American Medical Students. JAMA Netw Open 2023; 6:e2333067. [PMID: 37695582 PMCID: PMC10495868 DOI: 10.1001/jamanetworkopen.2023.33067] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 07/27/2023] [Indexed: 09/12/2023] Open
Abstract
Importance Asian American physicians have experienced a dual pandemic of racism and COVID-19 since 2020; understanding how racism has affected the learning environment of Asian American medical students is necessary to inform strategies to promoting a more inclusive medical school environment and a diverse and inclusive workforce. While prior research has explored the influence of anti-Asian racism on the experiences of Asian American health care workers, to our knowledge there are no studies investigating how racism has impacted the training experiences of Asian American medical students. Objective To characterize how Asian American medical students have experienced anti-Asian racism in a medical school learning environment. Design, Setting, and Participants This qualitative study included online video interviews of Asian American medical students performed between July 29, 2021, and August 22, 2022. Eligible participants were recruited through the Asian Pacific American Medical Students Association and snowball sampling, and the sample represented a disaggregated population of Asian Americans and all 4 medical school years. Main Outcomes and Measures The medical school experiences of Asian American medical students. Results Among 25 participants, Asian ethnicities included 8 Chinese American (32%), 5 Korean American (20%), 5 Indian American (20%), 3 Vietnamese American (12%), 2 Filipino American (8%), and 1 (4%) each Nepalese, Pakistani, and Desi American; 16 (64%) were female. Participants described 5 major themes concerning their experience with discrimination: (1) invisibility as racial aggression (eg, "It took them the whole first year to be able to tell me apart from the other Asian guy"); (2) visibility and racial aggression ("It transitioned from these series of microaggressions that every Asian person felt to actual aggression"); (3) absence of the Asian American experience in medical school ("They're not going to mention Asian Americans at all"); (4) ignored while seeking support ("I don't know what it means to have this part of my identity supported"); and (5) envisioning the future. Conclusions and Relevance In this qualitative study, Asian American medical students reported feeling invisible within medical school while a target of anti-Asian racism. Addressing these unique challenges related to anti-Asian racism is necessary to promote a more inclusive medical school learning environment.
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Affiliation(s)
- David H. Yang
- Department of Emergency Medicine, Yale University School of Medicine, New Haven, Connecticut
| | - Marissa Justen
- Yale University School of Medicine, Hew Haven, Connecticut
| | - Dana Lee
- Yale University School of Medicine, Hew Haven, Connecticut
| | - Heeryoung Kim
- Department of Psychiatry, Middlesex Hospital, Middletown, Connecticut
| | - Dowin Boatright
- Department of Emergency Medicine, New York University School of Medicine, New York
| | - Miraj Desai
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut
| | - Gunjan Tiyyagura
- Department of Pediatrics and Emergency Medicine, Yale School of Medicine, New Haven, Connecticut
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Justen M, Scodes J, Pavlicova M, Choo TH, Gopaldas M, Haeny A, Opara O, Rhee TG, Rotrosen J, Nunes EV, Hawk K, Edelman EJ. Homelessness and Treatment Outcomes Among Black Adults With Opioid Use Disorder: A Secondary Analysis of X:BOT. J Addict Med 2023; 17:463-467. [PMID: 37579110 PMCID: PMC10323031 DOI: 10.1097/adm.0000000000001125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE We sought to identify the sociodemographic and clinical characteristics associated with homelessnesss, and explore the relationship between homelessnesss and treatment outcomes among Black individuals. METHODS This is a secondary analysis of the subgroup of Black participants (n = 73) enrolled in "X:BOT," a 24-week multisite randomized clinical trial comparing the effectiveness of extended-release naltrexone versus sublingual buprenorphine-naloxone (n = 570). Outcomes included medication initiation, return to extramedical use of opioids assessed by both self-report and urine toxicology, and engagement in medications for opioid use disorder (MOUD) treatment at 28 weeks postrandomization. Descriptive statistics were performed. RESULTS Black participants were mostly unmarried and male, and about a third were aged 21-30 years. Among people experiencing homelessnesss, more were uninsured (45.5% [10/22] vs 19.6% [10/51]), unemployed (77.3% [17/22] vs 64.7% [33/51]), and reported alcohol (40.9% [9/22] vs 23.5% [12/51]) and sedative use (54.5% [12/22] vs 17.6% [9/51]) within the previous 30 days. Compared with housed Black individuals, a slightly higher proportion of Black individuals experiencing homelessnesss successfully initiated study medication (81.1% [18/22] vs 72.6% [37/51]); similar proportions returned to opioid use during the trial (68.2% [15/22] vs 68.6% [35/51]) and were engaged in MOUD at 28 weeks after trial entry (72.2% [13/18] vs 69.7% [23/33]) among participants located for follow-up. CONCLUSIONS These descriptive results among Black patients participating in a trial of MOUD suggest that efficacious MOUD is possible despite homelessnesss with additional clinical supports such as those provided by a clinical trial.
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Affiliation(s)
| | - Jennifer Scodes
- Department of Biostatistics, Brown University, Providence, RI, 02912, USA
- New York Psychiatric Institute, New York, NY, 10032, USA
| | - Martina Pavlicova
- Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, NY, 10032, USA
| | - Tse-Hwei Choo
- Division of Mental Health Data Science, New York State Psychiatric Institute, New York, NY, 10032, USA
| | - Manesh Gopaldas
- New York State Psychiatric Institute, New York, NY, 10032, USA
- Columbia Irving Medical Center, New York, NY, 10032, USA
| | - Angela Haeny
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, 06510
| | - Onumara Opara
- New York State Psychiatric Institute, New York, NY, 10032, USA
| | - Taeho Greg Rhee
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, 06510
- VA New England Mental Illness, Research, Education and Clinical Center (MIRECC), VA Connecticut Healthcare System, West Haven, CT, 06516, USA
| | - John Rotrosen
- NYU Grossman School of Medicine, New York, NY, 10016, USA
| | - Edward V. Nunes
- New York State Psychiatric Institute, New York, NY, 10032, USA
- Columbia Irving Medical Center, New York, NY, 10032, USA
| | - Kathryn Hawk
- Department of Emergency Medicine, Yale School of Medicine, New Haven, CT, 06510, USA
- Yale School of Public Health, New Haven, CT, 06510, USA
- Program in Addiction Medicine, Yale School of Medicine, New Haven, CT, 06510
| | - E. Jennifer Edelman
- Yale School of Public Health, New Haven, CT, 06510, USA
- Program in Addiction Medicine, Yale School of Medicine, New Haven, CT, 06510
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT, 06510
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Bommersbach T, Justen M, Bunting AM, Funaro MC, Winstanley EL, Joudrey PJ. Multidimensional assessment of access to medications for opioid use disorder across urban and rural communities: A scoping review. Int J Drug Policy 2023; 112:103931. [PMID: 36563489 DOI: 10.1016/j.drugpo.2022.103931] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 11/10/2022] [Accepted: 12/05/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND The majority of patients with opioid use disorder do not receive medications for opioid use disorder (MOUD), especially in rural areas. The patient-centered access to healthcare framework posits access as a multidimensional phenomenon impacted by five healthcare system and five patient ability dimensions. Interventions to improve local MOUD treatment outcomes require an understanding of how these dimensions differ across urban and rural communities. This scoping review sought to systematically appraise the literature on MOUD access across urban and rural communities (i.e., rurality) in the US using the patient-centered access framework. METHODS We performed a scoping review of 1) electronic databases, 2) grey literature, and 3) correspondence with content experts (March 2021). We included articles specifying the study sample by rurality and examining at least one dimension of access to MOUD. The analysis and qualitative synthesis of study results examined study characteristics and categorized key findings by access dimensions. RESULTS The search produced 3963 unique articles, of which 147 met inclusion criteria. Among included studies, 96% (142/147) examined healthcare system dimensions of access while less than 20% (25/147) examined any of the five dimensions of patient ability. Additionally, 49% (72/147) of studies compared access dimensions by rurality. Across studies, increasing rurality was associated with fewer available MOUD services, but little was known about geographic variation in other critical dimensions of access. CONCLUSIONS The vast majority of studies examined healthcare system dimensions of MOUD access and few studies made comparisons by rurality or prioritized the patient's perspective, limiting our understanding of how access differs by rurality in the US. As COVID-19 spurs novel changes in MOUD delivery, this inadequate multidimensional understanding of MOUD access may impede the tailoring of interventions to local needs. There is an urgent need for mixed-methods and community-engaged research prioritizing the patient's perspective of MOUD access by rurality. REGISTRATION Open Science Framework (https://osf.io/wk6b9/).
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Affiliation(s)
| | | | - Amanda M Bunting
- Department of Population Health, New York University Grossman School of Medicine, New York, NY, USA
| | - Melissa C Funaro
- Harvey Cushing/John Hay Whitney Medical Library, Yale University, New Haven, CT, USA
| | - Erin L Winstanley
- Department of Behavioral Medicine and Psychiatry, School of Medicine, West Virginia University, Morgantown, WV, USA; Department of Neuroscience, Rockefeller Neuroscience Institute, West Virginia University, Morgantown, WV, USA
| | - Paul J Joudrey
- Division of General Internal Medicine, Center for Research on Health Care, University of Pittsburgh, Pittsburgh, PA, USA
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Pathak N, Scott MC, Galivanche AR, Burroughs PJ, Moore HG, Hilibrand AS, Malpani R, Justen M, Varthi AG, Grauer JN. Postoperative bracing practices after elective lumbar spine surgery: A questionnaire study of U.S. spine surgeons. N Am Spine Soc J 2021; 5:100055. [PMID: 35141620 PMCID: PMC8820027 DOI: 10.1016/j.xnsj.2021.100055] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 02/14/2021] [Accepted: 02/21/2021] [Indexed: 11/25/2022]
Abstract
Background There is limited data available on the use of orthoses across varying elective spine surgeries. When previously studied in 2009, inconsistent lumbar postoperative bracing practices were reported. The present study aimed to provide a ten-year update regarding postoperative bracing practices after elective lumbar surgery among United States (U.S.) spine surgeons. Methods A questionnaire was distributed to attendees of the Lumbar Spine Research Society Annual Meeting (April 2019). The questionnaire collected demographic information, and asked surgeons to identify if they used orthoses postoperatively after ten elective lumbar surgeries. Information regarding type of brace, duration of use, and reason for bracing was also collected. Chi-square tests and one-way analysis of variance (ANOVA) were used for comparisons. Results Seventy-three of 88 U.S. attending surgeons completed the questionnaire (response rate: 83%). The majority of respondents were orthopaedic surgery-trained (78%), fellowship-trained (84%), and academic surgeons (73%). The majority of respondents (60%) did not use orthoses after any lumbar surgery. Among the surgeons who braced, the overall bracing frequency was 26%. This rate was significantly lower than that reported in the literature ten years earlier (p<0.0001). Respondents tended to use orthoses most often after stand-alone lateral interbody fusions (43%) (p<0.0001). The average bracing frequency after lumbar fusions (34%) was higher than the average bracing frequency after non-fusion surgeries (16%) (p<0.0001). The most frequently utilized brace was an off the shelf lumbar sacral orthosis (66%), and most surgeons braced patients to improve pain (42%). Of surgeons who braced, most commonly did so for 2–4 months (57%). Conclusion Most surgeon respondents did not prescribe orthoses after varying elective lumbar surgeries, and the frequency overall was lower than a similar study conducted in 2009. There continues to be inconsistencies in postoperative bracing practices. In an era striving for evidence-based practices, this is an area needing more attention.
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Affiliation(s)
- Neil Pathak
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, PO Box 208071, New Haven, CT 06520-8071, United States
| | - Michelle C Scott
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, PO Box 208071, New Haven, CT 06520-8071, United States
| | - Anoop R Galivanche
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, PO Box 208071, New Haven, CT 06520-8071, United States
| | - Patrick J Burroughs
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, PO Box 208071, New Haven, CT 06520-8071, United States
| | - Harold G Moore
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, PO Box 208071, New Haven, CT 06520-8071, United States
| | - Ari S Hilibrand
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, PO Box 208071, New Haven, CT 06520-8071, United States
| | - Rohil Malpani
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, PO Box 208071, New Haven, CT 06520-8071, United States
| | - Marissa Justen
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, PO Box 208071, New Haven, CT 06520-8071, United States
| | - Arya G Varthi
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, PO Box 208071, New Haven, CT 06520-8071, United States
| | - Jonathan N Grauer
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, PO Box 208071, New Haven, CT 06520-8071, United States
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Harper A, Ginapp C, Bardelli T, Grimshaw A, Justen M, Mohamedali A, Thomas I, Puglisi L. Debt, Incarceration, and Re-entry: a Scoping Review. Am J Crim Justice 2020; 46:250-278. [PMID: 32837173 PMCID: PMC7417202 DOI: 10.1007/s12103-020-09559-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/11/2020] [Accepted: 07/28/2020] [Indexed: 06/11/2023]
Abstract
People involved with the criminal justice system in the United States are disproportionately low-income and indebted. The experience of incarceration intensifies financial hardship, including through worsening debt. Little is known about how people who are incarcerated and their families are impacted by debt and how it affects their reentry experience. We conducted a scoping review to identify what is known about the debt burden on those who have been incarcerated and their families and how this impacts their lives. We searched 14 data bases from 1990 to 2019 for all original research addressing financial debt held by those incarcerated in the United States, and screened articles for relevance and extracted data from pertinent studies. These 31 studies selected for inclusion showed that this population is heavily burdened by debt that was accumulated in three general categories: debt directly from criminal justice involvement such as LFOs, preexisting debt that compounded during incarceration, and debts accrued during reentry for everyday survival. Debt was generally shown to have a negative effect on financial well-being, reentry, family structure, and mental health. Debts from LFOs and child support is very common among the justice-involved population and are largely unpayable. Other forms of debt likely to burden this population remain largely understudied. Extensive reform is necessary to lessen the burden of debt on the criminal justice population in order to improve reentry outcomes and quality of life.
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Affiliation(s)
- Annie Harper
- Department of Psychiatry, Yale University School of Medicine, 319 Peck st., Erector Sq. Building #1, New Haven, CT 06511 USA
| | | | - Tommaso Bardelli
- Department of Social and Cultural Analysis, New York University, 250 James Street, New Haven, CT 06513 USA
| | - Alyssa Grimshaw
- Harvey Cushing/ John Hay Whitney Medical Library, Yale University, New Haven, CT USA
| | | | | | | | - Lisa Puglisi
- Yale School of Medicine, Veterans Health Administration, New Haven, CT USA
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Weigand F, Goering E, Geissler J, Justen M, Dörr K, Ruck K, Schütz G. XMCD study of the Ruddlesden-Popper Phase La1.2Nd0.2Sr1.6Mn2O7. J Synchrotron Radiat 2001; 8:431-433. [PMID: 11512804 DOI: 10.1107/s0909049500016903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/31/2000] [Accepted: 11/10/2000] [Indexed: 05/23/2023]
Abstract
X-ray Magnetic Circular Dichroism (XMCD) measurements of the Ruddlesden-Popper Phase La1,2Nd0,2Sr1.6Mn2O7 are reported. The Mn K. La and Nd L2,L3 edges have been measured on a powder sample at two different magnetic fields at low temperature. The analysis of the spectra at B = 1T indicates a large orbital moment of the Nd 5d-states and a significant spin-polarization of the La 5d-band. Furthermore at the Mn K-edge a XMCD-signal is observed, showing a polarization of the Mn 4p-band. At lower field (0.2T) all XMCD-signals are about two times smaller corresponding to the lower total magnetization. The signal at the Nd L2 edge vanishes completely at 0.2T.
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Affiliation(s)
- F Weigand
- Lehrstuhl für Experimentelle Physik IV, Universität Würzburg, Germany.
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Abstract
The long-term prognosis after thrombolytic therapy in patients with acute myocardial infarction (AMI) is unknown. This question was investigated in a 4-year follow-up study of 227 patients. According to the status of reperfusion at the end of the acute catheterization, the patients were divided into a patent (n = 171) and an occluded (n = 56) group. Both hospital and 4-year mortality rates were significantly reduced in the patent group by 13 and 14%, respectively (p less than or equal to 0.005 for both). Baseline variables known to be important for prognosis did not differ between the 2 groups. Patients with a patent infarct artery who underwent early acute coronary artery bypass grafting (CABG) had a greater survival (p less than 0.10) and better left ventricular function (p less than 0.01) than did patients with a patent infarct artery who did not undergo CABG. This difference was associated with a lower frequency of fatal reinfarction and cardiogenic shock in the CABG group. Thus, survival is improved up to 4 years after successful thrombolysis and appears to be further enhanced by early CABG.
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Affiliation(s)
- D G Mathey
- Department of Cardiology, University Hospital Eppendorf, Hamburg, West Germany
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