Contingency Management Research Articles

Cocaine Use Disorder (CUD): Current Clinical Perspectives.

Cocaine use disorder (CUD) is a devastating disorder, impacting both individuals and society. Individuals with CUD face many barriers in accessing treatment for CUD, and most individuals with CUD never receive treatment. In this review, we provide an overview of CUD, including risk factors for CUD, common co-occurring disorders, acute and chronic effects of cocaine use, and currently available pharmacological and behavioral treatments. There are no FDA-approved pharmacological treatments for CUD. Future studies with larger sample sizes and testing treatment combinations are warranted. However, individuals with CUD and co-occurring disorders (eg, a mood or anxiety disorder) may benefit from medication treatments. There are behavioral interventions that have demonstrated efficacy in treating CUD – contingency management (CM) and cognitive-behavioral therapy for substance use disorders (CBT-SUD) in particular – however many barriers remain in delivering these treatments to patients. Following the discussion of current treatments, we highlight some promising emerging treatments, as well as offer a framework that can be used in building a treatment plan for individuals with CUD.

The Political Variable in the Institutionalization of Social Networks in the Administration. The Case of the Ministerial Communication in Spain

Technology is a key factor in the modernization of the State. Social networks, one of the most recent technologies, have spread in the Administration and have been a subject of study by an academia that has pointed out the importance of their institutionalization to achieve a successful technological adoption. This paper contributes to this debate, focusing on the political variable and how it affects institutionalization. For this purpose, we have chosen institutional communication, one of the various recognized uses of social technologies in institutions, a specific field such as the Spanish state administration, and a mixed research technique that includes both a descriptive and a quantitative analysis. The results clarify how the political variable significantly influences both on the decision to have social channels and their daily use and managament structure. Thus, the political factor is a barrier that weakens institutionalization, limiting the role of public employees, politically biasing the contents generated by institutional channels and giving rise to contingent management structures. The document offers a series of recommendations and some possible lines of research for further explore how the political factor affects the adoption of these technologies.

Contingency Management in Canadian Addiction Treatment: Provider Attitudes and Use.

Contingency management (CM) is an evidence-based treatment for addictive disorders that is underused in clinical practice. The attitudes of staff are frequently reported as barriers to the uptake and use of evidence-based treatments, including CM. Understanding these barriers is an important step in implementation and could have an impact on an intervention's efficacy. We investigated Canadian addiction treatment providers' (ATPs) beliefs and use of CM. Managers of addictions treatment programs across Canada were contacted between March 2019 and February 2021 and asked to forward our survey to interested ATPs (N = 298 respondents; female = 210, male = 80, other = 8) who offered services to help clients reduce substance use in their program(s). Providers in 103 programs across all 10 Canadian provinces participated (26.2% response rate). Most were not familiar with CM and reported largely neutral attitudes toward it. Training-related barriers to CM were the most highly endorsed compared with other barriers. Most ATPs reported a desire for additional training in CM. Some denied wanting additional training because of concerns about CM, which was consistent with previous literature. Our findings suggest that successful implementation of evidence-based treatments requires consideration of provider-level characteristics including attitudes, knowledge, and concerns about the intervention. Results highlight the importance of integrating training with efforts to address systemic-level barriers to implementation.

HIV patients' perceptions of a potential multi-component mindfulness-based smoking cessation smartphone application intervention.

Cigarette smoking rates among people living with HIV (PLWH) in the US is triple that of the general population. PLWH smokers are a high-risk group for smoking-related health disparities and should be a prime focus for smoking cessation efforts. Our team has developed a novel evidence-based Mindfulness Training (MT) smoking cessation smartphone application (app), "Craving-to-Quit." Using qualitative focus groups among PLWH smokers, this study aims to tailor and optimize the app's content and design to PLWH's unique psychosocial profile and needs. We conducted 8 focus groups among PLWH smokers (n = 59; 47.5% females; ≥18 years) to gain insight into participants' perceptions about the app, MT, and the feasibility and acceptability of adding two additional strategies (CM: Contingency Management; self-monitoring of anti-retroviral therapies intake [ART]) to further optimize the app. Participants were asked to practice MTs and watch videos from the app presented on a screen in the conference room to discuss their experience. Sessions were audio-taped, transcribed verbatim, and analyzed thematically using NVivo. Most participants were non-Hispanic black (67.8%), on a federal health insurance program (61.0%). Participants considered it easy to learn the app and thought that MT is helpful in reducing stress and motivating quit attempts and were supportive of adding CM and recommended providing $20-$50 weekly cash incentives to help in quitting. Participants felt that adding self-monitoring of ART is helpful but were concerned about confidentiality in case they lost their phone. Participants recommended making the app cost-free and adding information about smoking cessation medications and the negative effects of smoking among PLWH. Findings will guide the development of a novel multi-component smoking cessation intervention app integrating MT, CM, and ART self-monitoring strategies. This intervention has the potential to address several barriers to quitting in PLWH. Further clinical research is needed to test this intervention.

High-risk Coronary Plaque Regression in Cash-based Contingency Management Intervention Among Cocaine Users With HIV-associated Subclinical Coronary Atherosclerosis.

Cocaine use exacerbates human immunodeficiency virus (HIV)-associated subclinical coronary atherosclerosis. We investigated whether cocaine abstinence or reduced use achieved with contingency management (CM) intervention would retard high-risk coronary plaque progression among cocaine users with HIV and subclinical coronary atherosclerosis. Between March 2014 and August 2017, 76 cocaine users with HIV and coronary plaques were enrolled in a study designed to decrease cocaine use and determine whether doing so impacted progression of subclinical coronary atherosclerosis as measured by coronary artery computed tomography examinations. Of the 76, 7 did not complete the study, resulting in 69 participants. A 12-month cash-based CM intervention was implemented to promote cocaine abstinence or reduced cocaine use. Generalized estimating equation approach was used to perform longitudinal data analyses. During the 12-month CM, all 69 participants reduced cocaine use, and of these, 25 (36%; 95% confidence interval, 25%-49%) achieved cocaine abstinence. After adjusting for potential confounding factors, generalized estimating equation analyses showed that (1) endothelin-1 (ET-1) levels, a proinflammatory biomarker for endothelial dysfunction, at the 6-month and 12-month visits were significantly lower compared with baseline ET-1 ( P = 0.001 and P < 0.001, respectively), and (2) low-attenuation noncalcified coronary plaque volume, a predictor for myocardial infarction, at 12-month visit was significantly lower compared with baseline low-attenuation noncalcified coronary plaque volume ( P < 0.05). The findings of this study have not only demonstrated that CM is effective in achieving a sustained reduction in cocaine use, but also provided compelling evidence that reduction in cocaine use leads to quantifiable cardiovascular health benefits, including concurrent decrease in high-risk plaque burden and ET-1, among cocaine users with HIV-associated coronary atherosclerosis.

Cannabis Use Disorder Treatment Preferences: A Pilot Survey in Current Users of Cannabis.

Highly effective treatments for cannabis use disorder (CUD) are lacking, and patient preferences have not been considered during treatment development. We therefore conducted an exploratory crowdsourced survey of individuals reporting current cannabis use and a willingness to cut down or quit their cannabis use, to determine their interest in various treatment aspects. Subjects (n = 63) were queried about their willingness to take medications as a function of type, route, and regimen and to participate in adherence monitoring. Subjects were also asked about their willingness to engage in behavioral/psychosocial interventions as a function of type, setting, and duration. Measures theorized to be associated with treatment preferences were also collected, including cannabis use variables, readiness to change, reduction or cessation goal, perceived cessation barriers, and medication use beliefs and behaviors. Survey responses indicated that efforts to develop CUD medications should focus on nonsynthetic compounds administered orally or by mouth spray no more than once per day to maximize patient acceptance. Remote adherence monitoring and one-on-one outpatient behavioral treatment approaches, especially contingency management, are also anticipated to enhance participation. Most subjects indicated a preference to reduce their cannabis use rather than quit. These data provide guidance for the development of CUD interventions based on the preferences of individuals interested in treatment for their cannabis use. Additional research is needed to confirm these results in a larger sample and determine if matching CUD patients with their preferred treatments improves success rates.

A pilot study of a therapeutic workplace in women arrested for prostitution

AbstractPeople with substance use disorder who have been arrested for prostitution are likely to require intensive interventions to increase drug abstinence and reduce HIV risk behaviors. The Therapeutic Workplace (TW) may be ideal for this population, because it combines contingency management for drug abstinence and paid job training. This study was a preliminary evaluation of the TW intervention in opioid dependent women arrested for prostitution. Participants (N = 37) were randomly assigned to a specialized diversion program, or the diversion program plus the TW for 4 months. Group comparisons showed no difference in drug use. However, analysis of drug use relative to the onset of drug abstinence contingencies in the TW group showed greater abstinence during the implementation period, with a significant difference for opioids (p = 0.046). The pre‐post contingency outcomes provide preliminary evidence that the TW could promote drug abstinence in people involved in the criminal justice system who attend paid job training.

Current State of Treatment for Cannabis Use Disorder

Cannabis remains the most commonly used illicit psychoactive drug and contains substances that affect the brain and body. A range of acute and chronic health problems associated with cannabis use has been identified.Cannabis use disorder is defined as the continued use of cannabis despite clinically significant impairment. It is estimated that 1 in 10 people who use marijuana will become addicted. CUD is a problematic pattern of cannabis use that causes clinically significant impairment. There is not an available medication to successfully treat CUD, but psychotherapeutic models hold promise. Cognitive behavioural therapy, motivational enhancement therapy and contingency management can substantially reduce cannabis use and cannabis-related problems.The legalization of non-medical cannabis use in some high-income countries may increase the prevalence of CUD. Since this approach has not yet been validated for CUD, the improvement of psychosocial treatments with pharmacological therapies should be further explored in future clinical research.

The impact of marijuana use on cocaine use outcomes among patients in methadone maintenance treatment across five trials of contingency management.

Cocaine use is prevalent among patients in methadone maintenance and a risk factor for poor treatment outcomes. Contingency management (CM) decreases cocaine use in this population, but little is known about its efficacy when marijuana use is present prior to or during treatment. Data from five randomized CM trials (N = 557) were used to evaluate whether: (a) marijuana frequency (none, low, or high) prior to or during treatment impacts cocaine use outcomes and (b) marijuana use differentially impacts cocaine outcomes with standard care (SC) + CM versus SC alone. Relative to no marijuana use, low (β = .28, p < .01) and high marijuana use (β = .32, p < .05) during treatment were associated with roughly 1 week shorter duration of cocaine abstinence on average. Low marijuana use (β = .71, p < .05) during treatment was associated with a lower proportion of negative cocaine samples during treatment relative to no marijuana use. Treatment group by marijuana use (before or during treatment) interactions on duration and proportion of cocaine abstinence during treatment were not significant. For longer term outcomes, in SC + CM, marijuana use during treatment did not impact cocaine abstinence 6 months post-baseline. In SC, low (OR = .44, p < .05) and high (OR = .26, p < .001) marijuana use during treatment decreased odds of cocaine abstinence at 6 months post-baseline relative to no use. Findings highlight the benefits of SC + CM and abstaining from marijuana use during active treatment. At 6 months postbaseline, SC + CM evidenced similar cocaine abstinence regardless of marijuana use levels during treatment, while those with low and high marijuana use showed decreased abstinence rates in SC only. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

A Preliminary Evaluation of the Effects of a Contingency Management + Deposit Contract Intervention on Problematic Smartphone Use With College Students.

Problematic smartphone use (PSU) is smartphone usage that is, in some way, damaging to the user. PSU represents a growing public health concern that could be addressed via behavioral intervention. We recruited six college students who reported negative side effects of smartphone use and sought to decrease their PSU. The effects of a contingency management (CM) + deposit contract intervention on PSU was evaluated. During the CM + deposit contract condition, participants deposited $40 and had the opportunity to earn back their entire deposit by meeting daily smartphone usage goals. To promote adherence to study protocols, participants also had the opportunity to earn a $20 cooperation bonus. For all participants, lower levels of PSU were observed during intervention relative to baseline. The CM + deposit contract intervention produced consistent decreases in PSU for four participants (mean reduction percentages above 40% were obtained) and had inconsistent effects on PSU for two participants (mean reduction percentages below 20%). Maintenance of intervention effects was limited for all participants. Although preliminary, results suggest that CM + deposit contract interventions could be a viable, low-cost approach to addressing PSU. Potential explanations for our findings and avenues for future research are discussed.

Addressing stimulant use disorder through state opioid response grants from the substance abuse and mental health services administration: Missouri’s initial approach

ABSTRACT Background: The alarming growth of stimulant-involved deaths underscores the urgent need for states to expand existing opioid-specific approaches to intentionally reach and serve people who use stimulants. Recent permission from federal agencies has allowed states to spend grant funding that was previously restricted to opioid-related activities on approaches addressing stimulant use. Objectives: This manuscript describes the rationale, methods, and initial results supporting the implementation of Missouri’s recent stimulant-focused efforts – including previously-prohibited activities such as Contingency Management and fentanyl test strip distribution. Methods: Missouri’s State Opioid Response team facilitated the design and implementation of Contingency Management pilot programming abiding by federal spending limits of no more than $75 of incentives per client, mass distribution of fentanyl test strips, and publicly accessible harm reduction trainings and materials specific to stimulant use. Data sources used for initial evaluations included state-level treatment claims, fentanyl test strip distribution counts by type and region of organizations receiving them, and qualitative feedback from stakeholders. Results: Six substance use treatment agencies developed Contingency Management programs, serving 29 individuals in the first nine months. Over 20,000 fentanyl test strips were distributed using a prioritization system designed to reach those most likely to benefit from their use. Conclusions: Recent federally funded efforts to better address stimulant use in Missouri have increased access to evidence-based treatment and harm reduction resources. Lessons learned from early implementation, especially those regarding time allowed for program development and how best to ensure equitable resource distribution, will inform future stimulant-focused program efforts.

Feasibility, Acceptability, and Preliminary Efficacy of a Smartphone-Based Contingency Management Intervention for Buprenorphine Adherence.

Buprenorphine is an important medication for treating opioid use disorder, but medication adherence and treatment retention are key issues that can limit its impact, especially when patients have concurrent stimulant use. Contingency management is efficacious in promoting medication adherence and drug abstinence. Delivering contingency management via smartphones addresses practical barriers to its adoption and improves patient access. A single-group (n = 20) nonexperimental study was conducted to evaluate the feasibility of smartphone-based contingency management to promote adherence to buprenorphine treatment in people with opioid use disorder. Participants were recruited from outpatient treatment clinics. Over 12 weeks participants had access to a smartphone app that provided contingency management supported with peer recovery coaching. Adherence was confirmed daily either by GPS monitoring of clinic medication visits or self-recorded video, and salivary toxicology was conducted weekly. The overall rate of confirmed buprenorphine adherence was 76%, and visual inspection of individual participant outcomes shows consistent medication use for a large majority of participants. All participants were able to successfully use all app features and spend earnings. Participants rated the app and intervention highly on measures of likability, ease of use, and helpfulness. All participants (100%) were retained in buprenorphine treatment throughout the study period. Direct methods for confirming adherence appear superior to confirmation via salivary toxicology. This study shows that smartphone-based contingency management is a feasible means of promoting buprenorphine adherence. The potential efficacy of smartphone-based contingency management as a means of promoting buprenorphine adherence warrants evaluation in a randomized controlled trial.

Reduced Healthcare Resource Utilization in Patients with Opioid Use Disorder in the 12Months After Initiation of a Prescription Digital Therapeutic.

Background and AimsreSET-O, an FDA-authorized prescription digital therapeutic (PDT) delivering cognitive behavioral therapy and contingency management to patients with opioid u®se disorder (OUD), may help improve clinical outcomes. One-year differences in healthcare resource utilization (HCRU) and costs post-PDT initiation were evaluated.MethodsRetrospective analysis of healthcare claims data compared all-cause HCRU (across hospital facility encounters [sum of inpatient stays, treat-and-release emergency department [ED] visits, partial hospitalizations, and hospital outpatient department visits] and clinician services [procedure categories]) after PDT initiation (index) between reSET-O patients and controls. Overall and Medicaid-specific differences in HCRU, costs, and buprenorphine adherence were evaluated.FindingsCohorts included 901 reSET-O patients (median age 36 years, 62.4% female, 73.9% Medicaid) and 978 controls (median age 38 years, 51.1% female, 65.4% Medicaid). Compared to the control group, the reSET-O group experienced 12% fewer total unique hospital encounters (non-significant), driven by 28% fewer inpatient stays (IRR 0.72; 95% CI 0.55–0.96; P = 0.02), 56% fewer hospital readmissions [IRR 0.44; 95% CI 0.20–0.93; P = 0.033]), and 7% fewer ED visits (IRR 0.93; 95% CI 0.79–1.09; P = 0.386). Total clinician services increased by 1391 events versus controls. Differences were greater among the Medicaid patients. Adjustment for concomitant baseline substance use and mental health disorders resulted in similar HCRU incidence rate ratios. Changes in all-cause HCRU drove per-patient per-year cost differences of − $2791 versus controls (− $3832 versus Medicaid controls). Adjusted mean medication possession ratio was 0.848 (SE 0.0118) at 12 months for reSET-O patients, which was significantly higher than controls (0.761 [SE 0.0108]; P < 0.001).ConclusionsUse of reSET-O is associated with significant and durable real-world reductions in ED and inpatient (including readmissions) utilization, reduced net costs, and increased clinician services and buprenorphine adherence. Differences in costs versus controls were greatest among Medicaid patients.Infographic Supplementary InformationThe online version contains supplementary material available at 10.1007/s12325-022-02217-y.

Innovation in the Treatment of Persistent Pain in Adults With NF1: Implementation of the iCanCope Mobile App

Background Neurofibromatosis type 1 (NF1) is an autosomal dominant genetic condition affecting 1 in 2500 individuals. Over 50% of individuals with NF1 report significant pain and discomfort, which may be associated with benign and malignant tumors, but is often not localized to a structural lesion, thus presenting treatment challenges for patients and their medical caregivers. To date, there are very few treatments aside from surgical intervention to mitigate pain. Objective We developed the iCanCope-NF mobile app for pain self-management. iCanCope-NF is a customized self-monitoring and pain management mobile app designed to provide resources and support for those having chronic pain due to NF1. The app enables users to access daily pain monitoring and quality of life check-ins, allows them to plot interrelated variables on various timelines to observe trends in pain and interference across different areas of life (such as sleep, physical activity, and mood), and provides them with the option to set physiological and psychological goals as well as a robust library of written and video resources to help manage pain symptoms and to better cope with NF1. Methods This paper evaluated the iCanCope-NF to reduce pain severity and interference in adults with NF1. A total of 80 participants across 3 different groups (control, iCanCope-NF access condition, and iCanCope-NF contingency management condition where subjects were provided monetary incentives for engaging with the various features within the app [CM]) completed a randomized clinical trial in which evaluations were completed at intake (initial day of participation), discharge (2 months after intake), and 6 weeks after discharge. Results Preliminary data analysis demonstrated individuals randomized to the iCanCope-NF + CM had greater engagement with the mobile app than individuals who were randomized to iCanCope-NF. Additionally, individuals in the iCanCope-NF + CM consistently checked in more (SD 59.5/60 days) than individuals in the iCanCope-NF group (SD 51/60 days). Pain interference, as measured by the Pain Interference Index (PII), was significantly different across all 3 groups at discharge: control (M=6.3), iCanCope (M=5.7), iCanCope + CM (M=5.1), P&lt;.05. Conclusions Qualitative interviews completed at discharge for individuals with access to the app indicated that the app was a “wonderful measuring tool” and “provided credibility of my pain symptoms,” and that it was a dramatic and distinctive aide in the monitoring and tracking of their pain symptoms. We demonstrated preliminary acceptability and efficacy for iCanCope-NF as the first pain self-management tool for individuals with NF1. iCanCope-NF + CM was successful in increasing engagement and decreasing pain interference. Trial Registration ClinicalTrials.gov NCT04561765; https://clinicaltrials.gov/ct2/show/NCT04561765 Conflicts of Interest None declared.

The Setting-Intervention Fit of Nine Evidence-Based Interventions for Substance Use Disorders Within HIV Service Organizations Across the United States: Results of a National Stakeholder-Engaged Real-Time Delphi Study.

Given substance use disorders (SUDs) among people with HIV are highly prevalent, integrating SUD services within HIV service settings is needed to help end the HIV epidemic. In this study, we assessed the setting-intervention fit (SIF) of 9 evidence-based SUD interventions: acamprosate, disulfiram, oral naltrexone, injectable naltrexone, oral buprenorphine, injectable buprenorphine, contingency management, motivational interviewing, and cognitive behavioral therapy (CBT). Clinical and nonclinical HIV service organizations (HSOs) in the United States. In May 2020, a stakeholder-engaged real-time Delphi was completed with 202 HSOs. HSO respondents rated the extent to which each SUD intervention was fundable, implementable, retainable, sustainable, scalable, and timely for their HSO, and these 6 items were summed into an SIF score (possible range of 0-18). Motivational interviewing had the highest average SIF score (11.42), with SIF scores above the midpoint (9.5) for clinical (11.51) and nonclinical HSOs (11.36). For nonclinical HSOs, none of the other interventions were above the midpoint. For clinical HSOs, the average SIF scores were above the midpoint for CBT (10.97) and oral buprenorphine (9.51). Multivariate regression analyses, which controlled for characteristics of the HSO respondent, revealed geographic region of the United States and whether the HSO currently offered any substance use services as 2 of the best predictors of SIF scores. Notwithstanding the need to improve the SIF for the other evidence-based SUD interventions, motivational interviewing, CBT, and oral buprenorphine are currently the evidence-based SUD interventions with greatest perceived fit for integration within HSOs in the United States.

Principles and strategies for step-by-step AVM excision.

Arteriovenous malformations (AVMs) are some of the most challenging surgical entities. Like any challenging surgical procedure, AVM surgery is a series of basic but fundamental steps, each with its own nuances. Despite a myriad of published material regarding AVMs, there are few succinct illustrated summaries of these steps with an accompanying elucidation of the most common pitfalls. This paper provides a step-by-step description and illustration of the basic surgical principles of AVM microsurgical resection, focusing on the main key points and addressing the critical issues that surround this surgery. Deep anatomical knowledge and presurgical planning of these basic steps, combined with good contingency management skills, are paramount for an effective and safe AVM surgery.

Mediators of psychosocial treatment for adolescent ADHD.

Almost no studies identify mediators of psychosocial interventions for attention deficit/hyperactivity disorder (ADHD)-largely due to design limitations. Understanding mediators can promote streamlined interventions in usual care (UC) settings. When individual studies are insufficient to pursue complex questions, integrative data analysis (IDA) allows researchers to pool raw data from multiple studies to produce cumulative scientific knowledge. We leveraged IDA to pool and harmonize data from four randomized controlled trials of ADHD psychosocial treatment (N = 854) with three time points. Linear growth curve analyses examined the impact of four psychosocial treatment conditions on ADHD symptom outcomes and five candidate mediators (compared to no treatment). To test mediation, we examined whether treatment condition predicted linear growth in the mediator at posttreatment, and if the mediator predicted linear growth in the outcome at follow-up. Compared to no treatment, engagement-focused parent-teen treatment (d = .43-.72; Supporting Teens' Autonomy Daily [STAND]) and community-based usual care (d = .54-.99) led to greatest reductions in parent-rated ADHD symptoms, followed by the Summer Treatment Program-Adolescent (d = .29-.30; STP-A) and standard behavioral parent training + organization skills training (d = .26-.31; BPT/OST). Improvements in organization, time management, and planning skills mediated outcome for all treatments. BPT/OST and STP-A prevented deterioration of social skills, in turn mitigating escalation of ADHD symptoms. Improvements in parent-teen communication skills mediated outcome for STAND, BPT/OST, and the STP-A. Parent contingency management and disruptive classroom behavior were not treatment mediators. Psychosocial treatments for adolescent ADHD primarily improve ADHD symptoms through development of teen organization, time management (OTP), and parent-teen communication skills, as well as slowing deterioration of social skills. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Information Security Governance Framework in Public Cloud a Case in Low Resource Economies in Uganda

The study aimed at exploring the critical enablers to the development and usage of information security governance frameworks for cloud computing in Uganda. The study was motivated by the continuous information security governance challenges in the Public Cloud. The theoretical frameworks that underpinned this study included; Contingency management theory, the Risk Management framework, the Technological Organisational and Environmental (TOE) model and the Information Security Governance model. This study adopted a quantitative research approach to obtain data through a survey. Five key factors for information security governance were identified: a) Technological factors: flexibility, scalability, availability, agility, data protection governance, trust of cloud, data source, maintenance, data retention and policy. b) Organisation: size and structure of the organisation, top management support. c) Environmental factors: governance and regulation, marketing, vendor, resource availability, obsoleteness. d) Individual: user resistance, attitude, skills, belief and learnability. e) Risk management and control factors: risk assessment, disaster recovery, access and authorisation control, monitoring, auditing, and process risk control. The study contributes to theory and practice in information security. The developed framework and its accompanying model helped to inform public departments, organisational top management and information security strategies to avoid excessive information risks and potential regulatory compliance failures in public cloud. The study was inclined on subjective information security, which alone may not fully address all information security problems in a public cloud. Therefore, it is recommendable that future research studies on objective security in public cloud

JUVENILE PROBATION OFFICER PERCEPTIONS OF PARENTAL INVOLVEMENT IN JUVENILE PROBATION AND WITH CONTINGENCY MANAGEMENT.

Probation is a common sanction for youth substance users, and as such, juvenile probation officers (JPOs) shoulder much of the burden for treatment and rehabilitation. To improve youth outcomes and alleviate some of the burden, JPOs may seek parental involvement in the probation and substance use desistance processes. Using focus group data, we analyzed JPO perceptions of the role parents play in contingency management (CM)-an incentive system designed to produce and reward decreased substance use-and whether they perceived any value in CM. We found that most JPOs perceived parental involvement as critical to the success of both substance use treatment and CM for youth. Our findings also suggest JPOs found parental involvement in CM valuable given that CM was employed on nonstudy clients and future clients. This has implications for the practicality and sustainability of CM as a youth probation intervention.

How I do it: resection of spinal cord cavernous malformation.

Spinal cord cavernous malformations (CMs) account for 5 to 12% of all spinal vascular malformations. Surgical removal is indicated in symptomatic patients, especially if the CM comes close to the dorsal or lateral surface of the spinal cord. Spinal cord CMs pose critical challenges for the potential of severe disabling complications. We described the step-by-step surgical principles of spinal cord CM microsurgical resection. The main surgical steps are also illustrated in an accompanying operative video. Pre-surgical planning of the basic steps and good contingency management skills are paramount for an effective and safe spinal cord CM excision.