Discovering Mental Ill Health: 'Problem-Solving' in an English Magistrates' Court

People with problems of mental ill health are overrepresented in the criminal justice system. Community justice courts have established procedures for ‘problem-solving’ as a way of addressing these and other issues associated with pathways into crime. In this chapter Auburn et al examine problem-solving in one such court in England. The ways in which mental health issues are raised by members of the problem solving team and how signposting is implemented, is examined. Three main questioning forms are identified and the influence that these forms have on the meeting-talk trajectory is discussed. There was a continuum from eliciting ‘no problem’ responses to facilitating claims of mental ill health. Specific ‘diagnostic procedures’ are also identified as important precursors to advice delivery. The clinical relevance of these findings is considered

Engine of Destruction? An Introduction to the History of the Maori Land Court

For 130 years, the Maori Land Court had reflected and shaped policies concerning the ownership and disposal of Maori land. This article surveys the primary and secondary sources of information concerning the Court's operations, noting the abundance of material, but the paucity of analysis. It then moves to the Court's legislative base in the Native Land Acts from 1862 and the principles and methodology by which statute was converted to practice and Maori custom to English law. The costs to Maori of this system, especially those related to surveying, are explored. Finally, the developments and changes in the twentieth century, such as those in Te Ture Whenua Maori Act 1993, are considered

Elective Open Suprarenal Aneurysm Repair in England from 2000 to 2010 an Observational Study of Hospital Episode Statistics

Background: Open surgery is widely used as a benchmark for the results of fenestrated endovascular repair of complex abdominal aortic aneurysms (AAA). However, the existing evidence stems from single-centre experiences, and may not be reproducible in wider practice. National outcomes provide valuable information regarding the safety of suprarenal aneurysm repair. Methods: Demographic and clinical data were extracted from English Hospital Episodes Statistics for patients undergoing elective suprarenal aneurysm repair from 1 April 2000 to 31 March 2010. Thirty-day mortality and five-year survival were analysed by logistic regression and Cox proportional hazards modeling. Results: 793 patients underwent surgery with 14% overall 30-day mortality, which did not improve over the study period. Independent predictors of 30-day mortality included age, renal disease and previous myocardial infarction. 5-year survival was independently reduced by age, renal disease, liver disease, chronic pulmonary disease, and known metastatic solid tumour. There was significant regional variation in both 30-day mortality and 5-year survival after risk-adjustment. Regional differences in outcome were eliminated in a sensitivity analysis for perioperative outcome, conducted by restricting analysis to survivors of the first 30 days after surgery. Conclusions: Elective suprarenal aneurysm repair was associated with considerable mortality and significant regional variation across England. These data provide a benchmark to assess the efficacy of complex endovascular repair of supra-renal aneurysms, though cautious interpretation is required due to the lack of information regarding aneurysm morphology. More detailed study is required, ideally through the mandatory submission of data to a national registry of suprarenal aneurysm repair

Criminal Justice and Social Policy

ARTICLES: : 1. Editorial 2. Hans Boutellier - The Convergence of Social Policy and Criminal Justice 3. Daniël Gilling - Community - Safety and Social Policy 4. Loïc Wacquant - The Penalisation of Poverty and the Neo-Liberal Project 5. Ken Pease - Distributive Justice and Crime 6. Evelyne Ballergeau and Christine Schaut - Social Work and the Security Issue in the Netherlands and Belgium 7. Peter Goris - Community Crime Prevention and the 'Partnership Approach': A Safe Community for Everyone? 8. Angela Grier and Terry Thomas - Current Issues: The Employment of Ex-offenders and the UK's Criminal Record Burea

Accessible digital assessments of temporal, spatial or movement concepts for profoundly motor impaired and non-verbal individuals: a pilot study

Purpose: Here we present a study of two new Assistive Technology (AT) accessible digital assessments which were developed to address the current paucity of (English) spoken language comprehension assessments accessible to individuals who are both non-verbal and have profound motor impairments. Such individuals may rely heavily upon AT for communication and control. However, many assessments require that responses are given either verbally, by physical pointing or manipulating physical objects. A further problem with many assessments is their reliance upon static images to represent language components involving temporal, spatial or movement concepts. These new assessments aim to address some of these issues. Materials and methods: The assessments were used with 2 young people who are non-verbal and have profound motor impairments (GMFCS level IV/V) and who use eye gaze as their primary method of communication and access. One assessment uses static images and the other short video clips to represent concepts containing temporal, spatial or movement elements. The assessments were carried out with each participant, both before and after an intervention, as part of a larger study. Results: The assessments were accessible using AT (eye gaze) for both participants, although assessment scores varied. The design of the assessments particularly suited one participant who scored near maximum, but they appeared less suitable for the other participant. Conclusions: Making assessments AT accessible removes a barrier to assessing aspects of the spoken language comprehension abilities of some. Video may be a better medium for representing certain concepts within assessments compared with static images

Chronic Lymphocytic Leukemia Cells in a Lymph Node Microenvironment Depict Molecular Signature Associated with an Aggressive Disease

Chronic lymphocytic leukemia (CLL) cells survive longer in vivo than in vitro, suggesting that the tissue microenvironment provides prosurvival signals to tumor cells. Primary and secondary lymphoid tissues are involved in the pathogenesis of CLL, and the role of these tissue microenvironments has not been explored completely. To elucidate host-tumor interactions, we performed gene expression profiling (GEP) of purified CLL cells from peripheral blood (PB; n = 20), bone marrow (BM; n = 18), and lymph node (LN; n = 15) and validated key pathway genes by real-time polymerase chain reaction, immunohistochemistry and/or TCL1 trans-genic mice. Gene signatures representing several pathways critical for survival and activation of B cells were altered in CLL cells from different tissue compartments. Molecules associated with the B-cell receptor (BCR), B cell-activating factor/a proliferation-inducing ligand (BAFF/APRIL), nuclear factor (NF)-κB pathway and immune suppression signature were enriched in LN-CLL, suggesting LNs as the primary site for tumor growth. Immune suppression genes may help LN-CLL cells to modulate antigen-presenting and T-cell behavior to suppress antitumor activity. PB CLL cells overexpressed chemokine receptors, and their cognate ligands were enriched in LN and BM, suggesting that a chemokine gradient instructs B cells to migrate toward LN or BM. Of several chemokine ligands, the expression of CCL3 was associated with poor prognostic factors. The BM gene signature was enriched with antiapoptotic, cytoskeleton and adhesion molecules. Interestingly, PB cells from lymphadenopathy patients shared GEP with LN cells. In Eμ-TCL1 transgenic mice (the mouse model of the disease), a high percentage of leukemic cells from the lymphoid compartment express key BCR and NF-κB molecules. Together, our findings demonstrate that the lymphoid microenvironment promotes survival, proliferation and progression of CLL cells via chronic activation of BCR, BAFF/APRIL and NF-κB activation while suppressing the immune response

Does Size Matter? A Retrospective Study Analysing the Size of PI-RADS 4 Lesions and Its Associated Prostate Cancer Positivity with Transperineal Prostate Biopsy

Ali Hooshyari,1 David Scholtz,1 Keu Maoate,1 Samuel Robertson,1 Lodewikus Petrus Vermeulen,1,2 Luiz Gustavo Modelli De Andrade,3 Paulo Roberto Kawano,4 Peter Gilling,1,2 Mark Fraundorfer,1 Flavio Vasconcelos Ordones1,2,4 1Urology Department, Tauranga Hospital, Tauranga, New Zealand; 2Surgical Department, University of Auckland, Auckland City, New Zealand; 3Renal Department, Botucatu School of Medicine, São Paulo State University, São Paulo, Brazil; 4Urology Department, Botucatu School of Medicine, São Paulo State University, São Paulo, BrazilCorrespondence: Ali Hooshyari, Urology Department, Tauranga Hospital, Bay of Plenty, 829 Cameron Road, Tauranga, New Zealand, Tel + 64 211753979, Email [email protected]: Magnetic resonance imaging (MRI) is an essential tool in Prostate Cancer (PCa) diagnosis. PI-RADS v2.1 score correlates with clinically significant prostate cancer (CSPCa) and according to the most recent guidelines, prevalence of CSPCa with PI-RADS 4 is 33– 41%, while PI-RADS 5 is 62– 79%. These groups are separated only by a size of 15 mm yet the difference in risk is significant. This study aims to find a size threshold associated with CSPCa within the PI-RADS 4 group, which may be used in combination with other prostatic parameters, such as PSA density in order to help with risk stratification and patient counselling in the pre-biopsy setting. This may also aid with surveillance of smaller PI-RADS 4 lesions in the setting of a negative biopsy and avoid unnecessary repeat biopsies unless triggered by a size threshold.Methods: A retrospective study was performed with data from 407 patients undergoing transperineal prostate biopsy (TPPB) between April 2022 and November 2023. A subgroup of patients with PI-RADS 4 was included for analysis. A ROC-AUC was obtained.Results: Median age was 67 (interquartile range: 61– 71) and PSA density 0.20 (interquartile range 0.13– 0.28). PI-RADS score correlated with CSPCa: for PI-RADS 1 and 2, the frequency of CSPCa was 10%; for PI-RADS 3, it was 20%; for PI-RADS 4, it was 60%; and for PI-RADS 5, it was 80%, Pearson correlation = 0.51, p < 0.001. The Receiver Operating Characteristic Area Under the Curve (ROC-AUC) was determined to be 0.664 [0.579– 0.7499]. The optimal cut-off point was 8.5 mm. Patients with lesions larger than 8.5 mm had 2.31 times higher risk CSPCa.Conclusion: PI-RADS 4 size does matter and is a useful predictor of CSPCa. In our study, a cut-off of 8.5 mm was identified. The combination of PI-RADS 4 with PSA density provides a specificity higher than 80% for CSPCa detection.Keywords: PI-RADS 4, mpMRI, transperineal prostate biopsy, prostate cancer, siz