Perceptions of the effectiveness of healthcare for probationers

Purpose: This study sought to investigate the views of commissioners, providers, and criminal justice staff on how effective current healthcare provision is at meeting the health needs of people on probation. Understanding perceptions of what constitutes effective provision, where barriers are encountered, and where improvements could be made, is an important step towards improving access to care for this hard-to-reach group. Approach: The research was part of a wider study. This article focuses on findings from case studies conducted via semi-structured telephone interviews with 24 stakeholders in a purposive sample of six geographical areas of England. Interviews were conducted by researchers from a variety of backgrounds, and an individual with lived experience of the criminal justice system. Data were analysed using thematic analysis. Findings: Participants provided examples of effective healthcare provision, which largely involved multi-agency partnership working. It was apparent that there are many barriers to providing appropriate healthcare provision to people on probation, which are underpinned by the complexity of this population’s healthcare needs, the complexity of the healthcare landscape, and problematic commissioning processes. Practical Implications: Improvements are needed to provide appropriate and accessible healthcare that meets the needs of people on probation, and thereby reduce health inequalities. These include shared targets, improved funding, clearer pathways into care, and giving probation a voice in commissioning. Originality: This is the first study of commissioner, provider, and criminal justice staffs’ views on the effectiveness of current healthcare provision at meeting the health needs of people on probation

Researching healthcare availability for probation clients: an illustration of methodological challenges and lessons in surveying organisations

This article critically reflects on the methodological approach used in a multi-method study of healthcare provision for probation service clients in England. The study involved gathering data from a range of large criminal justice and health organisations. Drawing on the literature and using learning from this study as an example, we address two central questions which evolved during the research: why was it more difficult to gain access in some organisations than others, and what methodological strategies might best improve engagement with research in the future? We discuss gatekeeping, and the impact of organisational resources, culture, responsibilities, change and objectives on engagement with research. We make recommendations for future methodological approaches to address these challenges, which are relevant to researchers in any discipline trying to engage organisations in research

Aquaporin-1 Water Channel Expression in Human Kidney

The pattern of aquaporin-1 water channel protein (AQP1) expression in the human kidney was analyzed by immunocytochemistry using semi-thin and optimized high-resolution immunoelectron microscopy based on freeze-substituted and Lowicryl HM20 embedded tissue. In addition, in situ hybridization was used to determine AQP1 mRNA distribution. Immunoblots revealed a 28-kd band and a 35- to 45-kd band corresponding to unglycosylated and glycosylated AQP1. Glomerular capillary endothelium exhibited extensive AQP1 labeling, whereas glomerular podocytes and Bowman's capsule epithelium were unlabeled. AQP1 was localized in the proximal tubule, including the neck region directly connected to the glomerulus. However, there was a marked difference in the level of expression between cross-sections of the convoluted part and the proximal straight tubules, the latter displaying the most intense labeling. AQP1 labeling continued uninterrupted from the proximal straight tubule into descending thin limbs in outer medulla. Abrupt transitions from heavily labeled to unlabeled segments of thin limbs were observed, primarily in the inner medulla. This may represent the transition from the water-permeable thin descending limb to the water-impermeable thin ascending limb. In addition, heavy labeling of fenestrated endothelium was also observed in peritubular capillaries in cortex, outer medulla, and inner medulla. Immunolabeling controls were negative. In situ hybridization documented a marked difference in AQP1 mRNA levels within the proximal tubule, with the greatest AQP1 mRNA expression in straight proximal tubules. Glomeruli also showed marked signals, and descending thin limbs exhibited extensive expression in exact concordance with the immunocytochemical results. It was concluded that: (1) AQP1 is present in all proximal tubule segments, including segment 1 and the neck region, but there is a pronounced difference in expression levels with respect to both protein and mRNA levels; (2) AQP1 labeling is observed in the endothelium of fenestrated peritubular capillaries, as well as fenestrated glomerular capillaries; (3) AQP1 labeling continues directly from proximal tubules to descending thin limbs; and (4) abrupt transitions from labeled to unlabeled thin limb epithelium are noted

Axitinib in patients with advanced/metastatic soft tissue sarcoma (Axi-STS): an open-label, multicentre, phase II trial in four histological strata

Background: Axitinib is an oral vascular endothelial growth factor receptor inhibitor with anti-tumour activity in renal, thyroid, and pancreatic cancer. // Methods: Axi-STS was a pathologically-stratified, non-randomised, open-label, multi-centre, phase II trial of continuous axitinib treatment in patients ≥16 years, performance status ≤2, with pathologically-confirmed advanced/metastatic soft tissue sarcoma (STS). Patients were recruited within four tumour strata, each analysed separately: angiosarcoma, leiomyosarcoma, synovial sarcoma, or other eligible STSs. The primary outcome was progression-free survival at 12 weeks (PFS12). A Simon’s two-stage design with activity defined as PFS12 rate of 40% determined a sample size of 33 patients per strata. // Results: Between 31-August-2010 and 29-January-2016, 145 patients were recruited: 38 angiosarcoma, 37 leiomyosarcoma, 36 synovial sarcoma, and 34 other subtypes. PFS12 rate for each stratum analysed was 42% (95% lower confidence interval (LCI); 29), 45% (95% LCI; 32), 57% (95% LCI; 42), and 33% (95% LCI; 21), respectively. There were 74 serious adverse events including two treatment-related deaths of pulmonary haemorrhage and gastrointestinal bleeding. Fatigue and hypertension were the most common grade 3 adverse events. // Conclusions: Axitinib showed clinical activity in all STS strata investigated. The adverse event profile was acceptable, supporting further investigation in phase III trials. // Clinical Trial Registration: ISRCTN 6079133