Second-chance punitivism and the contractual governance of crime and incivility: New Labour, old Hobbes

The growing application of mechanisms of contractual governance to behaviour that breaches social norms, rather than the criminal law, appears to represent an ethopolitical concern with delinquent self-reform through the activation of technologies of the self. In fact, there is little empirical evidence that the contractual governance of incivility leads to such self-reform. Beneath the ideology of contractual agreement to observe social norms lies what this paper calls a ‘second-chance punitivism’ which operates to crystallise behavioural elements of the Hobbesian social contract, after breach, into a more specific form. The responsibilising and individualising properties of this form of contractual governance set the moral-ideological platform for a retributive punitivism, when the rational agents it creates fail to live up to their image, and are taken to have wasted their ‘second chance’

The impact of skills in probation work: A reconviction study

This article reports on the results of a quasi-experimental study of practitioners’ skills in probation work. Videotaped interviews were produced by a group of probation officers and analysed by researchers using a checklist designed to identify the range of skills used in one-to-one supervision. Reconviction rates were found to be significantly lower among those whose supervisors were assessed as using a wider range of skills. The article also reviews the recent history of research on practitioners’ skills in probation, and considers the implications of positive findings from this and other studies

Developing alternative over-the-counter medicine label formats: How do they compare when evaluated by consumers?

Background: In recent years, the Australian Therapeutic Goods Administration (TGA) has proposed implementing a standardized over-the-counter (OTC) medicine label. However, there were mixed consumer opinions regarding a label proposed in 2012 and limited evidence demonstrating the usability of the revised (2014) format. Objective: To develop and examine the usability of alternative OTC medicine label formats for standardization, and explore consumer perspectives on the labels. Materials and methods: Four alternative labels were developed for the exemplar medicine diclofenac. One was based on the Medicine Information label proposed by the TGA (‘Medicine Information’), one was based on the U.S. Drug Facts label (‘Drug Facts’), and two were based on suggestions proposed by consumers in the earlier needs analysis phase of this research (referred to as the ‘Medicine Facts’ and ‘Consumer Desires’ label formats). Five cohorts of 10 participants were recruited. Each cohort was assigned to user test one of the alternative labels or an existing label for a proprietary diclofenac product (which acted as a comparator) for diagnostic purposes. Each participant then provided feedback on all 5 labels. Each interview consisted of the administration of a user testing questionnaire, measuring consumers’ ability to find and understand key points of information, and a semi-structured interview exploring consumer perspectives. Results: Overall, all 4 alternative label formats supported consumers’ ability to find and understand key points. The existing comparator label was the poorer label with respect to participants’ ability to find and understand key points. Factors such as perceived usability, color, design, content, and/or content ordering impacted consumer preferences. The ‘Consumer Desires’ or ‘Drug Facts’ label formats were most often preferred by consumers for use as the standardized OTC label over the TGA proposed format. Conclusions: All alternative label formats demonstrated satisfactory usability and could be considered for use in OTC label standardization. User testing of OTC labels and consumer feedback received as part of the testing process can assist in the refinement of OTC labeling to ensure that implemented policies are evidence-based

Clinical Trial Results Summary for Laypersons: A User Testing Study

Objective: To apply “user testing” to maximize readability and acceptability of a Clinical Trial Results Laypersons Summary—a new European requirement. Methods: “User testing” (using questionnaire and semistructured interview) assessed whether people could find and understand key points. Findings were used to improve content and design, prior to retesting. Participants had a range of levels of health literacy and there was a higher education group. Participants accessed the summary on screen. In round 1 we tested 12 points of information. In round 2 a revised summary addressing round 1 findings was tested, leading to a third final version. Results: In round 1, 2 of 12 points of information did not reach the target and interviews raised further format and content issues (some distracting technical explanations and inability to find or understand the 2 main study purposes). These findings informed revisions for the version tested in round 2, with 2 different points not reaching the target (inclusion criteria relating to duration of seasonal allergies and how researchers found out about participants’ symptoms). Identified problems in both rounds were addressed and reflected in the final version. Despite improvements, participants did not consistently understand that summaries were intended for the public, or to only interpret results of single trials in the context of additional trials. All readers, including those with higher education, found the clear and straightforward language acceptable. Conclusions: Applying “user testing” resulted in a largely health-literate summary suitable for people across a range of backgrounds

Do Patients Use a Headline Section in a Leaflet to Find Key Information About Their Medicines? Findings From a User-Test Study

Background: In the European Union (EU), all medicines are mandated to be provided with a patient information leaflet (PIL). Many patients express concerns about the length and complexity of some PILs, and this can be a disincentive for patients to read the PILS. In order to address this, the UK’s regulatory body (Medicine and Healthcare products Regulatory Agency [MHRA]) suggested leaflets might include a headline section—information presented prominently at the beginning of a leaflet that summarizes key safety messages about a drug. Objective: To explore the extent to which readers used a headline section in a PIL, using a form of diagnostic testing called user-testing, which examines how readers find and understand key information. Methods: The study used a cross-sectional design to user-test a PIL with a headline section in a target sample of 20 participants. Participants were provided with an exemplar PIL, and the performance of the PIL was evaluated by a questionnaire and semistructured interview. Results: The results showed that a headline section was used just over one-third of the time (39%); 90% of participants used the headline section to find information when they initially began the user-test. The qualitative findings suggested that the participants valued the presence of the headline section. Conclusion: The research suggests there does not appear to be any negative impact from including a headline section in a PIL, and it is a technique that is highly valued by the consumers of medicines information

Consumer interpretation of ramipril and clopidogrel medication risk information – Implications for risk communication strategies

Purpose: Side effects and side-effect risk information can be provided using written medicine information. However, challenges exist in effectively communicating this information to consumers. This study aimed to explore broad consumer profiles relevant to ramipril and clopidogrel side-effect risk information interpretation. Methods: Three focus groups were conducted (n=18 consumers) exploring consumer perspectives, understanding and treatment decision making in response to ramipril and clopidogrel written medicine information leaflets containing side effects and side-effect risk information. All discussions were audio recorded, transcribed verbatim, and analyzed to explore consumer profiles pertaining to side-effect risk appraisal. Results: Three consumer profiles emerged: glass half-empty, glass half-full, and middle-of-the-road consumers, highlighting the influence of perceived individual susceptibility, interpretation of side-effect risk information, and interindividual differences, on consumers’ understanding of side-effect risk information. All profiles emphasized the importance of gaining an understanding of individual side-effect risk when taking medicines. Conclusion: Written side-effect risk information is not interpreted uniformly by consumers. Consumers formulated their own construct of individual susceptibility to side effects. Health care professionals should consider how consumers interpret side-effect risk information and its impact on medication use. Existing risk communication strategies should be evaluated in light of these profiles to determine their effectiveness in conveying information

Lidar Measurements of On-Shore Wind Diffusion

The concept to place electric power generating stations on the oceans off the coast of the United States has instilled new efforts in research for improved understanding of the diffusion properties of the atmosphere in the ocean-air interface. The Atomic Energy Commission has instigated a program by the Meteorology Group at Brookhaven National Laboratory to investigate the low level, on-shore wind systems that dominate many of the coastal regions. Analytical techniques and specialized instrumentation from previous studies at Brookhaven are being used in this new program. The Brookhaven Lidar system is used to measure some of the physical properties of the oil-fog plume originating from a portable smoke generator on a boat off the coast. The oil-fog plume is used as a tracer which can be observed, photographed and measured to determine the diffusive power of the atmosphere associated with the ocean-air interface and the discontinuities found in the ocean-land boundary. This paper will describe the program rather briefly and the oil-fog scattering measurements that have been made with the Lidar system

Molecular detection of occult disseminated disease in breast cancer patients.

A major clinical dilemma in the management of patients with early stage breast cancer is determining which patients are at risk of subsequent recurrence so that these patients may be offered adjuvant therapies. Currently, the major prognostic factors used in determining prognosis including nodal status and tumour size fail to identify up to 30% of patients classified as having low risk disease who subsequently recur with breast cancer. Therefore, there is a great need for new methodologies that can sensitively and specifically identify disseminated disease. During this study, the major aims were to use immunobead-based and methylation-based methods for the detection of occult disseminated disease in peripheral blood samples obtained from breast cancer patients. Firstly, an RT-PCR assay was developed that identified a panel of gene specific markers that could be used for sensitive and specific detection of any circulating epithelial cells with minimal risk of false positive results from contaminating haematopoietic compartment cells. These gene markers were used to assess breast cancer patients using immunobead enrichment prior to RT-PCR (IB RT-PCR) and resulted in the detection of circulating epithelial cells in 21157 peripheral blood samples. Importantly, some of these patients had been deemed lymph node negative and at low risk of relapse. Furthermore, it was decided to screen for gene promoter region methylation in freely circulating DNA in the plasma fraction, and in DNA from the nuclei of epithelial cells captured using the immunomagnetic enrichment method. The analysis of gene loci methylation of patient samples was conducted concurrently with the analysis of the frequency of gene loci methylation in mononuclear cells from normal individuals. Surprisingly, a high proportion of normal individuals were methylated at high frequency at gene loci that have previously been reported to be tumour specific. This finding had implications for the concurrent study using methylation as a marker of occult disseminated disease in breast cancer patients. The analysis of blood samples using the methodology presented in this thesis for the early detection of breast cancer dissemination, has the potential to be developed to a point where it can be introduced into the clinical setting. Once fully developed and validated, this minimally invasive methodology, that causes little discomfort to the patient, could help to improve breast cancer staging, and provide important prognostic information ensuring the identification of those early stage breast cancer patients with the greatest risk of relapse and in most need of adjuvant therapies.Thesis (Ph.D.) -- University of Adelaide, Dept. of Medicine, 200

Beyond needs and expectations: Identifying the barriers and facilitators to written medicine information provision and use in Australia

Purpose: This study aimed to explore peoples' needs and expectations of written medicines information (WMI), and to determine the barriers and facilitators experienced or perceived in the context of WMI provision and use. Methods: We conducted eight focus groups with 62 participants over 6weeks in late 2008 in New South Wales, Australia. Using a semi-structured topic schedule and examples of WMI from Australia and other English-speaking countries as a guide, we explored themes relevant to WMI, including participant experiences, attitudes, beliefs and expectations. Findings: Our findings suggest less than half had previously received WMI, with many unaware of its availability. Many, but not all, wanted WMI to supplement the spoken information they received but not to replace it, and it was predominantly used to facilitate informed choice, ascertain medicine suitability and review instructions. The current leaflets were considered technical and long, and a summary leaflet in addition to comprehensive information was favoured. Accurate side-effect information was the most important element that participants desired. The most common barriers to effective WMI use were time constraints and patient confidence, with participants citing empowerment, time and health-care professional (HCP)-patient relationships as important facilitators. Conclusion: The findings provide insight and understanding of peoples needs and expectations, and clarify issues associated with use and non-use of WMI. Challenges include addressing the barriers, especially of time and HCP attitudes to drive changes to workplace practices, and learning from the facilitating factors to encourage awareness and accessibility to WMI as a tool to empower patients