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Streptococcus pneumoniae, Haemophilus influenzae, and Neisseria meningitidis, which are typically transmitted via respiratory droplets, are leading causes of invasive diseases, including bacteraemic pneumonia and meningitis, and of secondary infections subsequent to post-viral respiratory disease. The aim of this study was to investigate the incidence of invasive disease due to these pathogens during the early months of the COVID-19 pandemic.

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The Invasive Respiratory Infection Surveillance (IRIS) Consortium was established to assess the impact of the COVID-19 pandemic on invasive diseases caused by Streptococcus pneumoniae, Haemophilus influenzae, Neisseria meningitidis, and Streptococcus agalactiae. We aimed to analyse the incidence and distribution of these diseases during the first 2 years of the COVID-19 pandemic compared to the 2 years preceding the pandemic.

This article explores the concept of ‘penal drift’ – the gradual adoption of criminal justice culture, language, and working practices – in voluntary sector organisations (VSOs) commissioned to deliver services to offenders. It identifies increases in coerced attendance, obligations to report non-compliance, targets to reduce reoffending, and contracts to ‘process’ high caseloads, as factors behind such drift, which can jeopardise relationships with service users and the sector's traditional ‘value-driven’ approach. It is concluded that most VSOs have so far managed to resist these threats and to balance contractual obligations with adherence to core values. However, this comes at a cost in staff time and energy and is difficult to sustain. There are concerns that the longer-term effects may be quite damaging to the sector.

BackgroundPneumococcal conjugate vaccines (PCVs) have the potential to prevent pneumococcal disease through direct and indirect protection. This multicentre European study estimated the indirect effects of 5-year childhood PCV10 and/or PCV13 programmes on invasive pneumococcal disease (IPD) in older adults across 13 sites in 10 European countries, to support decision-making on pneumococcal vaccination policies.MethodsFor each site we calculated IPD incidence rate ratios (IRR) in people aged ≥65 years by serotype for each PCV10/13 year (2011–2015) compared with 2009 (pre-PCV10/13). We calculated pooled IRR and 95% CI using random-effects meta-analysis and PCV10/13 effect as (1 − IRR)*100.ResultsAfter five PCV10/13 years, the incidence of IPD caused by all types, PCV7 and additional PCV13 serotypes declined 9% (95% CI −4% to 19%), 77% (95% CI 67% to 84%) and 38% (95% CI 19% to 53%), respectively, while the incidence of non-PCV13 serotypes increased 63% (95% CI 39% to 91%). The incidence of serotypes included in PCV13 and not in PCV10 decreased 37% (95% CI 22% to 50%) in six PCV13 sites and increased by 50% (95% CI −8% to 146%) in the four sites using PCV10 (alone or with PCV13). In 2015, PCV13 serotypes represented 20–29% and 32–53% of IPD cases in PCV13 and PCV10 sites, respectively.ConclusionOverall IPD incidence in older adults decreased moderately after five childhood PCV10/13 years in 13 European sites. Large declines in PCV10/13 serotype IPD, due to the indirect effect of childhood vaccination, were countered by increases in non-PCV13 IPD, but these declines varied according to the childhood vaccine used. Decision-making on pneumococcal vaccination for older adults must consider the indirect effects of childhood PCV programmes. Sustained monitoring of IPD epidemiology is imperative.

Background:There is very little research into the way that offender management strategies impinge on the practices and decision-making of palliative care personnel in community settings.Aims:To improve understanding of the challenges that community palliative care service providers encounter when caring for people who have been sentenced to custody and are under the supervision of the prison or probation services.Methods:This paper discusses one part of a larger multidisciplinary study on bereavement, loss and grief in the criminal justice system. It reports the findings from a focus group with 10 health professionals working within specialist community palliative care services. Thematic analysis was undertaken to identify and explicate the most significant themes arising from the transcript data.Results:There were situations where the participants were able to identify that patients were under the jurisdiction of the criminal justice system or had relatives in custody. Three themes emerged that highlighted distinctive aspects of providing care to this patient group. These themes were: patients under prison, probation or police supervision altered the dynamics of care provision; prisoners were restricted from supporting or contacting their dying relatives in the community; and participants (professionals) were obstructed from supporting patients at home because of criminal or antisocial behaviour by relatives of the dying.Conclusions:Health professionals face multiple challenges that curtail them from fully realising the aims of palliative care for patients and relatives under criminal justice supervision, in ways that merit further consideration and research.

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Supplemental Digital Content is available in the text.The aim of this retrospective study was to review the diagnostic accuracy of real-time polymerase chain reaction (PCR) testing of cerebrospinal fluid (CSF) samples for Streptococcus pneumoniaeDNA in comparison with traditional bacterial culture. The hypothesis was that PCR is more sensitive than culture and would detect more cases of pneumococcal meningitis, particularly in children treated with antimicrobials before CSF sampling occurred. Patients younger than 16 years of age who had a CSF sample tested for S. pneumoniaeDNA by PCR between 2004 and 2015 were included. A total of 2025 samples were included, and the PCR had a sensitivity of 100% and specificity of 98% for the detection of S. pneumoniaeDNA in comparison with culture. Of the 28 culture negative/PCR positive cases, 25 (89%) were probable meningitis cases and only 3 (11%) were suspected false positive results. Nineteen (76%) of the 25 probable cases required ICU admission, and 3 died (12%). Six different serotypes were found in the culture positive patients (18C, 6B, 14, 22F, 7F and 33F). This study demonstrates that PCR testing of CSF samples for S. pneumoniaeis sensitive and specific when compared with culture. PCR is particularly useful in detecting those cases where culture is negative, perhaps relating to pre-CSF sampling administration of antimicrobials.

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To assess the safety and pharmacokinetics of lisdexamfetamine dimesylate (LDX), a d-amphetamine prodrug, this double-blind study enrolled adults with clinically stable schizophrenia who were adherent (≥12 weeks) to antipsychotic pharmacotherapy. The participants received placebo or ascending LDX doses (50, 70, 100, 150, 200, and 250 mg) daily for 5 days at each dose (dose periods, 1–6; days, 1–5). Of the 31 enrolled participants, 27 completed the study (placebo, n = 6; LDX, n = 21). Treatment-emergent adverse events (AEs) were reported by 4 participants receiving placebo and by 23 participants receiving LDX (all doses) with no serious AEs while on active treatment. For all periods, the mean postdose change on day 5 (up to 12 hours postdose) in systolic and diastolic blood pressure and pulse, respectively, ranged from −4.62 to 8.05 mm Hg, −3.67 to 4.43 mm Hg, and −3.57 to 14.43 beats per minute for placebo and −3.83 to 11.25 mm Hg, −1.55 to 5.80 mm Hg, and −0.36 to 21.26 beats per minute for LDX. With ascending LDX dose, the mean (SD) maximum plasma concentration for LDX-derived d-amphetamine ranged from 51.68 (10.28) to 266.27 (56.55) ngmL. The area under the plasma concentration-time curve for 24 hours ranged from 801.8 (170.2) to 4397.9 (1085.9) ng[BULLET OPERATOR]hmL. The d-amphetamine maximum plasma concentration and area under the plasma concentration-time curve increased linearly with ascending LDX dose. Antipsychotic agents did not markedly affect d-amphetamine pharmacokinetics. Over a wide range of ascending doses, LDX safety profile in adults with schizophrenia was consistent with previous findings with no unexpected treatment-emergent AEs. Pulse tended to increase with LDX dose; overall, blood pressure did not increase with LDX dose. Consistent with previous studies, pharmacokinetic parameters increased linearly with increasing LDX dose.

The purpose of this work was to assess the pharmacokinetics and safety of lisdexamfetamine dimesylate (LDX) delivered and released regionally in the gastrointestinal (GI) tract. In this open-label, randomized, crossover study, oral capsules and InteliSite delivery capsules containing LDX (50 mg) with radioactive marker were delivered to the proximal small bowel (PSB), distal SB (DSB), and ascending colon (AC) during separate periods. Gamma scintigraphy evaluated regional delivery and GI transit. LDX and d-amphetamine in blood were measured postdose (≤72 h). Treatment-emergent adverse events (TEAEs) were assessed. Healthy males (n = 18; 18–48 years) were enrolled. Mean (S.D.) maximal plasma concentration (Cmax) was 37.6 (4.54), 40.5 (4.95), 38.7 (6.46), and 25.7 (9.07) ng/ml; area under the concentration-time curve to the last measurable time point was 719.1 (157.05), 771.2 (152.88), 752.4 (163.38), and 574.3 (220.65) ng · h · ml–1, respectively, for d-amphetamine after oral, PSB, DSB, and AC delivery of LDX. Median time to Cmaxwas 5, 4, 5, and 8 h, respectively. Most TEAEs were mild to moderate. No clinically meaningful changes were observed (laboratory, physical examination, or electrocardiogram). LDX oral administration or targeted delivery to small intestine had similar d-amphetamine systemic exposure, indicating good absorption, and had reduced absorption after colonic delivery. The safety profile was consistent with other LDX studies.

AbstractThis article reviews the ‘New’ Labour government's threadbare and contradictory penal reformist legacy with regards to women. For most of its period in office, the Labour government (May 1997-May 2010) presided over a growing prison population before belatedly supporting targeted and intensive intervention for ‘at risk’ women. This article accounts for the short-lived reductionist turn in officially sponsored reformist discourse and its attenuation in a loose network of community-based diversionary programs for women offenders. It examines the deployment of imprisonment as a tool for poverty management throughout three terms of Labour government. It then explores the ways in which structural inequalities associated with women's criminalisation and penality have been subsumed into categories of ‘need’, arguing that ‘needs’ talk has facilitated the reframing of social exclusion in terms of potential and actual criminogenic risk. In turn, this has legitimated the role of state and non-state actors in working to divert ‘at risk’ groups of women from criminal pathways. The conclusion considers the recurrent and recursive characteristics of official penal reform discourse.

Background

Powers: Arrevus, Celularity, Corbus, DaVolterra, Eicos, Eli Lilly, Evofem, Eyecheck, Fuji, Gilead, GSK group of companies, Johnson & Johnson, Microbion, Mustang, OPKO, Otsuka, Romark, Shiniogi, Vir: Consultancy.

To the authors' knowledge, few data currently are available regarding the tolerance to chemotherapy in older cancer patients. This prospective pilot study evaluated the changes in functional, mental, nutritional, and comorbid status, as well as the quality of life (QOL), in geriatric oncology patients receiving chemotherapy. Sixty patients age ≥ 70 years who were undergoing cancer chemotherapy were recruited in a university-based comprehensive cancer center. Changes in physical function were measured by the Eastern Cooperative Oncology Group performance status (ECOG PS) and Instrumental Activities of Daily Living (IADLs), mental health changes were measured by the Mini-Mental State Examination and the Geriatric Depression Scale (GDS), comorbidity was measured by Charlson's index and the Cumulative Illness Rating Scale-Geriatric, nutrition was measured by the Mini-Nutritional Assessment, and QOL was measured by the Functional Assessment of Cancer Therapy-General (FACT-G). Changes were assessed at baseline and at the end of treatment (EOT). Grade 4 hematologic and Grade 3–4 nonhematologic toxicities were recorded. Thirty-seven patients (63%) completed both assessments. Older cancer patients demonstrated a significant decline in measurements of physical function after receiving chemotherapy, as indicated by changes in scores on the IADL (P = 0.04) and on the physical (P = 0.01) and functional (P = 0.03) subscales of the FACT-G. They also displayed worse scores on the GDS administered postchemotherapy (P < 0.01). Patients who experienced severe chemotoxicity had more significant declines in ECOG PS (P = 0.03), IADL (P = 0.03), and GDS (P = 0.04), and more gain in the social well-being subscale (P = 0.02) of the FACT-G, than those who did not experience severe chemotoxicity. However, changes in most scores were small in magnitude clinically. No significant change was found between baseline and EOT in nutrition, comorbidity, and other aspects of the FACT-G. Older cancer patients undergoing chemotherapy may experience toxicity but generally can tolerate it with limited impact on independence, comorbidity, and QOL levels. It is important to recognize and monitor these changes during geriatric oncology treatment. Cancer 2003;97:1107–14. © 2003 American Cancer Society. DOI 10.1002/cncr.11110

Abstract: This article tests four models of how parental and childhood welfare use affects sons' labor supply: the correlated disadvantages model, Wilson's structural-environmental model, Mead's welfare culture model, and Murray's incentives model. Past research is extended by including measures of all seven factors that these models predict will shape sons' labor supply: parental welfare use, neighborhood welfare use, parental income, family noneconomic resources, neighborhood resources, labor market conditions, and state welfare benefits. There are four main findings. First, welfare use in the childhood neighborhood has no effects on sons' work hours. Second, only one group of sons is affected by parental welfare use: black sons' whose parents average $7,500 or more in welfare income per year. Third, black sons' adult work hours are strongly predicted by parental poverty and by labor market conditions; together these account for half the estimated relationships between heavy parental welfare use and black sons' labor supply. Fourth, parents' and neighbors' work hours strongly predict nonblack sons' labor supply.

In this article we describe a funded, innovative field-based training program for senior occupational therapy students to provide a state-of-the-art service model to the elderly and their caregivers in the home. The 9-month program addresses the urgent need for advanced training in collaborative, caregiver-centered treatment approaches that focus on the environmental forces shaping behavior and management practices. Students progress through three phases of professional development: (a) understanding the aging process, assessment and treatment in the home, and collaboration with informal providers (the caregivers), (b) collaboration with formal providers while comparing and contrasting one's own professional role with other professional roles, and (c) dissemination of information about the training and service model at local and state conferences. Under closely supervised field-based experiences, students refine their knowledge base through the development and implementation of interventions and in-services for older adults, their caregivers, and formal care providers in a variety of settings: the client's home, adult day-care centers, clinics, and professional conferences. Evaluations from caregivers demonstrate the effectiveness of the program and the importance of training students in a service model that focuses on collaboration and the environmental forces that shape behavior.

Someone Who 'll Watch Over Me Frank McGuinness West Yorkshire Playhouse, LeedsMythic Ireland Michael Dames Thames and Hudson, 1992They Have Fooled You Again: Michael O'Flanagan (1876-1942) Priest, Republican, Social Critic Denis Carroll The Columba Press, 1993Idir Dha Chultur Declan Kiberd Coisceim, 1993Ireland and France, A Bountiful Friendship: Literature, History and Ideas; Essays in Honour of Patrick Rafroidi Edited by Barbara Hayley and Christopher Murray Colin Smythe, 1992The Internationalism of Irish Literature and Drama Edited by Joseph McMinn Colin Smythe, 1992Irish Poetry Now: Other Voices Edited by Gabriel Fitzmaurice Wolfhound, 1993Familiar Things Pat Boran Dedalus, 1993Rock and Water Richard Kell Dedalus, 1993Listening to different drummers Ciaran O'Driscoll Dedalus, 1993Celtic, Christian, Socialist. The Novels of Anthony C. West Audrey Stockin Eyler Associated University Presses, 1993The Rattle of the North: An Anthology of Ulster Prose Edited by Patricia Craig Blackstaff Press, 1992Woman and Nation in Irish Literature and Society CL Innes Harvester, 1993Unveiling Treasures: The Attic Guide to the Published Works of Irish Women Literary Writers Ann Owens Weekes Attic Press, 1993Roots and Realities: A Profile of Irish Women in London London Irish Women's Centre, 1993The Economy of Northern Ireland; Perspectives for Structural Change Edited by Paul Teague Lawrence and Wishart, 1993The Red Hand: Protestant Paramilitaries in Northern Ireland Steve Bruce Oxford University Press, 1992Stone Cold: The True Story of Michael Stone and the Milltown Massacre Martin Dillon Arrow, 1992Sport, Sectarianism and Society in a Divided Ireland John Sugden and Alan Bairnes Leicester University Press, 1993The Irish in Australia Patrick O'Farrell New South Wales Press, rev. edn 1993

Individuals with Alzheimer's disease are likely to experience heightened sensitivity to influences from the environment. Such influences may contribute to a range of behaviors which may be maladaptive and pose difficulty for the caregiver. In order to understand and modify transactions between impaired individuals and the environment, an environmental model, developed by Barris and colleagues, is presented and expanded. From this discussion, twelve intervention principles are derived which can be used by a range of health care professionals to guide treatment. Case material exemplifies use of the twelve intervention principles.

As one aspect of a study of individual and organizational conditions contributing to faculty vitality, career socialization experiences and current career attitudes of three faculty generations were compared for two groups of tenured university faculty members. The first group was a representative sample drawn from the fields of the humanities, biological sciences, physical sciences, and social sciences. The second was a selected sample of faculty from the same areas who had been identified by judges as highly active in teaching, research, and service. The analyses focus on differences in the professional socialization experiences and career attitudes of the two groups that appear to be indicative of career success. Within these groups the generational trends are also examined.

Sensory deprivation in the elderly is an acquired syndrome which responx to intervention based on sensory integration principles and a sensitivity to former roles and cultural influences. Clinical observations of a group of regressed nursing home residents revealed maladaptive responses similar to those described by King in a sample of non-paranoid schizophrenic patients. Observations of maladaptive behavior were noted in posture and motor activity, perception, communication, cognition and psychosocial behavior. In the demonstration project presented here, eleven nursing home residents displaying symptoms of sensory deprivation were randomly assigned to one of two groups, intervention or control. The control group participated in individualized treatment utilizing biomechanical principles. In the intervention group, sensory integration principles provrded the framework in a program which structured the environment to promote adaptive responses. The groups met for forty minutes twice weekly during a sixteen week period. A pretest-posttest comparison revealed significant improvement in the adaptive responses of the intervention group.

Inhibitory extracts of carob and abscisic acid (ABA) were compared and found to behave differently in three types of tests. The carob inhibitors remained at the origin upon thin-layer chromatography in two different solvent systems while a cis-trans mixture of ABA had Rf's of 2.5 and 3.5 in the first system (chloroform:acetic acid, 95:5), and 3.5 and 4.5 in the second system (benzene:acetic acid:water, 8:3:5). When ABA and carob extract were mixed and then chromatographed, the ABA had the same Rf values as ABA chromatographed alone.