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’

Medical and Surgical Treatment Modalities for Lower Urinary Tract Symptoms in the Male Patient Secondary to Benign Prostatic Hyperplasia: A Review

Benign prostatic hyperplasia (BPH) with lower urinary tract symptoms (LUTS) is one of the most common ailments affecting aging men. Symptoms typically associated with BPH include weak stream, hesitancy, urgency, frequency, and nocturia. More serious complications of BPH include urinary retention, gross hematuria, bladder calculi, recurrent urinary tract infection, obstructive uropathy, and renal failure. Evaluation of BPH includes a detailed history, objective assessment of urinary symptoms with validated questionnaires, and measurement of bladder function parameters, including uroflowmetry and postvoid residual. In general, treatment of LUTS associated with BPH is based on the effect of the symptoms on quality of life (QOL) and include medical therapy aimed at reducing outlet obstruction or decreasing the size of the prostate. If medical therapy fails or is contraindicated, various surgical options exist. As the elderly population continues to grow, the management of BPH will become more common and important in maintaining patient's QOL

Associations among food security, BMI, diet diversity and food consumption patterns of women in rural Kenya

Enhancing food security is one of the United Nations Sustainable Development Goals. Improved agricultural production is an approach to addressing food insecurity. However, these efforts can result in significant changes that are associated with increased risk of non-communicable chronic diseases. Previous research with women in Central Kenya found that the number of years a woman-farmer was engaged in dairy development was associated with greater food security and energy (kJ) intake. No studies have examined food security and the nutrition transition among rural farm women involved in dairy development initiatives. A cross-sectional survey was conducted in 2009 and again in 2017. Chain referral sampling was used in 2009 to recruit 111 women in five groups based on how long they had been a dairy group member (non-members and members from one to more than 10 years). In 2017, 20 women were randomly selected from 85 of the dairy-group member households surveyed in 2009 and a comparison group of 20 women was randomly selected from a list that was generated by referral from the participants. In person one-on-one interviews were conducted with a translator. Demographic, household food security, and dietary intake were collected in both years. In 2009 women’s height and weight data were collected for BMI calculation. Associations among food security, BMI, dietary intake, and year of data collection were examined. Demographic characteristics were comparable between 2009 and 2017 and between food secure and food insecure  households. In both years, the majority of households were categorized as not food insecure (67% and 75%; 2009 and 2017, respectively). In 2009 almost half the women (49.4%) had BMIs in the overweight and obese category. Food secure women had a  significantly higher median BMI (26.5) compared with food insecure women (24.0). Diet diversity was low (<5) for all women and there was little evidence for a classic “western diet” of the nutrition transition. There was evidence of globalization in food availability and  greater purchasing capacity that was demonstrated by the high proportion of women that consumed sugar, refined fats and oils, refined maize and wheat flours, and bread. Household food security was associated with the consumption of sugar, cabbage, wheat  flour and bread. These findings support a unique rural nutrition transition, with food security, characterized by low dietary diversity, access to refined basic foods and high unhealthy BMI. Governments and non-governmental organizations need to support nutrition- sensitive agriculture and public health programs to curb the crisis of overweight, undernourishment and chronic diseases. Key words: agriculture, nutrition transition, rural, farm, Kenya, women, BMI, diet diversit

A randomised, controlled, observer-masked trial of corneal cross-linking for progressive keratoconus in children: the KERALINK protocol

INTRODUCTION: The KERALINK trial tests the hypothesis that corneal cross-linking (CXL) treatment reduces the progression of keratoconus in comparison to standard care in patients under 17 years old. KERALINK is a randomised controlled, observer-masked, multicentre trial in progressive keratoconus comparing epithelium-off CXL with standard care, including spectacles or contact lenses as necessary for best-corrected acuity. METHODS AND ANALYSIS: A total of 30 participants will be randomised per group. Eligible participants aged 10-16 years with progressive keratoconus in one or both eyes will be recruited. Following randomisation, participants will be followed up 3-monthly for 18 months. The effect on progression will be determined by K2 on corneal topography. The primary outcome measure is between-group difference in K2 at 18 months adjusted for K2 at baseline examination. Secondary outcomes are the effect of CXL on (1) keratoconus progression, (2) time to keratoconus progression, (3) visual acuity, (4) refraction, (5) apical corneal thickness and (6) adverse events. Patient-reported effects will be explored by questionnaires. ETHICS AND DISSEMINATION: Research Ethics Committee Approval was obtained on 30 June 2016 (ref: 14/LO/1937). Current protocol: V.5.0 (08/11/2017). Study findings will be published in peer-reviewed journals. TRIAL REGISTRATION NUMBER: European Union clinial trials register (EudraCT) 2016-001460-11

Necrotizing Enterocolitis following Gastroschisis Repair: An Update

Purpose: Necrotizing enterocolitis (NEC) is a known complication of gastroschisis with an incidence above the expected rate in the neonatal population. While many physicians today are aware of this association, the last publication to explore this association in detail and identify possible risk factors of NEC in gastroschisis patients was published over twenty years ago. From our large database of patients with gastroschisis managed by a single group of pediatric surgeons, we reviewed our experience and the recent literature to update what is known about gastroschisis and NEC. Methods: From 2001 to 2017, a gastroschisis registry was maintained. Data from 218 gastroschisis patients were reviewed. Patient demographics and hospital course were reviewed. Patients with confirmed NEC were compared to those without NEC. Results: Two hundred eighteen patients were born with gastroschisis during the time frame of this study. We observed a 5% rate (11 of 218) of NEC. Five patients (45%) developed recurring NEC and 4 patients (36%) were readmitted for NEC development following initial discharge. Variables associated with NEC included low gestational age (P=0.016) and low birth weight (P=0.003). Patients born prior to 37 weeks gestation had a 4.8 times greater risk of developing NEC than those born at term. Rates of IUGR were not statistically different between NEC and non-NEC patients. The method of delivery (cesarean vs vaginal), use of a silo, and form of nutrition were not significantly associated with NEC development. Conclusions: The overall incidence of NEC has decreased compared to earlier reports. NEC does complicate the hospital course for patients, significantly increasing duration of in-hospital treatment. NEC in gastroschisis differs in comparison to traditional NEC, presenting later in life. Risk factors identified include low gestational age and low birth weight. Avoiding elective preterm deliveries may decrease the rate of NEC in gastroschisis

A Review of Different Behavior Modification Strategies Designed to Reduce Sedentary Screen Behaviors in Children

Previous research suggests that reducing sedentary screen behaviors may be a strategy for preventing and treating obesity in children. This systematic review describes strategies used in interventions designed to either solely target sedentary screen behaviors or multiple health behaviors, including sedentary screen behaviors. Eighteen studies were included in this paper; eight targeting sedentary screen behaviors only, and ten targeting multiple health behaviors. All studies used behavior modification strategies for reducing sedentary screen behaviors in children (aged 1–12 years). Nine studies only used behavior modification strategies, and nine studies supplemented behavior modification strategies with an electronic device to enhance sedentary screen behaviors reductions. Many interventions (50%) significantly reduced sedentary screen behaviors; however the magnitude of the significant reductions varied greatly (−0.44 to −3.1 h/day) and may have been influenced by the primary focus of the intervention, number of behavior modification strategies used, and other tools used to limit sedentary screen behaviors

Exploring the impact of a Compassion Focused Therapy training course on Healthcare Educators

Background: Stress and particularly burnout, is a major problem among healthcare workers and can lead to high staff turnover and low patient/client satisfaction. Objective: To explore the impact of three-day Compassion Focused Therapy training on those delivering education to healthcare students. The underpinning premise was that the training course could potentially be replicated through the participants’ work with students embarking on a career within the helping professions. Design: Mixed methods study, with the qualitative findings being presented in this paper. Setting: Training course was delivered in one higher education institution in England. Methods: In total 44 healthcare lecturers attended the course, with 6 taking part in a reflective focus group. Findings: The analysis highlighted four main themes: reassurance and increased knowledge; increased compassion others; self-compassion and empathy; and blocks to compassion. Conclusion: Findings add to previous quantitative research findings showing that participants who undertook training were able to engage with their compassionate self and consider the importance of showing compassion towards the self and others in healthcare education