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An exponential rise in the number of older prisoners is creating new and costly challenges for the criminal justice system, state economies, and communities to which older former prisoners return. We convened a meeting of 29 national experts in correctional health care, academic medicine, nursing, and civil rights to identify knowledge gaps and to propose a policy agenda to improve the care of older prisoners. The group identified 9 priority areas to be addressed: definition of the older prisoner, correctional staff training, definition of functional impairment in prison, recognition and assessment of dementia, recognition of the special needs of older women prisoners, geriatric housing units, issues for older adults upon release, medical early release, and prison-based palliative medicine programs.

Introduction: Following twenty years of economic and social growth, Liberia's fourteen-year civil war destroyed its health system, with most of the health workforce leaving the country. Following the inauguration of the Sirleaf administration in 2006, the Ministry of Health & Social Welfare (MOHSW) has focused on rebuilding, with an emphasis on increasing the size and capacity of its human resources for health (HRH). Given resource constraints and the high maternal and neonatal mortality rates, MOHSW concentrated on its largest cadre of health workers: nurses., Case Description: Based on results from a post-war rapid assessment of health workers, facilities and community access, MOHSW developed the Emergency Human Resources (HR) Plan for 2007-2011. MOHSW established a central HR Unit and county-level HR officers and prioritized nursing cadres in order to quickly increase workforce numbers, improve equitable distribution of workers and enhance performance. Strategies included increasing and standardizing salaries to attract workers and prevent outflow to the private sector; mobilizing donor funds to improve management capacity and fund incentive packages in order to retain staff in hard to reach areas; reopening training institutions and providing scholarships to increase the pool of available workers., Discussion and Evaluation: MOHSW has increased the total number of clinical health workers from 1396 in 1998 to 4653 in 2010, 3394 of which are nurses and midwives. From 2006 to 2010, the number of nurses has more than doubled. Certified midwives and nurse aides also increased by 28% and 31% respectively. In 2010, the percentage of the clinical workforce made up by nurses and nurse aides increased to 73%. While the nursing cadre numbers are strong and demonstrate significant improvement since the creation of the Emergency HR Plan, equitable distribution, retention and performance management continue to be challenges., Conclusion: This paper illustrates the process, successes, ongoing challenges and current strategies Liberia has used to increase and improve HRH since 2006, particularly the nursing workforce. The methods used here and lessons learned might be applied in other similar settings.

In recent years, dozens of countries have introduced accreditation and other quality improvement initiatives. A great deal of information is available regarding best practices in high- and middle-income countries; however, little is available to guide developing nations seeking to introduce an accreditation programme. This paper describes the outputs and lessons learned in the first year of establishing an accreditation programme in Liberia, a developing nation in West Africa that in 2003 emerged from a brutal 14-year civil war. The Liberian experience of developing and implementing a government-sponsored, widespread accreditation programme may provide insight to other low-income and post-conflict countries seeking a way to drive rapid, system-wide reform in the health system, even with limited infrastructure and extremely challenging conditions.

At 6 months following the death of their spouse, 37 participants reported their grief-related symptoms and thoughts, and then, approximately 4.5 years later, they attempted to recall how they felt at the time of the 6-month report. Although participants were far less distressed at recall than initially, they recalled their 6-month grief rather accurately. Participants did however overestimate prior grief-related intrusive ideation. Participant's current level of grief predicted what they recalled slightly better than the actual initial grief. Conversely, what they recalled predicted current levels of grief across various measures. Participants whose grief diminished relatively little over time tended to overestimate prior grief more. The retrospective reappraisal that one's past grief was not severe may indicate effective coping.

We report a series of studies that assess the feasibility and sensitivity of imaging of herpes virus type one thymidine kinase (HSV1-tk) gene transfer and expression with [124I]-5-iodo-2'-fluoro-1-beta-D-arabinofuranosyluracil ([124I]-FIAU) and positron emission tomography (PET) and the ability of [124I]-FIAU-PET imaging to discriminate different levels of HSV1-tk gene expression. Studies were performed in rats bearing multiple s.c. tumors derived from W256 rat carcinoma and RG2 rat glioma cells. In the first set, we tested the sensitivity of [124I]-FIAU-PET imaging to detect low levels of HSV1-tk gene expression after retroviral-mediated gene transfer. HSV1-tk gene transduction of one of preestablished wild-type W256 tumor in each animal was accomplished by direct intratumoral injection of retroviral vector-producer cells (W256-->W256TK* tumors). Tumors produced from W256 and W256TK+ cells served as the negative and positive control in each animal. Highly specific images of [124I]-FIAU-derived radioactivity were obtained in W256TK* tumors (that were transduced in vivo) and in W256TK+ tumors but not in nontransduced wild-type W256 tumors. The level of "specific" incorporated radioactivity in transduced portions of both W256TK* and W256TK+ tumors was relatively constant between 4 and 50 h. In the second set, we tested whether [124I]-FIAU and PET imaging can measure and discriminate between different levels of HSV1-tk gene expression. Multiple s.c. tumors were produced from wild-type RG2 cells and stably transduced RG2TK cell lines that express different levels of HSV1-tk. A highly significant relationship between the level of [124I]-FIAU accumulation [% injected dose/g and incorporation constant (Ki)] and an independent measure of HSV1-tk expression (sensitivity of the transduced tumor cells to ganciclovir, IC50) was demonstrated, and the slope of this relationship was defined as a sensitivity index. We have demonstrated for the first time that highly specific noninvasive images of HSV1-tk expression in experimental animal tumors can be obtained using radiolabeled 2'-fluoro-nucleoside [124I]-FIAU and a clinical PET system. The ability to image the location (distribution) of gene expression and the level of expression over time provides new and useful information for monitoring clinical gene therapy protocols in the future.

Two "reverse prenyl" hexahydropyrroloindole alkaloids, 5-N-acetylardeemin and 5-N-acetyl-8-demethylardeemin, were evaluated as reversal agents in cells exhibiting a multidrug resistant (MDR) phenotype. These ardeemins (i) reversed drug resistance to vinblastine (VBL) or to taxol as much as 700-fold at relatively noncytotoxic concentrations in vitro; (ii) as a single agent at high concentrations killed MDR cells more efficaciously than the respective parent wild-type cells; and (iii) exhibited strong synergistic effects with doxorubicin (DX) and VBL against the growth of MDR neoplastic cells, and to a lesser extent, of the parent wild-type cells. Mechanistic studies showed that photoaffinity labeling of P-glycoprotein (Pgp) with [3H] azidopine was competitively inhibited by the ardeemins. Resistance to DX in MDR-[Pgp+ and MDR-associated protein (MRP)+], MDR-Pgp+, lung resistance protein (LRP)+-expressing, and wild-type lung cancer cells were reversed 110- to 200-fold, 50- to 66-fold, 7- to 15-fold, and 0.9- to 3-fold, respectively, by 20 microM of the ardeemins. Moreover, these compounds increased the intracellular accumulation of VBL and markedly decreased its efflux. Finally, in vivo combination studies demonstrated that nontoxic doses of the ardeemins with DX significantly improved the chemotherapeutic effects in B6D2F1 mice bearing DX-resistant P388 leukemia, and nude mice bearing human MX-1 mammary carcinoma xenografts. The above features indicate that the ardeemins may have utility in the therapy of cancer.

The construct of hemisphericity contends that some individuals process information analytically and others holistically, and that these individual differences reflect characteristic preferences or strategies for left- and right-hemisphere processing, respectively. We investigated whether hemisphericity was related to personality variables, as measured by trait anxiety and the tendency to express versus inhibit emotions. Sixty six right-handed subjects completed personality measures and were tested on two occasions with multiple measures of hemisphericity, including dichotic listening, tachistoscopic emotion recognition, verbal ability and spatial ability. Although some of the hemisphericity measures exhibited moderate reliability, they generally did not correlate significantly with each other or with measures of personality. However, a composite hemisphericity index indicated that right hemisphericity was modestly correlated with the tendency to express emotions and left hemisphericity with the tendency to inhibit emotions. We discuss some reasons for the failure to find either construct or predictive validity for hemisphericity.

Factors affecting delay were studied in patients seeking treatment for the first time for a particular symptom at clinics in a major, innercity hospital. On the basis of the patients' retrospective report, the total time from first noticing a symptom to the seeking of treatment was divided into three sequential stages: 1) appraisal delay--the time the patient takes to appraise a symptom as a sign of illness; 2) illness delay--the time taken from deciding one is ill until deciding to seek professional medical care; and 3) utilization delay--the time from the decision to seek care until the patient goes to the clinic and uses its services. The variables used to predict the length of delay for each of the three stages and for total delay included reports on concrete, sensory perceptions and abstract, conceptual beliefs about one's symptoms, behavioral factors such as strategies for self-appraisal and techniques for coping with illness, emotional reactions, negative imagery elicited by the illness threat, situational barriers, and socio-demographic factors. Patients experiencing a very painful symptom and patients who did not read about their symptom had a short appraisal delay. Patients with old symptoms and those who imagined possible, severe consequences of their illness had long illness delays. Utilization delay was shortest for persons who were not concerned about the cost of treatment, who had a painful symptom, and who were certain that their symptom could be cured. Patients who had short total delays were persons who did not have a competing personal problem and who had a painful symptom. All of these predictors were significantly correlated with the measure of delay at or beyond the p = .01 level. It was concluded that different factors mediate delay in each of the three stages and that studies which use only a single measure of total delay are likely to be of limited value in understanding delay.

Two experiments tested the hypothesis that positive emotions are processed primarily by the left hemisphere and negative emotions by the right hemisphere. In both experiments, facial expressions of positive and negative emotions were briefly presented to the left and right visual fields of normal dextral subjects. Experiment 1 investigated hemisphere differences in accuracy for naming the emotions, and Experiment 2 examined hemisphere differences in judging the intensity of the emotional expressions. Neither experiment found support for the hypothesized relationship. It was concluded that differential hemisphere involvement in processing positive and negative emotions, as suggested by previous studies, may occur, but only for the production, and not the perception of emotional expressions.

Cardiac screening programs are ineffective when participants with abnormal findings fail to seek treatment and, to a lesser extent, when participants with normal findings use medical facilities unnecessarily because of continuing concern about heart disease. Age, sex, measure of concern about cardiac symptoms and life stress, and abnormal test results were used to predict the use of physician services in the 3 months following screening. Abnormal test results predicted the use of physician services after screening, as did being older, and having life stress and concern about cardiac symptoms. Being older, male, and concerned about cardiac symptoms predicted having at least one abnormal test result. Participants with normal findings and high levels of concern about cardiac symptoms were as likely to see a physician after the screening as were persons with abnormal findings and low levels of concern about cardiac symptoms. Emphasizing participants' concern about symptoms of heart disease or feelings of stress failed to produce an increase in followup for persons who had abnormal screening outcomes.

Two experiments are presented in which lateralization of monaural, auditory input affected the evaluation of verbal passages. In Experiment 1, subjects listened to taped passages that consisted of three levels (positive, neutral, and negative) of tone of voice crossed with three similar levels of content or meaning, making a total of nine different tone/content combinations. Subjects rated these passages as positive, neutral, or negative, and although they were not instructed about which cues (tone or content) to use, 29 of 36 subjects who listened on the left ear primarily used the tone-of-voice cues to rate the passages, whereas 21 of 36 subjects who listened on the right ear used the content cues (p less than .01). In Experiment 2, subjects were asked to make objective ratings of both tone of voice and content. Subjects who listened on the right ear were more accurate in rating both cues. The lateral differences in evaluating the auditory stimuli are discussed in the framework of the left hemisphere's specialization for analytic processing of objective information and the right hemisphere's specialization for the holistic processing of subjective or emotional information. However, each hemisphere's specialization for tone and content cues can be greatly affected by the demands of the experimental task.

Vasodilating drugs are commonly used in the treatment of hypertension. These antihypertensive agents are considered as acting on small arteries which are preferentially damaged in the hypertensive vascular disease. Recent studies have emphasized that the hemodynamic abnormalities in hypertension were not restricted to arterioles but involved also large arteries, resulting in a decrease in arterial compliance. This finding is potentially important since cardio-vascular morbidity and mortality in patients treated for hypertension is related to ischemic accidents related to alterations of large vessels, as observed in the coronary and the carotid-cerebral circulation. From this observation, it ensues that the study of the effects of vasodilating drugs on the large arteries of hypertensive patients should be extremely relevant to improve cardiovascular morbidity and mortality. On the basis of experimental studies, several cases of pharmacological dissociation in the dilatation of small and large arteries have been observed in animals, mainly in the coronary circulation. However, little research has been done on the effect of antihypertensive drugs on large arteries in men with essential hypertension. In the present review, the hemodynamic concepts and the methodologic basis for the study of large arteries in man are presented. Thereafter, the different aspect of the dilatation of small and large arteries in hypertension are analyzed, with the study of consequences on the conduit and the buffering functions of large arteries and on the development of cardiac hypertrophy. Finally, large arteries have also an important baroreflex function involved in the neuro-humoral consequences of vasodilatation. This point will be particularly described and interpreted.

Since 1965, 103 patients with testicular neoplasms have been evaluated with lymphangiography for evidence of retroperitoneal disease. Thirty-five patients with testicular carcinomas had lymphadenectomies; corroboration of their initial lymphangiographic interpretaions with the surgical specimens was possible. There was an overall 79% (26 of 33) correlation. We feel that even with relatively inexperienced examiners, lymphangiography can be a useful means of evaluating the retroperitoneum.

Forty subjects viewed 10 pictures of facial expressions of emotion while they experienced a happy mood and 10 pictures while they experienced a sad mood. Later, while re-experiencing either a happy or sad mood, they were tested for recognition of these 20 target pictures intermixed with 20 distractors. Recognition of the 10 pictures seen earlier in a disparate mood was impaired significantly when they were presented at testing to the right hemisphere, but not when presented to the left. The right hemisphere appears to store the subject's mood as an integral part of a memory representation for an emotionally expressive face. When that face is presented at testing to the right hemisphere, recognition depends on whether the subject's test mood matches the mood stored in the representation. In contrast, the left hemisphere appears to store the subject's mood separately from encoded visual information about a face, and so recognition of a face presented at testing to the left hemisphere is unaffected by changes in mood.

Two studies assessed the potential impact of health education messages at worksite blood pressure screenings. The messages sought to: motivate hypertensives to enter or return to treatment, motivate normotensives to improve health habits and discourage inappropriate use of blood pressure screening by normotensives. A total of 473 participants in the two studies viewed slide/tape shows about blood pressure and/or health promotion. Individuals with elevated readings at screening viewed either a show containing standard blood pressure information or an experimental show which emphasized the asymptomatic nature of high blood pressure and which described some concrete strategies for coping with high blood pressure. In both studies, individuals with normal readings at screening viewed a standard show or an experimental show which emphasized coping strategies for preventing high blood pressure. In addition, in Study 2, some normotensive individuals viewed one of several experimental shows which focused on health promotion. Results indicate that the experimental programs were significantly more effective than the standard programs in achieving appropriate followup of screening results for both normotensives and hypertensives. Implications for worksite blood pressure screenings are discussed.

The models used in the study of communication and health behavior have changed from those describing how to impose health actions on relatively passive respondents to models describing how respondents regulate their own health practices. We have traced the change from the fear-drive model, which described how fear induced change, to the parallel response model, which described how subjects processed information and generated coping responses to solve the problem posed by both the objective health threat and by their subjective fear. The data supporting this change showed that increasing fear led to more favorable attitudes but that fear alone was insufficient to create action: Specific action instructions had to be added to both high and low fear and both combinations produced the same level of health action. Neither the data nor the parallel model specified what subjects learned about the threat that made exposure to a high or low fear message necessary for behavior change. The parallel response model has been elaborated into a more complete systems model and new studies show how health threats are represented. They have found attributes such as IDENTITY (label and symptoms), CAUSES, TIME LINES or duration, and CONSEQUENCES, that set goals and criteria to generate and evaluate problem solving (coping) behavior. Suggestions are made for applying this more complete model to public health practice.

The Special Projects Division of the City of Milwaukee Health Department conducted a telephone survey among randomly selected adult residents to determine the population having the greatest potential for benefiting from a health screening a counseling program. A modified version of the Health Hazard Appraisal (HHA) was completed by 268 respondents. From the survey results, it was estimated that by reducing various health risk factors, the respondents could lower their current probability of dying within 10 years by an average of 22 percent. The major predictor of the percentage of reducible risk was age. Persons 18-39 years old could reduce their current probability of dying within 10 years by an average of about 10 percent, whereas persons 40 years and older could reduce theirs by an average of more than 30 percent. Men could lower their probability by slightly more than women, but other sociodemographic factors, such as race, income, education, and residential area, either did not predict significantly the percentage of reducible risk or did so only because of their correlation with age. The results raise questions about the HHA's accuracy in calculating reducible risk, its use of death postponement information to motivate changes in behavior, and its value in health promotion programs, particularly for young adults who are not likely to die of chronic diseases within 10 years. The HHA should only be considered for public health screening programs that target middle-aged and, perhaps, elderly populations rather than the general population of persons under 40 years old.

Subjects judged whether two faces expressed same or different emotions. Subjects were alternately instructed to empathize with or label the first face which was shown for eight seconds. The second face was then exposed briefly in either the left or right visual field. Eighteen subjects had contrasting hemisphere superiorities in accuracy for making same/different judgments under the two instructions, whereas 12 subjects had consistent hemisphere superiorities. It is proposed that individuals may differ in the metacontrol of lateralization on a task, such that for some individuals, the hemisphere controlling cognitive operations can switch as a function of instructions, expectations, and strategies. For other individuals, the metacontrol of lateralization may dictate that the same hemisphere always controls processing on a particular task.