Understanding the impact of prison design on prisoners and prison staff through virtual reality: a multi-method approach

Purpose: The prison population is considered to be vulnerable to stress caused by the physical environment. The aim of this study was to evaluate the psychological effects of the prison’s environment on both inmates and staff. Design: We compared the psychophysiological arousal and self-report measurements of 73 participants (40 prisoners and 33 prison staff) to the prison environment through the exploration of three immersive virtual environments (the dormitory, the prison entrance, and the prison yard). Findings: There were few physiological activation differences between inmates and prison staff during the task, but significant discrepancies did arise, particularly from self-reported assessments. Compared to prison staff, prisoners demonstrated a greater decrease in finger pulse, indicating a stronger orienting response to virtual environments. While prison staff emphasized the importance of good lighting throughout the environments, prisoners focused their hatred on the furniture of the cells and on the layout and function of the prison yard. Both groups had conflicting emotions towards the virtual environments. Originality: Our study offers a realistic portrayal of the prison population's perceptions about the setting in which they are engaged in everyday life and activities. Practical implications: Hence, there are implications for both prison rehabilitation and designing prison renovations that are in line with the psychological needs of inmates and prison staff

Tailored Immunosuppression and Steroid Withdrawal in Pancreas-Kidney Transplantation

BACKGROUND: Recent improvements in simultaneous pancreas-kidney transplantation (SPK) and the striking decrease in acute rejection lead us to focus on the effects of long-term immunosuppression. AIM OF THIS STUDY: Evaluation of a policy of steroid withdrawal and tailored immunosuppression in pancreas-kidney patients treated in a single center. METHODS: review of the clinical charts in 9 SPK recipients (male/female = 5/4, median age 41 years, median follow-up 42 months), by the same operator, under supervision of the two usual caregivers. Therapeutic protocols. Induction phase: all patients received mycophenolate mophetil (starting dose: 2 grams), tacrolimus and steroids, 8 received Simulect, 1 received thymoglobulins. Maintenance therapy was slowly reduced, with the goal of steroid withdrawal. RESULTS: The therapeutic adjustments were mainly determined by two almost opposing elements: 1. Rapid adjustments in the case of side-effects (gastrointestinal problems, infections and neoplasia); 2. Slow tapering off in the case of good organ function. On the other hand, a switch to cyclosporine A and to rapamycine was considered in the case of chronic organ malfunction. By these means, over a median of 42 months follow-up, steroid withdrawal was slowly obtained in 6/9 patients (at a median time of 25 months). CONCLUSIONS: Within the limits of this small-scale study, a tailored immunosuppressive policy allows at least some "positively selected" patients to reach the "dream" of steroid withdrawal after SPK