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Many male prisoners have significant mental health problems, including anxiety and depression. High proportions struggle with homelessness and substance misuse.
This study aims to evaluate whether the Engager intervention improves mental health outcomes following release.
The design is a parallel randomised superiority trial that was conducted in the North West and South West of England (ISRCTN11707331). Men serving a prison sentence of 2 years or less were individually allocated 1:1 to either the intervention (Engager plus usual care) or usual care alone. Engager included psychological and practical support in prison, on release and for 3–5 months in the community. The primary outcome was the Clinical Outcomes in Routine Evaluation Outcome Measure (CORE-OM), 6 months after release. Primary analysis compared groups based on intention-to-treat (ITT).
In total, 280 men were randomised out of the 396 who were potentially eligible and agreed to participate; 105 did not meet the mental health inclusion criteria. There was no mean difference in the ITT complete case analysis between groups (92 in each arm) for change in the CORE-OM score (1.1, 95% CI –1.1 to 3.2, P = 0.325) or secondary analyses. There were no consistent clinically significant between-group differences for secondary outcomes. Full delivery was not achieved, with 77% (108/140) receiving community-based contact.
Engager is the first trial of a collaborative care intervention adapted for prison leavers. The intervention was not shown to be effective using standard outcome measures. Further testing of different support strategies for prison with mental health problems is needed.
Psychiatry is facing major challenges during the current coronavirus disease 2019 (COVID)-19 pandemic. These challenges involve its actual and perceived role within the medical system, in particular how psychiatric hospitals can maintain their core mission of attending to people with mental illness while at the same time providing relief to overstretched general medicine services. Although psychiatric disorders comprise the leading cause of the global burden of disease, mental healthcare has been deemphasised in the wake of the onslaught of the pandemic: to make room for emergency care, psychiatric wards have been downsized, clinics closed, psychiatric support systems discontinued and so on. To deal with this pressing issue, we developed a pandemic contingency plan with the aim to contain, decelerate and, preferably, avoid transmission of COVID-19 and to enable and maintain medical healthcare for patients with mental disorders.
To describe our plan as an example of how a psychiatric hospital can share in providing acute care in a healthcare system facing an acute and highly infectious pandemic like COVID-19 and at the same time provide support for people with mental illness, with or without a COVID-19 infection.
This was a descriptive study.
The plan was based on the German national pandemic strategy and several legal recommendations and was implemented step by step on the basis of the local COVID-19 situation. In addition, mid- and long-term plans were developed for coping with the aftermath of the pandemic.
The plan enabled the University Hospital to maintain medical healthcare for patients with mental disorders. It has offered the necessary flexibility to adapt its implementation to the first and second waves of the COVID-19 pandemic in Germany. The plan is designed to serve as an easily adaptable blueprint for psychiatric hospitals around the world.
Si is a promising anode material for Li storage due to its high theoretical specific capacity surpassing 4200 Ah/kg. Si based anodes exhibit an extreme instability upon electrochemical incorporation of Li given the accompanied large volume expansion of about 400%. We show innovative anode assemblies composed of a forest of free standing Si nanowires conformally integrated on carbon meshes. The morphology of silicon nanowires allows a volume expansion and compression lowering strain incorporation. In this paper, we demonstrate the utilization of SiNW grown on top of a current collector made of a carbon fiber network. This leads to an increase of stability of Si with a remaining effective capacitance above 2000 Ah/kg(Si) after 225 full charge/discharge cycles. This is significantly better compared to previous results shown in literature. The anodes are fabricated by a simple and inexpensive method promising for a transfer into industrial integration.
Vast areas of tropical forests have been deforested by human activities, resulting in landscapes comprising forest fragments in matrices of deforested habitats. Soil seed banks (SSB) are essential sources for the regeneration of tropical forests after disturbance. In a fragmented montane landscape in the Bolivian Andes, we investigated SSB in three different habitat types that were associated with different degrees of disturbance, i.e. in forest interior, at forest edges and in deforested habitats. Sampling of habitats was replicated at six sites ranging in altitude from 1950 to 2450 m asl. We extracted seeds from dried soil samples by sieving, classified seeds into morphospecies and size classes, and characterized SSB in terms of density, species richness and composition. We tested effects of disturbance (i.e. habitat type) and altitude on SSB characteristics. Overall, small seeds (<1 mm) dominated SSB (81% of sampled seeds). Seed density and species richness were lowest in deforested habitats, especially in large seeds and distant from adjacent forests (≥20 m), while small-seeded species were most numerous near forest margins. Species turnover between habitats was high. Altitude altered the composition of SSB, but had no effects on seed density and species richness. We conclude that the potential of SSB for natural regeneration of deforested habitats is low and decreases with increasing distance from forest remnants and that forest edges may be eventually invaded by small-seeded species from deforested habitats.
The minimum size of radiocarbon samples for which reliable results can be obtained in an accelerator mass spectrometry (AMS) measurement is in many cases limited by carbon contamination introduced during sample preparation (i.e. all physical and chemical steps to which samples were subjected, starting from sampling). Efforts to reduce the sample size limit down to a few μg carbon require comprehensive systematic investigations to assess the amount of contamination and the process yields. We are introducing additional methods to speed up this process and to obtain more reliable results. A residual gas analyzer (RGA) is used to study combustion and graphitization reactions. We could optimize the reaction process at small CO2 pressures and identify detrimental side reactions. Knowing the composition of the residual gas in a graphitization process allows a reliable judgment on the completeness of the reaction. Further, we use isotopically enriched 13C (≥98% 13C) as a test material to determine contamination levels. This offers significant advantages: 1) The measurement of 12C/13C in CO2 is possible on-line with the RGA, which significantly reduces turnaround times compared to AMS measurements; 2) Both the reaction yield and the amount of contamination can be determined from a single test sample.
The first applications of isotopically enriched 13C and the RGA have revealed that our prototype setup has room for improvements via better hardware; however, significant improvements of our sample processing procedures were achieved, eventually arriving at an overall contamination level of 0.12 to 0.15 μg C during sample preparation (i.e. freeze-drying, combustion, and graphitization) of μg-sized samples in aqueous solution, with above 50% yield.
Multilayered and nanostructured coatings of amorphous carbon (DLC), silicon composite multilayers and nanocluster containing films today have great potential for applications as hard coatings, wear reduction layers and as diffusion barriers in biomaterials. Plasma immersion ion implantation and deposition (PIII&D) is a powerful technique to synthesize such films. The quantitative nanoscale analysis of the elemental distribution in such multielemental films and thin film stacks however is demanding.
In this paper it is shown how the high spatial resolution capabilities of energy filtered trans-mission electron microscopy (EFTEM) chemical analysis can be combined with accurate and standard-less concentration determination of ion beam analysis (IBA) techniques like Rutherford Backscattering Spectroscopy (RBS) and Elastic Recoil Detection Analysis (ERDA) to achieve absolute and accurate multielement concentration profiles in complicated nanomaterials.
To assess the influence of prophylactic selective bowel decontamination (SBD) on the spectrum of microbes causing bloodstream infection (BSI).
The microbes causing BSI in neutropenic patients of a hematologic ward (HW) and a bone marrow transplantation unit (BMTU), respectively, were compared by retrospective analysis of blood culture results from January 1996 to June 2003.
A 30-bed HW (no SBD) and a BMTU including a 7-bed normal care ward and an 8-bed intensive care unit (SBD used) of a 2,200-bed university teaching hospital.
The overall incidences of bacteremia in the HW and the BMTU were similar (72.6 vs 70.6 episodes per 1,000 admissions; P = .8). Two hundred twenty episodes of BSI were recorded in 164 neutropenic patients of the HW and 153 episodes in 127 neutropenic patients of the BMTU. Enterobacteriaceae (OR, 3.14; CI95, 1.67–5.97; P = .0002) and Streptococcus species (OR, 2.04; CI95, 1.14–3.70; P = .015) were observed more frequently in HW patients and coagulase-negative staphylococci more frequently in BMTU patients (OR, 0.15; CI95, 0.09–0.26; P< .00001). No statistically significant differences were found for gram-negative nonfermentative bacilli (P = .53), Staphylococcus aureus (P = .21), Enterococcus species (P = .48), anaerobic bacteria (P = .1), or fungi (P = .50).
SBD did not lead to a significant reduction in the incidence of bacteremia, but significant changes in microbes recovered from blood cultures were observed. SBD should be considered when empiric antimicrobial therapy is prescribed for suspected BSI.
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