Towards an Economy of Higher Education

This paper draws a distinction between ways thinking and acting, and hence of policy and practice in higher education, in terms of different kinds of economy: economies of exchange and economies of excess. Crucial features of economies of exchange are outlined and their presence in prevailing conceptions of teaching and learning is illustrated. These are contrasted with other possible forms of practice, which in turn bring to light the nature of an economy of excess. In more philosophical terms, and to expand on the picture, economies of excess are elaborated with reference, first, to the understanding of alterity in the work of Emmanuel Levinas and, second, to the idea of Dionysian intensity that is to be found in Nietzsche. In the light of critical comment on some current directions in policy and practice, the implications of these ways of thinking for the administrator, the teacher and the student in higher education are explored

Clinical effectiveness and cost-effectiveness of issuing longer versus shorter duration (3-month vs. 28-day) prescriptions in patients with chronic conditions: systematic review and economic modelling.

BACKGROUND: To reduce expenditure on, and wastage of, drugs, some commissioners have encouraged general practitioners to issue shorter prescriptions, typically 28 days in length; however, the evidence base for this recommendation is uncertain. OBJECTIVE: To evaluate the evidence of the clinical effectiveness and cost-effectiveness of shorter versus longer prescriptions for people with stable chronic conditions treated in primary care. DESIGN/DATA SOURCES: The design of the study comprised three elements. First, a systematic review comparing 28-day prescriptions with longer prescriptions in patients with chronic conditions treated in primary care, evaluating any relevant clinical outcomes, adherence to treatment, costs and cost-effectiveness. Databases searched included MEDLINE (PubMed), EMBASE, Cumulative Index to Nursing and Allied Health Literature, Web of Science and Cochrane Central Register of Controlled Trials. Searches were from database inception to October 2015 (updated search to June 2016 in PubMed). Second, a cost analysis of medication wastage associated with < 60-day and ≥ 60-day prescriptions for five patient cohorts over an 11-year period from the Clinical Practice Research Datalink. Third, a decision model adapting three existing models to predict costs and effects of differing adherence levels associated with 28-day versus 3-month prescriptions in three clinical scenarios. REVIEW METHODS: In the systematic review, from 15,257 unique citations, 54 full-text papers were reviewed and 16 studies were included, five of which were abstracts and one of which was an extended conference abstract. None was a randomised controlled trial: 11 were retrospective cohort studies, three were cross-sectional surveys and two were cost studies. No information on health outcomes was available. RESULTS: An exploratory meta-analysis based on six retrospective cohort studies suggested that lower adherence was associated with 28-day prescriptions (standardised mean difference -0.45, 95% confidence interval -0.65 to -0.26). The cost analysis showed that a statistically significant increase in medication waste was associated with longer prescription lengths. However, when accounting for dispensing fees and prescriber time, longer prescriptions were found to be cost saving compared with shorter prescriptions. Prescriber time was the largest component of the calculated cost savings to the NHS. The decision modelling suggested that, in all three clinical scenarios, longer prescription lengths were associated with lower costs and higher quality-adjusted life-years. LIMITATIONS: The available evidence was found to be at a moderate to serious risk of bias. All of the studies were conducted in the USA, which was a cause for concern in terms of generalisability to the UK. No evidence of the direct impact of prescription length on health outcomes was found. The cost study could investigate prescriptions issued only; it could not assess patient adherence to those prescriptions. Additionally, the cost study was based on products issued only and did not account for underlying patient diagnoses. A lack of good-quality evidence affected our decision modelling strategy. CONCLUSIONS: Although the quality of the evidence was poor, this study found that longer prescriptions may be less costly overall, and may be associated with better adherence than 28-day prescriptions in patients with chronic conditions being treated in primary care. FUTURE WORK: There is a need to more reliably evaluate the impact of differing prescription lengths on adherence, on patient health outcomes and on total costs to the NHS. The priority should be to identify patients with particular conditions or characteristics who should receive shorter or longer prescriptions. To determine the need for any further research, an expected value of perfect information analysis should be performed. STUDY REGISTRATION: This study is registered as PROSPERO CRD42015027042. FUNDING: The National Institute for Health Research Health Technology Assessment programme

Effects of correctional boot camps on offending

Background: Correctional boot camps were first opened in United States adult correctional systems in 1983. Since that time they have rapidly grown, first within adult systems and later in juvenile corrections, primarily within the United States. In the typical boot camp, participants are required to follow a rigorous daily schedule of activities including drill and ceremony and physical training, similar to that of a military boot-camp. Punishment for misbehavior is immediate and swift and usually involves some type of physical activity like push-ups. Boot-camps differ substantially in the amount of focus given to the physical training and hard labor aspects of the program versus therapeutic programming such as academic education, drug treatment or cognitive skills. Objectives: To synthesize the extant empirical evidence on the effects of boot-camps and boot camp like programs on the criminal behavior (e.g., postrelease arrest, conviction, or reinstitutionalization) of convicted adult and juvenile offenders. Search Strategy: Numerous electronic databases were searched for both published an unpublished studies. The keywords used were: boot camp(s), intensive incarceration, and shock incarceration. We also contacted U.S and non-U.S. researchers working in this area requesting assistance in locating additional studies. The final search of these sources was completed in early December of 2003. Selection Criteria: The eligibility criteria were (a) that the study evaluated a correctional boot camp, shock incarceration, or intensive incarceration program; (b) that the study included a comparison group that received either probation or incarceration in an alternative facility; (c) that the study participants were exclusively under the supervision of the criminal or juvenile justice system; and (d) that the study reported a post-program measure of criminal behavior, such as arrest or conviction. Data Collection and Analysis: The coding protocol captured aspects of the research design, including methodological quality, the boot-camp program, the comparison group condition, the participant offenders, the outcome measures and the direction and magnitude of the observed effects. All studies were coded by two independent coders and all coding differences were resolved by Drs. MacKenzie or Wilson. Outcome effects were coded using the odds-ratio and meta-analysis was performed using the random effects model. Main Results: Thirty-two unique research studies met our inclusion criteria. These studies reported the results from 43 independent boot-camp/comparison samples. The random effects mean odds-ratio for any form of recidivism was 1.02, indicating that the likelihood that boot camp participants recidivating was roughly equal to the likelihood of comparison participants recidivating. This overall finding was robust to the selection of the outcome measure and length of follow-up. Methodological features were only weakly related to outcome among these studies and did not explain the null findings. The overall effect for juvenile boot camps was slightly lower than for adult boot camps. Moderator analysis showed that studies evaluating boot-camp programs with a strong treatment focus had a larger mean odds-ratio than studies evaluating boot camps with a weak treatment focus. Conclusions: Although the overall effect appears to be that of “no difference,” some studies found that boot camp participants did better than the comparison, while others found that comparison samples did better. However, all of these studies had the common element of a militaristic boot camp program for offenders. The current evidence suggests that this common and defining feature of a boot-camp is not effective in reducing post boot-camp offending

The effects of custodial vs. non-custodial sentences on re-offending: A systematic review of the state of knowledge

As part of a broad initiative of systematic reviews of experimental or quasiexperimental evaluations of interventions in the field of crime prevention and the treatment of offenders, our work consisted in searching through all available databases for evidence concerning the effects of custodial and non-custodial sanctions on reoffending. For this purpose, we examined more than 3,000 abstracts, and finally 23 studies that met the minimal conditions of the Campbell Review, with only 5 studies based on a controlled or a natural experimental design. These studies allowed, all in all, 27 comparisons. Relatively few studies compare recidivism rates for offenders sentenced to jail or prison with those of offenders given some alternative to incarceration (typically probation). According to the findings, the rate of re-offending after a non-custodial sanction is lower than after a custodial sanction in 11 out of 13 significant comparisons. However, in 14 out of 27 comparisons, no significant difference on re-offending between both sanctions is noted. Two out of 27 comparisons are in favour of custodial sanctions. Finally, experimental evaluations and natural experiments yield results that are less favourable to non-custodial sanctions, than are quasi-experimental studies using softer designs. This is confirmed by the meta-analysis including four controlled and one natural experiment. According to the results, non-custodial sanctions are not beneficial in terms of lower rates of re-offending beyond random effects. Contradictory results reported in the literature are likely due to insufficient control of pre-intervention differences between prisoners and those serving “alternative” sanctions

South Carolina business opportunities

This is a listing, published twice per week, of proposed procurements in construction, information technology, supplies & services as well as other information of interest to the business community