An empirical analysis of conviction patterns, change over the life-course and external influences in relation to sexual offending behaviour

This PhD uses statistical analysis and qualitative interviews to analyse behaviour patterns in the context of causal theories of sexual offending and desistance from it, with a particular emphasis on socio-cultural reasons why people offend, stop offending, or offend at different points in life. This research makes an original contribute to the literature in a number of ways. There are six main findings from this research that contribute to the literature in this area. One of the key findings is that there is substantial heterogeneity of offending behaviour amongst sexual offenders, suggesting that there is no one-size-fits-all approach for prevention, intervention or management. There was support in the research for a link between sexual offending and prolific non-sexual offending, but this only appeared to be one of several different sexual offending pathways. Other groups of offenders displayed considerable specialism in their offending (in terms of type of sexual offence and the fact that they had often only been convicted of sexual offences). This was magnified by the finding that offending rates were generally lower for sexual convictions than for other convictions: in fact, the vast majority of people in the dataset only had convictions for one sexual offence. There was evidence from the qualitative interviews that adverse life events were a contributory factor to sexual offending, and the thesis has found that there is support for both psychological and socio-cultural causes (including gender-based elements), as well as an interaction between the two. It also suggested that there is evidence that sexual offending is not stable over the life-course, and that situational factors appear to be important in terms of determining behavioural change. Implications for prevention, intervention and management of sexual offenders are discussed

A comparative analysis of a disposable and a reusable pedicle screw instrument kit for lumbar arthrodesis: integrating HTA and MCDA

Objective: Lumbar arthrodesis is a common surgical technique that consists of the fixation of one or more motion segments with pedicle screws and rods. However, spinal surgery using these techniques is expensive and has a significant impact on the budgets of hospitals and Healthcare Systems. While reusable and disposable instruments for laparoscopic interventions have been studied in literature, no specific information exists regarding instrument kits for lumbar arthrodesis. The aim of the present study was to perform a complete health technology assessment comparing a disposable instrument kit for lumbar arthrodesis (innovative device) with the standard reusable instrument. Methods: A prospective and observational study was implemented, by means of investigation of administrative records of patients undergoing a lumbar arthrodesis surgical procedure. The evaluation was conducted in 2013, over a 12- month time horizon, considering all the procedures carried out using the two technologies. A complete health technology assessment and a multi-criteria decision analysis approach were implemented in order to compare the two alternative technologies. Economic impact (with the implementation of an activity based costing approach), social, ethical, organisational, and technology-related aspects were taken into account. Results: Although the cost analysis produced similar results in the comparison of the two technologies (total cost equal to € 4,279.1 and € 4,242.6 for reusable instrument kit and the disposable one respectively), a significant difference between the two instrument kits was noted, in particular concerning the organisational impact and the patient safety. Conclusions: The replacement of a reusable instrument kit for lumbar arthrodesis, with a disposable one, could improve the management of this kind of devices in hospital settings