Offenders with intellectual disabilities in prison: what happens when they leave?

BACKGROUND: People with intellectual disabilities, if convicted of offences, may be sentenced to prison, but little is known about their life when they are released. METHOD: This study followed up men with intellectual disabilities who were leaving prisons in England. RESULTS: The men were hard to contact, but 38 men were interviewed, on average 10 weeks after leaving prison. The men were living in a variety of situations and often were very under-occupied, with limited social networks. A total of 70% were above the clinical cut-off for anxiety, and 59.5% were above the clinical cut-off for depression. The men were receiving little support in the community, and many had been reinterviewed by police. CONCLUSIONS: Community teams need to provide better support to this very vulnerable group.

Neurosarcoidosis presenting as an isolated intrasellar mass: case report and review of the literature.

OBJECTIVE: Isolated neurosarcoidosis without evidence of extracranial manifestation continues to be a rare phenomenon. This case report and others in the literature demonstrate the difficulty in making the diagnosis of isolated neurosarcoidosis, as it may be indistinguishable from other pathologies on radiographic and laboratory studies. This case report and review of the literature will emphasize the need for clinical suspicion for neurosarcoidosis in patients with intrasellar lesions and the appropriate clinical history. CASE HISTORY: A 37-year-old female presented with visual field changes and a headache unresponsive to nonsteroidal anti-inflammatory medications. A history of Bell's palsy, hypothyroidism, and a history of sarcoidosis in the patient's father were noted. Imaging revealed an intrasellar mass resembling a pituitary macroadenoma. Routine neuroendocrine laboratory studies were consistent with hypopituitarism, and all other standard laboratory tests were normal. An endonasal transsphenoidal resection of the intrasellar lesion was done. The tissue was inconsistent with a typical adenoma. Intraoperative pathology reported non-caseating granulomatous disease. Based on the patient's history and intraoperative pathology she was diagnosed with neurosarcoidosis, which was confirmed by final pathologic analysis. Minimal debulking was performed to decompress the optic chiasm. The patient was then placed on corticosteroids and methotrexate and responded well to medical therapy. CONCLUSION: If isolated neurosarcoidosis is diagnosed early it will save a costly and invasive work-up. Radiographic and laboratory studies may aid in diagnosis but no studies are pathognomonic. Neurosarcoidosis is diagnosed by a combination of imaging, diagnostic tests, and good clinical suspicion.

Multilayer Electrolyzer Stack Converts Carbon Dioxide to Gas Products at High Pressure with High Efficiency.

Electrochemical reduction of CO2 is a value-added approach to both decrease the atmospheric emission of carbon dioxide and form valuable chemicals. We present a zero gap electrolyzer cell, which continuously converts gas phase CO2 to products without using any liquid catholyte. This is the first report of a multilayer CO2 electrolyzer stack for scaling up the electrolysis process. CO formation with partial current densities above 250 mA cm-2 were achieved routinely, which was further increased to 300 mA cm-2 (with ∼95% faradic efficiency) by pressurizing the CO2 inlet (up to 10 bar). Evenly distributing the CO2 gas among the layers, the electrolyzer operates identically to the sum of multiple single-layer electrolyzer cells. When passing the CO2 gas through the layers consecutively, the CO2 conversion efficiency increased. The electrolyzer simultaneously provides high partial current density, low cell voltage (-3.0 V), high conversion efficiency (up to 40%), and high selectivity for CO production.

Prognostic significance of DNA ploidy in carcinoma of prostate.

Flow cytometry was used to measure the DNA content in archived paraffin-embedded human prostatic cancer tissue for 69 patients with known outcomes that presented between 1975 and 1982. Of these, 51 patients had clinically localized lesions and were surgically staged prior to radical prostatectomy, while 18 patients presented with advanced Stage D2 disease. Thirty-six of 37 (97.3%) pathologic Stage B lesions were diploid. In contrast, the majority (72.2%) of patients with metastatic disease had aneuploid tumors. The average Gleason grade for aneuploid tumors was 8.2 +/- 1.98 versus 5.5 +/- 1.89 for diploid tumors (p less than 0.01). For 51 patients with clinically localized tumors, 13.9 percent of diploid tumors with a low Gleason sum (2 to 6) had extracapsular spread of tumor or regional lymph node involvement compared with 83.3 percent of aneuploid tumors with high Gleason scores (7 to 10). The addition of DNA ploidy to degree of glandular differentiation may enhance the prognostic evaluation of prostatic tumors and eventually improve our ability to select patients who are likely to benefit from radical prostatectomy.

Intermittent vertebral artery compression caused by C1-root schwannoma: case report.

Extradural schwannomas of the C1-root are extremely rare. As the tumor grows in size, it may compress surrounding neurovascular structures and cause symptoms. In the present case report, the left vertebral artery (VA) was severely compressed by the tumor, eliciting severe vertigo on turning the head to the right side and with neck extension. We report a 52-year-old man who presented with a history of intermittent episodes of severe vertigo on head movement that was caused by a C1-root schwannoma. The lesion was exposed through an extreme lateral transcondylar approach. At exposure the lesion was yellowish in color and was extradural in location lying between the markedly eroded C1-posterior arch and the compressed vertebral artery (V3) on the left side. The medial portion of the tumor was attached to the C1-nerve root. The tumor was excised enbloc with decompression of the VA. The patient's symptoms completely resolved immediately following surgery, with no recurrence of the symptoms at one year follow up. The vertebral artery may frequently be compressed by osteophytes in cervical spondylosis or due to other causes in the cervical spinal canal, but compression of the artery by C1 extradural schwannoma with vascular insufficiency is rare. Removel of the tumor and the resultant decompression of the artery can be facilitated by the extreme lateral approach as demonstrated by this case.

Breast cancer: causes of patients' distress identified by qualitative analysis.

BACKGROUND: Previous investigations of the psychological consequences of having breast cancer have usually involved quantitative analysis within medical models. AIM: This qualitative study set out to identify key events which had caused distress to women with breast cancer and to compare the frequency of these events with doctors' beliefs about their relative frequency. METHOD: The causes of distress in 26 women with breast cancer were identified by qualitative analysis of unstructured interviews. Subsequently, all hospital doctors and general practitioners in the Exeter health district were sent a list in random order of the eight events which had most commonly caused distress and were asked to rank them in order of frequency for patients with breast cancer. RESULTS: The responses suggest a mismatch between the doctors' expectations and the experience of the patients. CONCLUSION: Patients may suffer distress in areas of management doctors do not suspect are important; qualitative analysis can identify these areas.

Time between presentation and treatment of six common cancers: a study in Devon.

The time between a person presenting to a general practitioner with a symptom of cancer and that person starting treatment has been studied in Devon. Retrospective analysis was undertaken of the general practitioner records of 1465 patients proven to have cancer who were registered with 245 general practitioners. During inspection of these records dates of first presentation, of referral, of first hospital consultation and of the start of treatment were noted for people with six common types of cancer (cancer of the breast, large bowel, lung, oesophagus, prostate and stomach). The general practitioner stage time and hospital stage time (pre-appointment and post-appointment) were calculated for each patient. Large differences were found in median times for the general practitioner stage according to the type of cancer, ranging from a median value of 0 days for people with breast cancer to 84 days for people with cancer of the oesophagus. For patients with cancer of the breast, large bowel, lung or prostate, median general practitioner times were shorter than median hospital stage times, while for patients with cancer of the oesophagus and stomach cancer, median general practitioner stage times were longer than median hospital stage times. Comparison of the hospital stage times for people with breast cancer and cancer of the large bowel showed notable differences between the four health districts in Devon, pre- and post-appointment times being twice as long in one district as in another. This retrospective record analysis was acceptable to participating practitioners. The results provide a basis for general practitioners and hospital staff to review their own work.

Knowledge and perceptions of a domiciliary hospice service among general practitioners and community nurses.

Within a single district health authority all the general practitioners and community registered general nurses were asked to complete a questionnaire regarding awareness and perceptions of a domiciliary hospice service. Responses were received from 127 doctors (71%) and 58 nurses (80%). Awareness of resources offered by the domiciliary hospice service was high, especially among the 102 respondents with access to the service. Eighty per cent or more of general practitioners and community nurses were satisfied with the amount of information received concerning changes in the patient's condition and who was involved in the care process. However, 33% of nurses agreed that it was difficult to know who had overall responsibility for the patient's care and 28% of nurses felt that their own contribution was under-rated. These findings were reinforced by a number of written statements submitted by the nurses. There was a desire expressed by both general practitioners and community nurses for more educational input from the domiciliary service. Overall, assistance from the service was welcomed and its special skills acknowledged. In the future planning of a comprehensive hospice service the differing needs expressed by doctors and nurses should be taken into account.

Adult polyglucosan body disease.

We describe a case of adult polyglucosan body disease with characteristic clinical symptoms of peripheral neuropathy, upper motor neuron signs, and bowel and bladder dysfunction. Sural nerve biopsy revealed diagnostic intra-axonal polyglucosan bodies. On electron microscopic examination, the inclusions were located mainly within myelinated nerve fibers and consisted of branched filaments that were 6 to 8 nm wide. The diagnosis of adult polyglucosan body disease was confirmed by a skin biopsy from the axilla showing similar inclusions in myoepithelial cells of apocrine glands. This report provides additional evidence that skin biopsy, to date advocated by a single case report only, may be a less invasive and simpler diagnostic alternative to sural nerve or brain biopsies.

Death from cancer at home: the carers' perspective.

OBJECTIVES: To collect information from principal carers of people who had died at home with cancer; to identify areas of support which need improvement. DESIGN: Semistructured interviews with carers two to four months after the death. SETTING: 38 general practices in the Exeter, Torbay, and Plymouth health districts. SUBJECTS: 207 carers. MAIN OUTCOME MEASURES: Services received by carers and quality of support. RESULTS: 161 of 207 patients were aged 60 or over. 88 carers were aged under 60, 110 were 60-80, and 9 were > 80. Carers had difficulty in getting urgent professional help in only 15 out of 177 cases. 124 carers were not given advice on financial help and 174 were not told of support available from local charities. Although pain was well controlled, 25% of patients had no relief of other symptoms. Overall, 150 carers considered the support excellent, 45 good, 8 moderate, 2 poor, and 2 had no comment. CONCLUSIONS: Although care has improved in recent years, health professionals need to give carers more advice about help available outside health services. Domestic help was often needed earlier. Better appreciation of carers' problems is needed.

Molecular dynamics of haloalkane corral formation and surface halogenation at Si(111)-7 x 7.

Long-chain organic molecules, 1-halododecane, RX (X = Cl,Br), adsorbed on Si(111)-7 x 7 were shown to form stable dimeric corrals; type I around corner holes and type II around corner adatoms S. Dobrin et al. [Surf. Sci. Lett. 600, L43 (2006)]. Here we examine the molecular dynamics of corral formation, in which mobile physisorbed adsorbates spontaneously convert to immobile. At high coverage the mechanism gives evidence of involving collisions between mobile vertical monomers, giving types I and II immobile horizontal dimers, vD +vD -->h2 (I, II). At low coverage mobile vertical monomers collide with immobile horizontal ones to form largely type-II corrals, vD + h-->h2 (II). Thermal reaction of corrals with X = Br brominates the surface by two distinct molecular pathways, thought to have more general applicability: "daughter-mediated" reaction of vertical v(A) with a low activation energy (here Ea approximately 5 kcal mol(-1)) and "parent-mediated" reaction of horizontal h or h2 with high activation energy (here Ea = 29 kcal mol(-1)).