Rehabilitating antisocial personalities: treatment through self-governance strategies

Offenders with antisocial personality disorder (ASPD) are widely assumed to reject psychotherapeutic intervention. Some commentators, therefore, argue that those with the disorder are better managed in the criminal justice system, where, following the introduction of indeterminate sentences, engagement with psychological treatment is coercively linked to the achievement of parole. By comparison, National Institute of Clinical Excellence guidelines on the management and treatment of ASPD recommend that those who are treatment seeking should be considered for admission to specialist psychiatric hospitals. The rationale is that prison-based interventions are underresourced, and the treatment of ASPD is underprioritised. The justification is that offenders with ASPD can be rehabilitated, if they are motivated. One problem, however, is that little is known about why offenders with ASPD seek treatment or what effect subsequent treatment has on their self-understanding. The aim of this paper is to address these unresolved issues. It draws on the findings of Economic and Social Research Council (ESRC) funded qualitative study examining the experiences of sentenced male offenders admitted to a specialist personality disorder ward within the medium secure estate and the medical practitioners who treat them. The data are analysed with reference to Michel Foucault’s work on governmentality and strategy in power relations. Two arguments are advanced: first, offenders with ASPD are motivated by legal coercive pressures to implement a variety of Foucauldian-type strategies to give the false impression of treatment progress. Second, and related, treatment does not result in changes in self-understanding in the resistive client with ASPD. This presupposes that, in respect of this group at least, Foucault was mistaken in his claim that resistive behaviours merely mask the effectiveness of treatment norms over time. Nevertheless, the paper concludes that specialist treatment in the hospital setting can effect changes in the resistive offender’s self-understanding, but not if the completion of treatment results, as is commonplace, in his prison readmission

Conservation law enforcement : policing protected areas

This article examines how recent increases in commercial poaching of wildlife intensify the dictates that underpin conservation law and its enforcement; namely, the securing of space, punishing of transgressors, and protecting of nonhuman life. Drawing on ethnographic research with antipoaching personnel in Mozambique, I examine how rangers translate these legal and normative manifestations of conservation law enforcement on the ground and in their daily practices to police protected areas and the wildlife within them. This article makes two contributions. First, drawing on insights from the political geography and ecology of conservation with the political geography of policing, I demonstrate how territorial, sovereign, and biopolitical practices and logics coalesce to secure the spaces and the lives of the nonhuman from ostensible human threats. Second, it is rangers who are deployed as petty environmental sovereigns to achieve these objectives through often violent practices. Although many rangers might feel uncomfortable with the use of violence, their agency to commit or resist using violence is authorized, enabled, and constrained by the normative and legal structures of conservation law enforcement within which they operate. The social differentiation among rangers also means that some have more agency to navigate these structures than others. These insights help understand the actually existing operationalization of delegated and performative power over bodies, space, and the use of direct violence. I suggest that critiques of conservation violence, and the use of violence by those acting as petty sovereigns more broadly, should be primarily oriented at the broader structures within which they operate

PPARα and PPARγ activation is associated with pleural mesothelioma invasion but therapeutic inhibition is ineffective

Mesothelioma is a cancer that typically originates in the pleura of the lungs. It rapidly invades the surrounding tissues, causing pain and shortness of breath. We compared cell lines injected either subcutaneously or intrapleurally and found that only the latter resulted in invasive and rapid growth. Pleural tumors displayed a transcriptional signature consistent with increased activity of nuclear receptors PPARα and PPARγ and with an increased abundance of endogenous PPAR-activating ligands. We found that chemical probe GW6471 is a potent, dual PPARα/γ antagonist with anti-invasive and anti-proliferative activity in vitro. However, administration of GW6471 at doses that provided sustained plasma exposure levels sufficient for inhibition of PPARα/γ transcriptional activity did not result in significant anti-mesothelioma activity in mice. Lastly, we demonstrate that the in vitro anti-tumor effect of GW6471 is off-target. We conclude that dual PPARα/γ antagonism alone is not a viable treatment modality for mesothelioma

Factors affecting the use of patient survey data for quality improvement in the Veterans Health Administration

<p>Abstract</p> <p>Background</p> <p>Little is known about how to use patient feedback to improve experiences of health care. The Veterans Health Administration (VA) conducts regular patient surveys that have indicated improved care experiences over the past decade. The goal of this study was to assess factors that were barriers to, or promoters of, efforts to improve care experiences in VA facilities.</p> <p>Methods</p> <p>We conducted case studies at two VA facilities, one with stable high scores on inpatient reports of emotional support between 2002 and 2006, and one with stable low scores over the same period. A semi-structured interview was used to gather information from staff who worked with patient survey data at the study facilities. Data were analyzed using a previously developed qualitative framework describing organizational, professional and data-related barriers and promoters to data use.</p> <p>Results</p> <p>Respondents reported more promoters than barriers to using survey data, and particularly support for improvement efforts. Themes included developing patient-centered cultures, quality improvement structures such as regular data review, and training staff in patient-centered behaviors. The influence of incentives, the role of nursing leadership, and triangulating survey data with other data on patients' views also emerged as important. It was easier to collect data on current organization and practice than those in the past and this made it difficult to deduce which factors might influence differing facility performance.</p> <p>Conclusions</p> <p>Interviews with VA staff provided promising examples of how systematic processes for using survey data can be implemented as part of wider quality improvement efforts. However, prospective studies are needed to identify the most effective strategies for using patient feedback to improve specific aspects of patient-centered care.</p

A lanthanum picrate complex of a 1,2-bisamide substituted calix[4]arene

The synthesis and structural characterization of a lanthanum picrate complex of the proximally-substituted calix[4]arene bisamide, 5,11,17,23-tetra-tert-butyl-25,26- bis(diethylcarbamoylmethoxy)-27,28-dihydroxycalix[4] arene (L), is reported. The complex is formulated as [La(L-H)(picrate)2]2.75CH2Cl2 and crystallises with two inequivalent metal complexes in the unit cell. The differing dispositions of the picrate anions in the two complexes suggest that intramolecular interactions between the aromatic rings of the picrate and calixarene are less significant than the forces involved in the crystal packing of the complexes

Management and resistance in the digital newsroom

What happens when there is conflict between the profit motivations of a news outlet and the professional values of its journalists? Questions of managerial influence and journalistic autonomy have interested media scholars from the seminal work of Warren Breed onwards. However, there have only been a handful of studies since the introduction of audience metrics which, this research suggests, allow managers to more efficiently monitor and discipline their journalists. This article presents an ethnographic case study of a Reuters newswire bureau during a time of conflict between the management and journalists. The article outlines the strategies that management used to incentivize their journalists to change their reporting priorities. These included the strategic dissemination of audience metrics and praise, and the hiring and promotion of ‘appropriate’ journalists to positions of influence. These interventions changed who was considered a ‘good journalist’ at the newswire, disrupting existing hierarchies, and eventually changing the culture of the newsroom. The article draws on the insights of Pierre Bourdieu’s field theory to help explain how managerial power operates, and the role that individual journalists play producing and reinforcing newsroom norms

Fingolimod: therapeutic mechanisms and ocular adverse effects.

Fingolimod is an oral immunomodulating drug used in the management of relapsing-remitting multiple sclerosis (RRMS). We aim to review the published literature on ocular manifestations of fingolimod therapy and their possible underlying mechanisms. The therapeutic effects of fingolimod are mediated via sphingosine receptors, which are found ubiquitously in various organs, including lymphoid cells, central nervous system, cardiac myocytes, and smooth muscle cells. Fingolimod-associated macular oedema (FAME) is the most common ocular side effect but retinal haemorrhages and retinal vein occlusion can occur. The visual consequences appear to be mild and, in cases of FAME, resolution is often attained with discontinuation of therapy. However, in cases of retinal vein occlusion, discontinuation of fingolimod alone may not be sufficient and intra-vitreal therapy may be required. We also propose a pragmatic service pathway for monitoring patients on fingolimod therapy, which includes stratifying them by risk and visual acuity