Volunteering in prisons: a systematic review and narrative synthesis.

BACKGROUND: Individuals from the community who volunteer within prisons are an understudied population, despite previous research indicating the increase in involvement of the penal voluntary sector and benefits to both prisons and prisoners from effective implementation of volunteer programmes. OBJECTIVES: This study aimed to identify the characteristics, motivations and experiences of individuals who volunteer in prisons. STUDY DESIGN: This was a systematic review conducted according to Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. METHODS: Peer-reviewed publications were identified through searchers of five electronic databases (MEDLINE, PsycINFO, Scopus, Applied Social Sciences Index & Abstracts and Social Sciences Database) without date restrictions, supplemented by hand searching and reference checking of retrieved articles. Explicit inclusion and exclusion criteria determined study eligibility. Study quality was appraised using standard tools. A narrative synthesis was conducted, and motivations were organised according to the Volunteer Function Inventory. RESULTS: Eight studies (five qualitative and three quantitative) reported a total of 764 volunteers across five countries. More than half of the included studies investigated individuals providing primarily religious volunteer support; volunteers in these studies were typically middle aged, White and female. Prison volunteers frequently described motivations related to altruistic or humanitarian values, as well as social reasons. Positive experiences of volunteering were related to personal benefits to volunteers. Negative experiences were related to a lack of support and challenges in volunteers' relationships with prison staff. CONCLUSIONS: Prison volunteer programmes have the ability to improve the psychological health of prisoners and provide a range of potential benefits to penal systems and volunteers themselves, but research on individuals who volunteer in prisons is limited. Difficulties in the volunteer role could be mitigated by developing formal induction and training packages, promoting closer integration with paid prison staff and providing ongoing supervision. Interventions to improve the volunteer experience should be developed and evaluated.

Longitudinal characterisation of haematological and biochemical parameters in cancer patients prior to and during COVID-19 reveals features associated with outcome.

BACKGROUND: Cancer patients are at increased risk of death from severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Cancer and its treatment affect many haematological and biochemical parameters, therefore we analysed these prior to and during coronavirus disease 2019 (COVID-19) and correlated them with outcome. PATIENTS AND METHODS: Consecutive patients with cancer testing positive for SARS-CoV-2 in centres throughout the United Kingdom were identified and entered into a database following local governance approval. Clinical and longitudinal laboratory data were extracted from patient records. Data were analysed using Mann-Whitney U test, Fisher's exact test, Wilcoxon signed rank test, logistic regression, or linear regression for outcomes. Hierarchical clustering of heatmaps was performed using Ward's method. RESULTS: In total, 302 patients were included in three cohorts: Manchester (n = 67), Liverpool (n = 62), and UK (n = 173). In the entire cohort (N = 302), median age was 69 (range 19-93 years), including 163 males and 139 females; of these, 216 were diagnosed with a solid tumour and 86 with a haematological cancer. Preinfection lymphopaenia, neutropaenia and lactate dehydrogenase (LDH) were not associated with oxygen requirement (O2) or death. Lymphocyte count (P < 0.001), platelet count (P = 0.03), LDH (P < 0.0001) and albumin (P < 0.0001) significantly changed from preinfection to during infection. High rather than low neutrophils at day 0 (P = 0.007), higher maximal neutrophils during COVID-19 (P = 0.026) and higher neutrophil-to-lymphocyte ratio (NLR; P = 0.01) were associated with death. In multivariable analysis, age (P = 0.002), haematological cancer (P = 0.034), C-reactive protein (P = 0.004), NLR (P = 0.036) and albumin (P = 0.02) at day 0 were significant predictors of death. In the Manchester/Liverpool cohort 30 patients have restarted therapy following COVID-19, with no additional complications requiring readmission. CONCLUSION: Preinfection biochemical/haematological parameters were not associated with worse outcome in cancer patients. Restarting treatment following COVID-19 was not associated with additional complications. Neutropaenia due to cancer/treatment is not associated with COVID-19 mortality. Cancer therapy, particularly in patients with solid tumours, need not be delayed or omitted due to concerns that treatment itself increases COVID-19 severity.

Extended Water-Level Drawdowns in Dammed Rivers Enhance Fish Habitat: Environmental Pool Management in the Upper Mississippi River.

Environmental Pool Management (EPM) can improve ecosystem function in rivers by restoring aspects of the natural flow regime lost to dam construction. EPM recreates summer baseflow conditions and promotes the growth of terrestrial vegetation which is inundated in the fall, thereby improving habitat heterogeneity for many aquatic taxa. A three-year experiment was conducted wherein terrestrial floodplain areas were dewatered through EPM water-level reductions and the resulting terrestrial vegetation was (1) allowed to remain or (2) removed in paired plots in Mississippi River pool 25. Fish assemblage and abundance were quantified in paired plots after inundation. Abundances of many fish species were greater in vegetated plots, especially for species that utilize vegetation during portions of their life history. Fish assemblages varied more between plot types when the magnitude of EPM water-level drawdowns was greater, which produced greater vegetation growth. Young-of-year individuals, especially from small, early maturing species and/or species reliant on vegetation for refuge, feeding, or life history, utilized vegetated plots more than devegetated plots. Vegetation growth produced under EPM was heavily used by river fishes, including young-of-year individuals, which may ultimately positively influence recruitment. Increased habitat heterogeneity may mitigate some of the negative impacts of dam construction and water-level regulation on river fishes. Annual variability in vegetation responses that occurs under EPM enhances natural environmental variability which could ultimately contribute to increased fish diversity. Low-cost programs like EPM can be implemented as a part of adaptive management plans to help maintain biodiversity and ecosystem health in anthropogenically altered rivers.

Key enabling technologies for optical communications at 2000 nm.

This paper discusses the potential for opening a new wavelength window at the 2 µm waveband for optical communications, showing current limitations of the system's performance. It focuses on novel results for key enabling technologies, including the analysis of laser injection locking at this waveband, an improved responsivity for bulk and strained InGaAs edge-couple detectors, and also an increased gain profile for thulium-doped fiber amplifiers.

Diversity in prevalent PCR ribotypes of clinical strains of C. difficile.

In 2009, a programme of Clostridium difficile ribotyping was established in the north east. The aim of this project was to profile circulating ribotypes in the region, In all, 50 notified north east Clostridium difficile cases were ribotyped. The majority of cases occurred in patients over 70 years and in hospital in-patients. The most common ribotype identified was 027 (n = 12, 24%) and 005 (n = 8, 16%). Ribotype 078 was also detected (n = 5, 10%). Comparison with a 2009 national ribotyping study demonstrated that there were a number of ribotypes identified in the north east that were not identified during the national study and visa versa. The results of this study point to the existence of regional variation in circulating Clostridium difficile strains in Ireland. A reference facility for Ireland is urgently required to provide a central point for enhanced testing and epidemiological analysis of national and regional Clostridium difficile trends.

Salmonella Typhimurium and Salmonella Enteritidis in England: costs to patients, their families, and primary and community health services of the NHS.

This is the first study comparing societal costs of acute illness with Salmonella Typhimurium (ST) and Salmonella Enteritidis (SE) in the UK. It included the cost and severity of the illness and explored the impact of each Salmonella serovar on the patients, their families, the NHS, and the wider economy. The study ascertained confirmed cases of ST and SE between July and November 2008. The mean costs per case were £1282 (ST) and £993 (SE). The indirect costs associated with the work-time lost by the case, parents, or carers were £409 (ST) and £228 (SE); this difference was statistically significant. The aggregate cost of ST and SE identified using laboratory test results for the UK as a whole was estimated as £6.5 million. Work-time lost and caring activities are cost categories that are not frequently investigated within the infectious intestinal disease literature, although they represent an important societal cost.

A comparison of serial computed tomography and functional change in bronchiectasis.

In bronchiectasis the morphological determinants of (marginal) fluctuations in pulmonary function tests are uncertain. The aim of the present study was to evaluate serial computed tomography (CT) changes in relation to pulmonary function trends in patients with bronchiectasis. The relationships between pulmonary function indices and CT scans in 48 adult patients with bronchiectasis were evaluated at baseline and at follow-up, at a median interval of 28 months (range 6-74 months). Two independent observers semiquantitatively scored CT features of bronchial and small airways disease. At initial assessment, the severity of airflow obstruction was linked primarily to the extent of mosaic attenuation. However, serial changes in pulmonary function indices were only associated with serial changes in mucous plugging scores. Alterations in mucous plugging on serial CT were associated with changes in the severity of bronchiectasis and bronchial wall thickness. Greater severity of all three morphological abnormalities at baseline CT were predictive of significant declines in forced expiratory volume in one second, with severe bronchial wall thickness being the most adverse prognostic determinant. Variations in mucous plugging on computed tomography correlate with minor fluctuations in pulmonary function tests in bronchiectasis. However, the severity of bronchial wall thickness is the primary determinant of subsequent major functional decline.

Functional consequences of pleural disease evaluated with chest radiography and CT.

PURPOSE: To identify a system for the quantification of pleural thickening with an acceptable level of interobserver variation and good functional correlation in individuals with pleural disease. MATERIALS AND METHODS: The extent of pleural thickening and plaques was assessed in 50 patients by using the following: (a) a radiographic score based on the International Labour Office system, (b) a subjective simple computed tomographic (CT) score, (c) a subjective comprehensive CT score, (d) an objective nonautomated method, and (e) an objective computer-aided semiautomated method. RESULTS: Similar correlations between the extent of diffuse pleural thickening and forced vital capacity were seen for each system (objective CT, r = -0.72, P <.001; simple CT, r = -0.69, P <.001; radiographic, r = -0.67, P <.001; comprehensive CT, r = -0.66, P <.001). Comparable correlations were observed for total lung capacity. After controlling for extent of diffuse pleural thickening, pleural plaque scores were functionally irrelevant. CONCLUSION: Comparable functional-morphologic correlations were achieved by using different CT and radiographic scoring systems for pleural disease. A subjective simple CT system had the advantages of ease of application and potential to aid in the accurate assessment of the lung parenchyma, which may be important in individuals exposed to asbestos.

Impact of gemifloxacin on the normal human intestinal microflora.

Gemifloxacin is a new fluoroquinolone that has been shown to possess a broad spectrum of antimicrobial activity against gram-positive and gram-negative microorganisms including methicillin-susceptible and methicillin-resistant staphylococci, Streptococcus pneumoniae, Haemophilus influenzae and most members of the family Enterobacteriaceae. The aim of the present study was to investigate the effect of gemifloxacin on the human intestinal microflora. Gemifloxacin was given in oral doses of 320 mg for 7 days to 10 healthy subjects and 5 subjects received a once-daily dose of matched placebo for 7 days. Faecal samples were collected prior to administration (days -8 and -6), during the administration period (days 2 and 4) and after withdrawal of administration (days 8, 11, 21, 28 and 56). In the aerobic intestinal microflora the numbers of enterobacteria were suppressed during the gemifloxacin administration and the numbers of enterococci and streptococci were also decreased. No other aerobic microorganisms were affected. In the anaerobic microflora the numbers of anaerobic cocci and lactobacilli were suppressed during the gemifloxacin administration while no other changes occurred. The microflora was normalized 49 days after the administration of gemifloxacin had stopped. No selection or overgrowth of resistant bacterial strains or yeasts occurred. The ecological impact of gemifloxacin was shown to be selective and similar to that of ciprofloxacin, levofloxacin and ofloxacin.

Revealing the existence of child abuse in the context of marital breakdown and custody and access disputes.

OBJECTIVE: Child abuse in the context of legal and de facto marital breakdown has received little attention internationally. Many believe it does not exist in this context and regard it as just a "gambit in the divorce wars." Recently, however, family courts in a number of countries have become concerned over the management of child abuse allegations in custody and access cases, known more commonly now as residence and contact cases. This article presents a unique research study, which investigated how the Family Court of Australia dealt with such cases. The study, covering all forms of child abuse, sought to discover who were the families bringing these problems to family courts, what precisely the abuse was and how the courts dealt with it. METHOD: The study reviewed court records of some 200 families where child abuse allegations had been made in custody and access disputes in jurisdictions in two states, observed court proceedings and interviewed court and related services' staff. RESULTS: The findings showed that these cases had become a core component of the court's workload without any public or professional awareness of this change, that the abuse was real, that it was severe and serious, and that the courts and child protection services did not provide appropriate services to the families. CONCLUSION: A new specialized intervention system was developed based on the research and it is now being trialed and evaluated. The new intervention system contains features derived from the research findings that may be suitable internationally for implementation.

Retained intrathoracic surgical swab: CT appearances.

A retained surgical swab (gossypiboma) is a rare but important complication of intrathoracic surgery. The radiographic and computed tomography (CT) appearances are variable and depend on the chronicity and site of the swab within the chest. Two cases of retained swabs within the chest are reported. In both cases, the swab had become surrounded by lung. The swab within the pleural space acted as a nidus and resulted in infolding of the lung, superficially resembling an intrapulmonary abscess on CT.

Nitrofurantoin-induced lung disease: two cases demonstrating resolution of apparently irreversible CT abnormalities.

A reticular pattern on high resolution CT (HRCT) invariably represents significant lung pathology and is the dominant feature of irreversible fibrosis. We present two cases of nitrofurantoin-induced pulmonary toxicity in which the initial HRCT showed a widespread reticular pattern and associated distortion of the lung parenchyma, thought to represent established fibrosis. Follow-up HRCT scans after withdrawal of the drug showed resolution of this supposedly irreversible pattern.

Dental student perceptions of the elderly: measuring negative perceptions with projective tests.

Stereotypic perceptions of older patients have been documented to influence relationships with older adults. To assess the impact of age and dentate status on dental student treatment decisions and perceptions of patients, we designed a qualitative study utilizing projective tests. Seventy first- and third-year dental students wrote stories about two "cue" statements, one describing a young patient and one an older patient. Each cue varied by dentate status, having either a complete dentition or seven remaining teeth. The stories were evaluated for negativity and for general themes of stereotypic statements. The results indicated that while patient age did not influence the dental care prescribed, a high level of negativity existed toward old patients in general (45%, older patient with teeth; 47%, older patient with seven teeth) and toward a younger patient with few remaining teeth (57.6%). The level of negativity expressed toward the young patient with full dentition (27%) may suggest a patient gender bias among dental students in this sample.

Use of recombinant human follicle-stimulating hormone for in vitro fertilization-embryo transfer after severe systemic immunoglobulin E-mediated reaction to urofollitropin.

OBJECTIVE: To report the successful use of recombinant human FSH in a patient with a history of a severe systemic immunoglobulin E (IgE)-mediated reaction to urofollitropin. SETTING: University hospital. PATIENT: A 38-year-old infertility patient who had experienced a whole-body rash with hives, tachycardia, fever, and other symptoms after urofollitropin administration, with confirmation of IgE-mediated sensitivity to urofollitropin by intradermal skin testing. INTERVENTION: In vitro fertilization-ET after the use of recombinant human FSH to stimulate ovarian follicular development. RESULTS: Establishment of a clinical pregnancy. CONCLUSIONS: Our case provides evidence for the involvement of nongonadotropin proteins as the direct cause of some adverse reactions from conventional urine-derived human FSH preparations.

Use of a pressure gauge to differentiate gastric from pulmonary placement of nasoenteral feeding tubes.

This study was conducted to determine the reliability and validity of using a pressure gauge to differentiate gastric from pulmonary placement of nasoenteral tubes in nonmechanically ventilated patients. It was anticipated that on inhalation, tubes properly placed in the gastric region would yield positive readings owing to positive gastric pressures. Conversely, tubes that were inadvertently placed in the pulmonary system should yield negative pressure readings owing to the negative pulmonary pressures that exist on inhalation. Forty-six subjects were enrolled in the study. Of those, 44 had positive gauge readings, and x-ray results showed that these nasoenteral tubes were in the gastric region. Two patients had negative gauge readings, and the x-rays for both of these subjects demonstrated that the nasoenteral tubes were in the pulmonary system. Thus, the findings were consistent with what was anticipated. Despite the small sample size, the results of this study indicate that this method of assessing nasoenteral tube placement may be a safe, reliable, and cost-effective method of differentiating gastric from pulmonary tube placement in this patient population.

Double modulation of 5-fluorouracil in the treatment of advanced colorectal carcinoma: report of a trial with sequential methotrexate, intravenous (loading dose) folinic acid, 5-fluorouracil, and a literature review.

5-Fluorouracil (5-FU) modulation with either folinic acid (FA) or methotrexate (MTX) has improved 5-FU's potential cytoreductivity. We combined MTX and FA with 5-FU to further augment 5-FU's cytoreductivity. Patients (n = 34) with advanced colorectal carcinoma were first given intravenous MTX (escalated from 30 mg/m2 to 70 mg/m2). FA (100 mg/m2) was infused 17-24 hr later, followed by 5-FU (600 mg/m2). Oral rescue doses of FA were begun 24 hr after MTX. Patients were treated every 2 weeks. No previously treated patient (n = 6) responded. Eight of the remaining 28 (29%) (95% confidence interval, 15-47%) patients achieved a PR. Median survival was 9.3 months. Toxicity (primarily gastrointestinal) necessitated dosage modification in 10 patients (29%). These results, in addition to a literature review, reveal that the manipulation of 5-FU by two modulating agents does not improve the response rate seen with single-agent modulation.

The impact of dose intensity of standard chemotherapy regimens in extensive stage small cell lung cancer.

Oncologists often attenuate the doses of chemotherapy drugs in published standard regimens to avoid toxicity. The impact on survival of this practice in patients with extensive stage small cell lung cancer (SCLC) is uncertain. We have compared the outcome of 85 patients treated with a program of cyclophosphamide, doxorubicin, and vincristine to a group of 37 patients treated with conventional regimens of higher dose intensity. The two groups of patients were shown to be equivalent in terms of staging evaluation, response and survival criteria, and pretreatment prognostic factors. The latter was confirmed by applying a published prognostic algorithm. Complete response rates (38% vs 14%) were significantly better with the higher intensity regimens (p = .003). The median survival (39 vs 26 weeks), 1 year survival (32% vs 12%), and overall survival (p = .002) were superior with the full-dose intensity protocols. Myelotoxicity was also greater with the contemporary treatments. Cox proportional hazards analysis, correcting for pretreatment prognostic variables, confirmed the improved survival with conventional doses of therapy (p = .0055). These results support the concept that full-dose intensity chemotherapy provides survival benefit in patients with extensive stage SCLC.

Evaluation of bone marrow iron stores in anemia associated with chronic disease: a comparative study of serum and red cell ferritin.

The serum ferritin (SERFER) may be elevated and misleading in the setting of chronic disease (chronic inflammation, liver disease, and neoplasm). The red cell ferritin (RBCFER) may be more stable in clinical situations that affect the SERFER. We compared the ability of SERFER and RBCFER to assess iron stores in these settings. Iron stores were defined by bone marrow aspirate staining. We studied 120 anemic (Hb < 14 g/dl) male patients. Twenty-eight (23%) were iron deficient based on the absence of marrow iron. The SERFER correlation with marrow iron stores (r = 0.58; P < 0.001) was better than the RBCFER (r = 0.36; P < 0.001). Cutoff values for the diagnosis of iron deficiency were determined by chi-square analysis (SERFER < 70 ng/ml; RBCFER < or = 4 ag/RBC). The sensitivity for detecting iron deficiency with SERFER (0.60) was less than RBCFER (0.82). The specificity of SERFER (0.90) was slightly better than RBCFER (0.83). Neither difference reached statistical significance (P > 0.05). The positive predictive value between the two assays was the same (SERFER 0.65 vs. RBCFER 0.59). The combination of SERFER < 70 ng/ml with RBCFER < or = 4 ag/RBC was more specific (0.97) when compared with the SERFER alone (0.90) (P = 0.04). In addition, the potential of this combination to predict iron deficiency (0.82) was higher than that seen with either SERFER (0.65) or the RBCFER (0.59). Our findings show that the RBCFER as a single assay is not anymore accurate than the SERFER. However, we find that the RBCFER can effectively complement the SERFER to either predict iron depletion or confirm the presence of bone marrow iron.

Detection and staging of small cell lung carcinoma with a technetium-labeled monoclonal antibody. A comparison with standard staging methods.

Tumor-associated radiolabeled monoclonal antibodies (MoAb) can detect neoplasms in a variety of settings. The authors conducted a study comparing the ability to detect and stage small cell lung carcinoma by using a Tc-99m labeled monoclonal antibody (NR-LU-10 Fab) (NeoRx Corp, Seattle, WA) with standard staging methods. Standard staging included a physical examination, chest x-ray, a battery of radionuclide scans and/or computerized tomographic studies (head, abdomen, and bone), and bone marrow examination. A total of 22 comparisons were performed in 17 patients (five patients had reevaluations after therapy). Fifty-four (74%) of the 73 lesions defined by standard staging were detected by the radiolabeled MoAb. Seven of eight patients (88%) classified by standard staging as having "limited stage" disease on presentation were concordantly "limited stage" by radioimmunoimaging. One patient deemed "limited stage" by standard staging was correctly upstaged (bone marrow involvement) as a result of the radiolabeled MoAb. Two patients found to have extensive disease at diagnosis were characterized as "limited stage" by the MoAb, for an overall staging accuracy of 0.88. Thirteen of 19 missed lesions were smaller than 2 cm (10 were smaller than 1 cm; 3 measured 1 to 2 cm). This comparative study shows that radioimmunoimaging by Tc-99m labeled NR-LU-10 Fab antibody is capable of complementing standard staging methods used in the evaluation of small cell lung carcinoma.