Disseminating science-based prevention: lessons learned from CSAP's CAPTs

A wide variety of prevention approaches that reduce substance use and associated problems have been developed and tested. But successes have been limited in promoting the use of these scientific advances by the policy makers, practitioners, and concerned citizens. The Center for Substance Abuse Prevention's six regional Centers for the Application of Prevention Technologies (CSAP's CAPTs) are a major mechanism by which CSAP brings research to practice. This article synthesizes the issues that the CAPTs have faced, the solutions they have developed, and conclusions concerning the work that still needs to be done to increase the application of science-based approaches to prevention. These discussions highlight the particular importance of addressing issues related to the larger systems in which prevention programs and strategies operate.     

Women in Ties: Informal Social Networks Among Women in Cross-Border Trading in Accra,Ghana

This paper discusses how women in cross-border trading in Ghana have established informal social networks, which are either kinship-based or non-kinship-based, to address not only their economic needs but also the social, political and psychosocial challenges that they face as they travel across national frontiers. It highlights how women depend on bonds of empathy, obligation or sometimes a conscious need to present a united front to address their several challenges as cross-border traders. In-depth interviews were used to interview 60 women involved in cross-border trading within the Economic Commission of West African States region. These women were purposively sampled using snowballing method. The narratives of women do not only show their resilience or determination to survive, and sustain their businesses but also how they address their personal and private matters through these informal networks. The level of reciprocity and trust among these women is a major factor that accounts for and maintains these active networks. The paper recommends that policies designed to support these women should take into account the role of women’s informal networks as these are assets that could be built on to address the challenges of women in cross-border trading.     

‘Nothing happened’: Legal implications of false denials among abused children

People lie on a frequent basis. However, when a victim of maltreatment lies by denying the abuse, lies can become forensically relevant. We have reviewed the relevant literature on the prevalence and memory consequences of such false denials. The way forensic interviewers proceed in the face of denying children will be shaped by their beliefs about the frequency with which truly abused children deny abuse. We discuss that estimates of the prevalence of false denials among abused children vary but that such false denials do happen. When falsely denying children eventually come forward with their experiences, a second issue lingers: how valid are maltreated children's statements after a false denial? We review the literature indicating that false denials can negatively affect memory for the investigative interview during which the lie was told. Yet, memory for the denied experience itself seems to be mostly preserved, and some research even found potential protective effects of false denials. We conclude that denials should always be handled with care in the court room, since the ground truth usually is not known, but that statements should not be dismissed based solely on previous denials.     

Combining evidence from clinical trials in conditional or accelerated approval

Conditional (European Medicines Agency) or accelerated (U.S. Food and Drug Administration) approval of drugs allows earlier access to promising new treatments that address unmet medical needs. Certain post-marketing requirements must typically be met in order to obtain full approval, such as conducting a new post-market clinical trial. We study the applicability of the recently developed harmonic mean ${\chi }^2$-test to this conditional or accelerated approval framework. The proposed approach can be used both to support the design of the post-market trial and the analysis of the combined evidence provided by both trials. Other methods considered are the two-trials rule, Fisher's criterion and Stouffer's method. In contrast to some of the traditional methods, the harmonic mean ${\chi }^2$-test always requires a post-market clinical trial. If the $p$-value from the pre-market clinical trial is $\ll 0.025$, a smaller sample size for the post-market clinical trial is needed than with the two-trials rule. For illustration, we apply the harmonic mean ${\chi }^2$-test to a drug which received conditional (and later full) market licensing by the EMA. A simulation study is conducted to study the operating characteristics of the harmonic mean ${\chi }^2$-test and two-trials rule in more detail. We finally investigate the applicability of these two methods to compute the power at interim of an ongoing post-market trial. These results are expected to aid in the design and assessment of the required post-market studies in terms of the level of evidence required for full approval.