MI Implementation in Juvenile Justice: A Case Report

Motivational interviewing (MI) is a communication style focused on enhancing clients’ own motivation towards change. In the justice system MI has evidence to support that it enhances communication and change behaviors in youth. As most MI training is designed for healthcare settings training and implementation of MI must be adapted to fit the juvenile justice model. This includes both rehabilitation and restorative justice. Here we describe the details that allowed one county small county in Pennsylvania to roll out MI training and initial skills review in less than 6 months. The case reviews the details of planning, trainings, and timing of activities. We then discuss what elements of those details fit into a greater implementation plan that may be applied elsewhere. Four key elements were instrumental to implementation: 1) appreciation of JPO time constraints, 2) cost containment 3) using blending to enhance JPO flexibility with MI use, and 4) policies that normalize use of MI. This outline may assist other courts in their own implementation efforts.     

Factors Associated with Physician Discussion of Health Behaviors with Adolescents

Behaviors developed in adolescence influence health later in life. The purpose of this study was to investigate the frequency of health care provider's discussion of health behaviors with overweight and non-overweight adolescents and identify demographic and health behaviors related to exercise, hours of television viewing, and weight issues associated with these discussions. A Cross sectional survey of urban adolescents was conducted. Trained interviewers administered surveys over a three month period in 2001 at an urban academic pediatric and adolescent clinic. The 252 adolescents surveyed had a mean age of 15 with 49% categorized as being at risk for overweight/overweight and 51% as normal weight using the CDC percentiles for BMI. While 16% of the adolescents reported that their physician or nurse discussed the amount of television they watched, rates of discussion related to exercise (58%), and weight (54%) were much higher. In multivariate analyses, health care provider discussions with adolescents regarding exercise were more common for overweight (O.R.=2.42, 95% C.I. [1.28–4.57]) and at risk for overweight (O.R.=1.98, 95% C.I. [1.03–3.81]) adolescents, whereas physician discussion of television viewing was not associated with weight. Discussions of weight were more common for female (O.R.=2.18, 95% C.I. [1.21–3.95]), African-American (O.R.=2.53, 95% C.I. [1.40–4.57]), and overweight (O.R.=3.92, 95% C.I. [1.97–7.81]) adolescents. Even after adjusting for weight, race and gender strongly influenced the frequency of discussions about weight in physician offices. Although health care providers frequently address weight and exercise with adolescents, more discussions related to sedentary behaviors such as television viewing may be warranted to address adolescent obesity.Received PhD in Epidemiology from University of California, San Diego. Research interests include smoking prevention and cessation among adolescents and health promotion interventions.Received MD from University of Missouri-Kansas City and MPH from Johns Hopkins University. Research interests include health services research and research in support of measurable, systematic improvements in the quality of medical care.Received medical degree from Christian Medical College, Punjab, India and Master of Public Health from University of Kansas School of Medicine. Research interests include diet and physical activity behaviors, role of the environment in obesity and obesity prevention, especially among children and adolescents.Received MBBS from Allama Iqbal Medical College, Punjab University, Lahore, Pakistan and MPH from University of Kansas Medical Center. Research interests include smoking cessation, database design, implementation, data management and analysis, and use of information technology in health care settings.Director, Cancer Prevention, Control, and Population Sciences, Kansas Cancer Institute. Received MD/MPH from Tulane University and MS from Harvard School of Public Health. Research interests include disparities in healthcare; smoking cessation among underserved populations, specifically African Americans; diet, nutrition, obesity, and physical activity.     

Flies eggs: a new method for the estimation of short-term post-mortem interval?

Three modeling methods were used to estimate the time for laying of Lucilia sericata eggs (Diptera, Calliphoridae) after measurements of hatching times at several constant temperatures. These models were tested first under controlled conditions with 19 profiles of fluctuating temperatures, and on the other hand under field conditions on mice. All three models were allowed to determine the time of laying within a period of about 2h, and consequently this determines the time of death, as this species lays immediately after death under favorable conditions. Rearing of eggs sampled on a corpse may therefore contribute to the determination of a short post-mortem interval (PMI).     

Determination of drug levels in larvae of Protophormia terraenovae and Calliphora vicina (Diptera: Calliphoridae) reared on rabbit carcasses containing morphine

Two species of blow flies (Diptera: Calliphoridae) were reared on tissues from rabbits administered different dosages of morphine. These species, Protophormia terraenovae and Calliphora vicina are among the first wave of insects colonizing a dead body. Two series of 3 rabbits were given dosages of 10, 20, and 40 mg/h of morphine over a 3 h period via ear artery perfusion. A morphine blood level plateau was attained after 1 h of perfusion. Two other rabbits were used as controls. Samples of tissues collected from rabbits using a coelioscopic technique were determined to have morphine concentrations similar to those encountered in human overdoses and were correlated with dosages of morphine administered. All samples from control rabbits were negative for morphine. Larvae and puparia of both species were regularly collected from each rabbit for toxicological analysis. Concentrations of morphine in larvae reared on rabbit carcasses containing morphine were significantly lower than concentrations found in the tissues. There was a decrease in concentration in morphine observed in transition from feeding 3rd instar larva to puparium. A correlation between larval concentration and tissue concentration was found only in feeding 3rd instar larvae.     

Immunohistochemical contribution to the study of morphine metabolism in Calliphoridae larvae and implications in forensic entomotoxicology

Morphine was detected by immunohistochemistry on sections of third stage larvae of Calliphora vomitoria (Diptera, Calliphoridae) reared on minced beef meat previously treated with morphine hydrochloride. The detection was performed with an avidin-biotin-peroxidase-complex method. Positive specimens showed specific staining of the haemolymph and a more intense immunoreaction in an area located at the limit between exocuticle and endocuticle. These results constitute an evidence of morphine accumulation inside the cuticle of Diptera larvae during their development. During the pupariation, the larval cuticle is transformed into the sclerotized puparium. This study consequently points out the possibilities of analyzing empty pupariae when suitable tissues or living necrophagous insects are absent.     

Morphine perfused rabbits: a tool for experiments in forensic entomotoxicology

In order to establish an animal model for entomotoxicological studies, the kinetics of morphine elimination from blood after a single intravenous injection of morphine and the concentration of morphine in tissues following a continuous perfusion were studied. The aim of these experiments was to obtain controlled morphine tissue concentrations similar to those encountered in fatal human heroin overdoses. These tissues can be used as a food source for developing fly larvae in entomotoxicological studies. In the single injection experiment, seven rabbits were administered 1 or 2 mg/kg body weight of morphine chlorhydrate via the main ear artery. Blood samples of 200 microL were removed regularly via a catheter. Morphine concentration was determined using RIA techniques. Morphine was found to be first rapidly distributed and then slowly eliminated, following a two-exponential equation. Elimination of morphine from blood can be described as a two-compartment model. Constants of the equation were determined using the Kaleidagraph program. Using those constants, the main pharmacokinetics parameters were calculated. Results of these parameters showed the following: clearance from 13.3 to 16.2 L.h.1, half-life of the distribution phase from 0.6 to 0.9 min, and half-life of the elimination phase from 21 to 26 min. These results were used to calculate the rate of perfusion of morphine for rabbits to obtain desired, controlled, and constant concentrations of morphine in tissues. In the second experiment, three rabbits received a perfusion of morphine intravascularly at a rate of 2 mg/kg/h for a period of 3 h. These rabbits were sacrificed and analyses performed on several abdominal and thoracic organs. Results showed that the concentrations of morphine differed according to the organ analyzed, but were reproducible for organs between animals. These concentrations were similar to those normally encountered in cases of human death due to heroin overdoses.     

Detection of deception with fMRI: Are we there yet?

A decade of spectacular progress in functional magnetic resonance imaging (fMRI) technology and systems neuroscience research has so far yielded few changes in our daily lives. The dearth of clinical applications of this prolific and academically promising research tool began raising the eyebrows of the public and the research funding agencies. This may be one of the reasons for the enthusiasm and interest paid to the growing body of literature suggesting that blood oxygenation level‐dependent (BOLD) fMRI of the brain could be sensitive to the differences between lie and truth. The word ‘differences’ is critical here since it refers to the often‐ignored core concept of BOLD fMRI: it is only sensitive to differences between two brain states. Thus, available studies report using fMRI to discriminate between lie and truth or some other comparative state rather than to positively identify deception. This nuance is an example of the extent to which applied neuroscience research does not lend itself to the type of over‐simplification that has plagued the interpretation of fMRI‐based lie detection by the popular press and the increasingly vocal academic critics. As an early contributor to the modest stream of data on fMRI‐based lie detection, I was asked by Dr Aldert Vrij to write a piece in favour of fMRI‐based lie detection, to be contrasted with a piece by Dr Sean Spence presenting an opposite point of view ( Spence, 2008 ). This seemingly straightforward task presented two hurdles: having to respond to the popular as well as scientific view of what lie detection with fMRI is and present a wholly positive view of evolving experimental data.