Punishment and solidarity? An experimental test of the educative-moralizing effects of legal sanctions

Objectives: Both scholars and legal practitioners have long theorized that a central function of criminal punishments is to reinforce moral values and, in so doing, symbolically reaffirm the vitality of the shared beliefs that underpin social trust and bonding—or what Durkheim refers to as “mechanical solidarity”. Crime, according to this theoretical scholarship, is a symbol of disconsensus and possesses the potential to trigger a demoralization cascade. Punishment counteracts the demoralizing effect of crime by demonstrating that a consensus remains about the moral boundaries in society and that legal authorities continue to have the motivation and resources necessary to enforce this consensus. Versions of this denunciatory or expressive theory of punishment can be found in the criminological, sociological, and legal literatures. All varieties of the theory share a common feature: to date, they have largely escaped empirical scrutiny. Methods: The current study tests this theoretical tradition’s foundational hypotheses using data from a randomized factorial survey experiment conducted with a sample of 5042 Americans. Results: The findings provide no support for expressive theories of punishment. However, the evidence does show that punishment may play an important role in reducing the emotional impact of crime on citizens. Specifically, when the offender is caught and punished it appears to diminish the aversive emotional reactions (e.g., anger) caused by learning that a crime was committed in the first place. Conclusions: Our study suggests that, although punishing crimes may not influence individuals’ social or moral beliefs, it might serve another important function by attenuating potentially criminogenic emotional reactions to crime, such as anger. The sanctioning effect, then, shares similarities with conventional coping mechanisms described in general strain theory

Cross-sectional study of the prevalence, causes and management of hospital-onset diarrhoea.

BACKGROUND:The National Health Service in England advises hospitals collect data on hospital-onset diarrhoea (HOD). Contemporaneous data on HOD are lacking. AIM:To investigate prevalence, aetiology and management of HOD on medical, surgical and elderly-care wards. METHODS:A cross-sectional study in a volunteer sample of UK hospitals, which collected data on one winter and one summer day in 2016. Patients admitted ≥72 hours were screened for HOD (definition: ≥2 episodes of Bristol Stool Type 5-7 the day before the study, with diarrhoea-onset >48 hours after admission). Data on HOD aetiology and management were collected prospectively. FINDINGS:Data were collected on 141 wards in 32 hospitals (16 acute, 16 teaching). Point-prevalence of HOD was 4.5% (230/5142 patients; 95% CI 3.9-5.0%). Teaching hospital HOD prevalence (5.9%, 95% CI 5.1-6.9%) was twice that of acute hospitals (2.8%, 95% CI 2.1-3.5%; odds ratio 2.2, 95% CI 1.7-3.0). At least one potential cause was identified in 222/230 patients (97%): 107 (47%) had a relevant underlying condition, 125 (54%) were taking antimicrobials, and 195 (85%) other medication known to cause diarrhoea. 9/75 tested patients were Clostridium difficile toxin positive (4%). 80 (35%) patients had a documented medical assessment of the diarrhoea. Documentation of HOD in medical notes correlated with testing for C. difficile (78% of those tested versus 38% not tested, p<0.001). 144 (63%) patients were not isolated following diarrhoea onset. CONCLUSION:HOD is a prevalent symptom affecting thousands of patients across the UK health system each day. Most patients have multiple potential causes of HOD, mainly iatrogenic, but only a third had medical assessment. Most were not tested for C. difficile and were not isolated