Critical perspectives on Arts on Prescription

The positive outcomes of engaging in the arts are increasingly reported in the research literature, supporting the use of the arts to enhance individual and community health and wellbeing. However, little attention is given to the less positive aspects of arts engagement. In some countries, healthcare practitioners and link workers can refer service-users experiencing mental health issues to social interventions such as Arts on Prescription (AoP) programmes. This critical review identifies problematic issues across such social prescriptions and AoP, including failures in arts and health projects, participants' negative experiences, and an absence of ethical guidelines for arts and health practice. Furthermore, it is evident that there is a lack of awareness and knowledge within healthcare systems, leading to inappropriate referrals, failure to take account of individual preferences, and a lack of communication between the third sector and healthcare services. Significantly, it is also unclear who holds the health responsibility for AoP participants. This article raises more questions than it answers, but for AoP to be effectively embedded in healthcare practice, the issues highlighted need to be addressed in order to safeguard participants and support the effective implementation of programmes more widely.

On-road and wind-tunnel measurement of motorcycle helmet noise

The noise source mechanisms involved in motorcycling include various aerodynamic sources and engine noise. The problem of noise source identification requires extensive data acquisition of a type and level that have not previously been applied. Data acquisition on track and on road are problematic due to rider safety constraints and the portability of appropriate instrumentation. One way to address this problem is the use of data from wind tunnel tests. The validity of these measurements for noise source identification must first be demonstrated. In order to achieve this extensive wind tunnel tests have been conducted and compared with the results from on-track measurements. Sound pressure levels as a function of speed were compared between on track and wind tunnel tests and were found to be comparable. Spectral conditioning techniques were applied to separate engine and wind tunnel noise from aerodynamic noise and showed that the aerodynamic components were equivalent in both cases. The spectral conditioning of on-track data showed that the contribution of engine noise to the overall noise is a function of speed and is more significant than had previously been thought. These procedures form a basis for accurate experimental measurements of motorcycle noise.

Predictive and prognostic factors for treatment and survival in 305 patients with advanced gastrointestinal neuroendocrine carcinoma (WHO G3): the NORDIC NEC study

BACKGROUND

As studies on gastrointestinal neuroendocrine carcinoma (WHO G3) (GI-NEC) are limited, we reviewed clinical data to identify predictive and prognostic markers for advanced GI-NEC patients.

PATIENTS AND METHODS

Data from advanced GI-NEC patients diagnosed 2000-2009 were retrospectively registered at 12 Nordic hospitals.

RESULTS

The median survival was 11 months in 252 patients given palliative chemotherapy and 1 month in 53 patients receiving best supportive care (BSC) only. The response rate to first-line chemotherapy was 31% and 33% had stable disease. Ki-67<55% was by receiver operating characteristic analysis the best cut-off value concerning correlation to the response rate. Patients with Ki-67<55% had a lower response rate (15% versus 42%, P<0.001), but better survival than patients with Ki-67≥55% (14 versus 10 months, P<0.001). Platinum schedule did not affect the response rate or survival. The most important negative prognostic factors for survival were poor performance status (PS), primary colorectal tumors and elevated platelets or lactate dehydrogenase (LDH) levels.

CONCLUSIONS

Advanced GI-NEC patients should be considered for chemotherapy treatment without delay.PS, colorectal primary and elevated platelets and LDH levels were prognostic factors for survival. Patients with Ki-67<55% were less responsive to platinum-based chemotherapy, but had a longer survival. Our data indicate that it may not be correct to consider all GI-NEC as one single disease entity.

Aeroacoustic sources of motorcycle helmet noise

The prevalence of noise in the riding of motorcycles has been a source of concern to both riders and researchers in recent times. Detailed flow field information will allow insight into the flow mechanisms responsible for the production of sound within motorcycle helmets. Flow field surveys of this nature are not found in the available literature which has tended to focus on sound pressure levels at ear as these are of interest for noise exposure legislation. A detailed flow survey of a commercial motorcycle helmet has been carried out in combination with surface pressure measurements and at ear acoustics. Three potential noise source regions are investigated, namely, the helmet wake, the surface boundary layer and the cavity under the helmet at the chin bar. Extensive information is provided on the structure of the helmet wake including its frequency content. While the wake and boundary layer flows showed negligible contributions to at-ear sound the cavity region around the chin bar was identified as a key noise source. The contribution of the cavity region was investigated as a function of flow speed and helmet angle both of which are shown to be key factors governing the sound produced by this region.

The care of pin sites with external fixation

Two protocols for the operative technique and care of the pin-site with external fixation were compared prospectively. There was a total of 120 patients with 46 in group A and 74 in group B. Infection was defined as an episode of pain or inflammation at a pin site, accompanied by a discharge which was either positive on bacterial culture or responded to a course of antibiotics. Patients in group B had a lower proportion of infected pin sites (p = 0.003) and the time to the first episode of infection was longer (p < 0.001). The risk of pin-site infection is lower if attention is paid to avoiding thermal injury and local formation of haematoma during surgery and if after-care includes the use of an alcoholic antiseptic and occlusive pressure dressings.

Patient empowerment in secondary prevention of coronary heart disease

Despite a large evidence base, the practice of secondary prevention in coronary artery disease is suboptimum and needs improvement. We have shown that although patient empowerment led to an increase in cholesterol checks, the action taken by health-care professionals as a result of these checks was poor.

Photophysical studies on antimalarial drugs

Most drugs used in the treatment of malaria produce phototoxic side effects in both the skin and the eye. Cutaneous and ocular effects that may be caused by light include changes in skin pigmentation, corneal opacity, cataract formation and other visual disturbances including irreversible retinal damage (retinopathy) leading to blindness. The mechanism for these reactions in humans is unknown. We irradiated a number of antimalarial drugs (amodiaquine, chloroquine, hydroxychloroquine, mefloquine, primaquine and quinacrine) with light (lambda > 300 nm) and conducted electron paramagnetic resonance (EPR) and laser flash photolysis studies to determine the possible active intermediates produced. Each antimalarial drug produced at least one EPR adduct with the spin-trap 5,5-dimethyl-1-pyrroline N-oxide in benzene: superoxide/hydroperoxyl adducts (chloroquine, mefloquine, quinacrine, amodiaquine and quinine), carbon-centered radical adducts (all but primaquine), or a nitrogen-centered radical adduct only (primaquine). In ethanol all drugs except primaquine produced some superoxide/hydroperoxyl adduct, with quinine, quinacrine, and hydroxychloroquine also producing the ethoxyl adduct. As detected with flash photolysis and steady-state techniques, mefloquine, quinine, amodiquine and a photoproduct of quinacrine produced singlet oxygen ([symbol: see text]delta = 0.38; [symbol: see text]delta = 0.36; [symbol: see text]delta = 0.011; [symbol: see text]delta = 0.013 in D2O, pD7), but only primaquine quenched singlet oxygen efficiently (2.6 x 10(8) M-1 s-1 in D2O, pD7). Because malaria is a disease most prevalent in regions of high light intensity, protective measures (clothing, sunblock, sunglasses or eye wraps) should be recommended when administering antimalarial drugs.

Medical Information Service via Telephone. The pioneer of physician consultation services

The organization and development of MIST were a response to the needs of health professionals in Alabama, principally rural physicians, who expressed a desire to access the knowledge of the faculty at the UAB Medical Center. MIST provides free service on a 24-hour, 7-day-a-week basis for physicians around the world. At any time, practitioners can obtain specific medical information and discuss possible diagnoses or patient-related problems with UAB specialists. MIST, the first and largest medical professional telephone consultation program of its kind, receives numerous requests from other institutions seeking information and advice on developing similar programs. Such programs now exist in many states. One reason for the success of MIST is that it has always enjoyed high visibility with UAB physicians, credibility with the physician callers, and priority within UAB's Office of the Vice President for Health Affairs. As a consultative system, MIST continues to contribute to improved health care for citizens of Alabama and beyond and to save patients and taxpayers the expense of unnecessary or inappropriate treatment. MIST provides consultation and continuing education at the moment of need for the professional in private practice. In return, UAB specialists are given access to vital research and demographic information, as well as patient referrals. MIST plays an important role in removing barriers to education and consultation for busy medical personnel and in facilitating patient referrals to an acclaimed center of research and excellent patient care. Rather than searching for the proper contact, one call to an easy-to-remember number puts the health professional in touch with the appropriate source. Rural doctors, as well as medical personnel working in urban areas, can feel that they are practicing "right next door" to an outstanding university medical center where colleagues who are ready and able to offer expert consultation and support at the critical moment of need are only a telephone call away.

Utilization of offender case information by "lenient" vs. "punitive" clinicians

Presentence evaluations conducted by psychologists and psychiatrists (clinicians) and correctional counselors (caseworkers) were subjected to multiple regression analyses in order to specify the relative contribution of inmate characteristics (offense severity and recidivism probability) and decision-maker response biases to sentencing recommendations. Although both groups of decision-makers showed a response bias effect for cases that were difficult to discriminate, the effect was generally larger for clinicians than for caseworkers. Response bias (lenient vs. punitive) was not associated with type of clinical judgment model (linear vs. configural) or predictability of recommendation, although it was associated with the degree of relative weighting of the two independent variables and, in the case of extremely punitive decision-makers, with the tendency to utilize only one evaluative dimension (offense severity) to the exclusion of the other. Furthermore, it was found that inmates who committed the most serious offenses were exposed selectively to those decision-makers most likely both to place exclusive emphasis on offense severity and to recommend relatively punitive case dispositions. The need for an accountability system designed to minimize the effects of the response biases of correctional decision-makers was discussed.

Personality patterns among correctional officer applicants

The MMPI profiles of 359 correctional officer applicant were cluster analyzed, which resulted in the identification of five relatively homogeneous subgroups. While MMPI performance was not related to later events in the correctional careers of the Ss, certain similarities were noted between the officer group and two samples of inmates previously studied in a comparable fashion. In this respect, although the officers manifested generally lower profile elevations than inmates, configural similarities were noted between the average inmate and the officer profiles, and partial overlap was seen between the profile types identified in the two groups. The implications of the findings for occupationally adaptive and maladaptive correctional officer behavior were discussed.

Personality patterns among short-term prisoners undergoing presentence evaluations

The MMPI profiles of 295 short-term prisoners undergoing presentence evaluations were cluster-analyzed, resulting in four distinct groups. These groups differed in IQ, on recidivism-related characteristics reflected in a Base Expectancy score and an estimate of extensiveness of arrest record, and on type of psychiatric-psychological recommendation made to the referring courts. However, they did not differ on age, educational level, or the severity of their offenses. In comparing these results with those of other typological investigations of offender groups, it was tentatively concluded that these short-term prisoners being considered for probation seem less emotionally disturbed than those serving sentences for custodial or other purposes.

Prisoner intellectual and personality correlates of offense severity and recidivism probability

Multiple regression analyses were performed relating the severity of offense and probability of recidivism of 295 prison inmates to their performance on the MMPI and AGCT. The MMPI was found to be correlated with recidivism probability and the recidivism-related component of the Offense Severity variable, while AGCT IQ was found to be correlated with recidivism probability and the non-recidivism-related component of the Offense Severity variable. The implications for future research were discussed regarding this selective sensitivity of the MMPI to recidivism-related variables.

Cost-performance analysis of TWX-mediated interlibrary loans in a medium-sized medical center library

The need for a cost-performance analysis of TWX-mediated versus mail-mediated ILL requests is presented. Three hypotheses are proposed: (1) Unit cost for TWX-mediated ILL requests is greater then for mail-mediated ILL requests; (2) Completion time is shorter for TWX-mediated ILL requests than for mail-mediated ILL requests; (3) An analytic model can be developed that can be used to generate administrative data concerning a TWX installation. The data presented support all three hypotheses. It is shown, also, that through the use of this model a library can arrive at a cost for service of TWX versus mail-mediated ILL.