Screening, isolation, and decolonisation strategies in the control of meticillin resistant Staphylococcus aureus in intensive care units : cost effectiveness evaluation

Objective: To assess the cost-effectiveness of screening, isolation and decolonisation strategies in the control of methicillin-resistant Staphylococcus aureus (MRSA) in intensive care units (ICUs). Design: Economic evaluation. Setting: England and Wales. Population: ICU patients. Main outcome measures: Infections, deaths, costs, quality adjusted life years (QALYs), incremental cost-effectiveness ratios for alternative strategies, net monetary benefits (NMBs). Results: All strategies using isolation but not decolonisation improved health outcomes but increased costs. When MRSA prevalence on admission to the ICU was 5% and the willingness to pay per QALY gained was between £20,000 and £30,000, the best such strategy was to isolate only those patients at high risk of carrying MRSA (either pre-emptively or following identification by admission and weekly MRSA screening using chromogenic agar). Universal admission and weekly screening using polymerase chain reaction (PCR)-based MRSA detection coupled with isolation was unlikely to be cost-effective unless prevalence was high (10% colonised with MRSA on admission to the ICU). All decolonisation strategies improved health outcomes and reduced costs. While universal decolonisation (regardless of MRSA status) was the most cost-effective in the short-term, strategies using screening to target MRSA carriers may be preferred due to reduced risk of selecting for resistance. Amongst such targeted strategies, universal admission and weekly PCR screening coupled with decolonisation with nasal mupirocin was the most cost-effective. This finding was robust to ICU size, MRSA admission prevalence, the proportion of patients classified as high-risk, and the precise value of willingness to pay for health benefits. Conclusions: MRSA control strategies that use decolonisation are likely to be cost-saving in an ICU setting provided resistance is lacking, and combining universal PCR-based screening with decolonisation is likely to represent good value for money if untargeted decolonisation is considered unacceptable. In ICUs where decolonisation is not implemented there is insufficient evidence to support universal MRSA screening outside high prevalence settings.

Funding grant proposals for scientific research : retrospective analysis of scores by members of grant review panel

Objectives: To quantify randomness and cost when choosing health and medical research projects for funding. Design: Analysis of retrospective data from grant review panels. Setting: The National Health & Medical Research Council of Australia. Participants/Data: All panel members’ scores for grant proposals submitted in 2009. Main outcome measure: The proportion of grant proposals that were always, sometimes and never funded after accounting for random variability arising from variation in panel members’ scores; the cost-effectiveness of different size assessment panels. Results: 59% of 620 funded grants were sometimes not funded when random variability was accounted for. Only 9% of grant proposals were always funded, 61% were never funded and 29% were sometimes funded. The extra cost per grant effectively funded from the most effective system was $18,541. Conclusions: Allocating funding for scientific research in health and medicine is costly and somewhat random. There are many useful research questions to be addressed that could improve current processes.

Comparing the cost-effectiveness of MRSA control strategies between ICU and non-ICU settings

Introduction / objectives Many strategies are used to control MRSA in hospitals. Only a few have been assessed in clinical trials and it is not obvious how findings should be generalised between settings. Uncertainty remains about which strategies represent the most appropriate use of scarce resources. We assess the cost-effectiveness of alternative MRSA screening and infection control strategies in England and Wales and discuss international relevance. Methods Models of MRSA transmission in ICUs and general medical (GM) wards were developed and used to evaluate different screening methods combined with decolonisation or isolation. Strategies were compared in terms of costs and health benefits (quality adjusted life years, QALYs). Different prevalences, proportions of high risk patients and ward sizes were investigated, and probabilistic sensitivity analyses (PSA) conducted. Results Decolonisation strategies were cost-saving in ICUs at a 5% admission prevalence, with admission and weekly PCR screening the most cost-effective (£3,929/QALY). In ICUs, screening and isolation reduced infection rates by ~10%. With admission prevalence ≤5%, targeting screening and isolation to high risk patients was optimal. In GM wards decolonisation and isolation strategies, though able to reduce MRSA infection rates up to ~50%, were not cost-effective. Conclusion The largest reductions in MRSA infection were achieved by screening and decolonisation strategies, and were cost-effective in ICU settings. In comparison, there is limited potential for screening and control strategies to be cost-effective in GM wards due to lower infection and mortality rates.

Laying the Groundwork for the Successful Deployment of Communication Interception Technology (CIT) in Modern Policing

With the growth and development of communication technology there is an increasing need for the use of interception technologies in modern policing. Law enforcement agencies are faced with increasingly sophisticated and complex criminal networks that utilise modern communication technology as a basis for their criminal success. In particular, transnational organised crime (TOC) is a diverse and complicated arena, costing global society in excess of $3 trillion annually, a figure that continues to grow (Borger, 2007) as crime groups take advantage of disappearing borders and greater profit markets. However, whilst communication can be a critical success factor for criminal enterprise it is also a key vulnerability. It is this vulnerability that the use of CIT, such as phone taps or email interception, can exploit. As such, law enforcement agencies now need a method and framework that allows them to utilise CIT to combat these crimes efficiently and successfully. This paper provides a review of current literature with the specific purpose of considering the effectiveness of CIT in the fight against TOC and the groundwork that must be laid in order for it to be fully exploited. In doing so, it fills an important gap in current research, focusing on the practical implementation of CIT as opposed to the traditional area of privacy concerns that arise with intrusive methods of investigation. The findings support the notion that CIT is an essential intelligence gathering tool that has a strong place within the modern policing arena. It identifies that the most effective use of CIT is grounded within a proactive, intelligence‐led framework and concludes that in order for this to happen Australian authorities and law enforcement agencies must re‐evaluate and address the current legislative and operational constraints placed on the use of CIT and the culture that surrounds intelligence in policing.

Raising awareness of traffic pollution: the potential benefits and problems of using a warning smell

Exposure to traffic pollution is increasing worldwide as people move to cities, and as more vehicles join the roads, creating longer journeys and more traffic jams. Most traffic pollutants are odourless and invisible, which hides exposure from the public. If traffic pollution had a distinctive smell it would enable people to avoid exposure, and increase the political will for difficult policy changes. A smell may also instigate longer-term changes, such as switching to active transport for school pick-ups. A smell could be added using a fuel additive or a temporary device attached to vehicle exhausts.

Sex, crime and morality

Over the last few decades, there has been a marked increase in media and debate surrounding a specific group of offences in modern Democratic nations which bear the brunt of the label ‘crimes against morality’. Included within this group are offences related to prostitution and pornography, homosexuality and incest and child sexual abuse. This book examines the nexus between sex, crime and morality from a theoretical perspective. This is the first academic text to offer an examination and analysis of the philosophical underpinnings of sex-related crimes and social attitudes towards them and the historical, anthropological and moral reasons for differentiating these crimes in contemporary western culture. The book is divided into three sections corresponding to three theoretical frameworks: - Part 1 examines the moral temporality of sex and taboo as a foundation for legislation governing sex crimes - Part 2 focuses on the geography of sex and deviance, specifically notions of public morality and the public private divide - Part 3 examines the moral economy of sex and harm, including the social construction of harm. Sex, Crime and Morality will be key reading for students of criminology, criminal justice, gender studies and ethics, and will also be of interest to justice professionals.

Points of convergence and divergence : normative, institutional and operational relationships between R2P and POC

As an international norm, the Responsibility to Protect (R2P) has gained substantial influence and institutional presence—and created no small controversy—in the ten years since its first conceptualisation. Conversely, the Protection of Civilians in Armed Conflict (PoC) has a longer pedigree and enjoys a less contested reputation. Yet UN Security Council action in Libya in 2011 has thrown into sharp relief the relationship between the two. UN Security Council Resolutions 1970 and 1973 follow exactly the process envisaged by R2P in response to imminent atrocity crimes, yet the operative paragraphs of the resolutions themselves invoke only PoC. This article argues that, while the agendas of PoC and R2P converge with respect to Security Council action in cases like Libya, outside this narrow context it is important to keep the two norms distinct. Peacekeepers, humanitarian actors, international lawyers, individual states and regional organisations are required to act differently with respect to the separate agendas and contexts covered by R2P and PoC. While overlap between the two does occur in highly visible cases like Libya, neither R2P nor PoC collapses normatively, institutionally or operationally into the other.

Serious firearm offending in New Zealand : issues for gun controls and public safety

Reducing or preventing the misuse of firearms (whether criminal, suicidal or accidental) is central to gun controls policy. In June 1997 the New Zealand Government received the recommendations of the Review of Firearms Control, an independent inquiry commissioned by the Minister of Police and chaired by Sir Thomas Thorp.The Review comprehensively examined several firearm-related issues, including the nature and extent of serious firearm offending in New Zealand. The research presented in this article was commissioned by the Review. Based on a population of 709 offences for the 12 months ending 30 June 1996, this study provides an analysis of serious firearm offending in New Zealand and discusses the implications of these findings for gun controls policy.

Criminology and genetically modified food

Genetically modified or engineered foods are produced from rapidly expanding technologies that have sparked international debates and concerns about health and safety. These concerns focus on the potential dangers to human health, the risks of genetic pollution, and the demise of alternative farming techniques as well as biopiracy and economic exploitation by large private corporations. This article discusses the findings of the world's first Royal Commission on Genetic Modification conducted in New Zealand and reveals that there are potential social, ecological and economic risks created by genetically modified foods that require closer criminological scrutiny. As contemporary criminological discourses continue to push new boundaries in areas of crimes of the economy, environmental pollution, risk management, governance and globalization, the potential concerns posed by genetically modified foods creates fertile ground for criminological scholarship and activism.

Evaluating the economics of the Australian National Hand Hygiene Initiative

The National Hand Hygiene Initiative, implemented in Australia in 2009, is currently being evaluated for effectiveness and cost-effectiveness by a multidisciplinary team of researchers. Data from a wide range of sources are being harvested to address the research questions. The data are observational and appropriate statistical and economic modelling methods are being used. Decision makers will be provided with new knowledge about how hand hygiene interventions should be organised and what investment decisions are justified. This is novel research and the authors are unaware of any other evaluation of hand hygiene improvement initiatives. This paper describes the evaluation currently underway.

Occupational therapy students’ contribution to occasions of service during practice placements in health settings

Currently in the Australian higher education sector, the productivity benefits of occupational therapy clinical education placements are a contested issue. This article will report results of a study that developed a methodology for documenting time use during placements and investigated the productivity changes associated with occupational therapy clinical education placements in Queensland, Australia. Supervisors’ and students’ time use during placements and how this changed for supervisors compared to pre- and post-placement is also presented. Methods: Using a cohort survey design, participants were students from two Queensland universities, and their supervisors employed by Queensland Health. Time use was recorded in 30 minute blocks according to particular categories. Results: There was a significant increase in supervisors’ time spent in patient care activities (F = 94.0112,12.37 df, P < 0.001) between pre- and during placement (P < 0.001) and decrease between during and post-placement (P < 0.001). Supervisors’ time spent in all non-patient care activities was also significant (F = 4.5802,16 df, P = 0.027) increasing between pre- and during placement (P = 0.028). There was a significant decrease in supervisors’ time spent in placement activities (F = 5.1332,19.18 df, P = 0.016) from during to post-placement. Students spent more time than supervisors in patient care activities while on placement. Discussion: A novel method for reporting productivity and time-use changes during clinical education programs for occupational therapy has been applied. Supervisors spent considerable time in assessing and managing students and their clinical education role should be seen as core business in standard occupational therapy practice. This paper will contribute to future assessments of the economic.

Dangerous Exits: The Abuse of Women in Rural America

Decade after decade, violence against women has gained more attention from scholars, policy makers, and the general public. Social scientists in particular have contributed significant empirical and theoretical understandings to this issue. Strikingly, scant attention has focused on the victimization of women who want to leave their hostile partners. This groundbreaking work challenges the perception that rural communities are safe havens from the brutality of urban living. Identifying hidden crimes of economic blackmail and psychological mistreatment, and the complex relationship between patriarchy and abuse, Walter S. DeKeseredy and Martin D. Schwartz propose concrete and effective solutions, giving voice to women who have often suffered in silence.

Crime in Rural Australia

Contemporary rural crime is more varied and sophisticated than it once was. The new forms range from agricultural crimes, such as the theft of water designated for agricultural production, to environmental crimes such as the illegal dumping of waste. They take place side by side with “traditional” rural crimes such as cattle duffing while “urban” crimes such as drug and alcohol abuse and violent assaults are also prevalent, and on the rise. Crime in Rural Australia covers them all. It brings together leading academics who examine the major dimensions of crime and justice in rural and regional Australia including: •the extent of rural crime •farm crime •violence •juvenile crime •policing •Indigenous crime and justice •crime prevention •drugs •fear of crime, and •sentencing and punishment. It includes vignettes on rural policing and the stock squad from the perspectives of the NSW police. An ideal text for rural crime and criminology courses, Crime in Rural Australia will also be of interest to criminal justice practitioners, policy-makers, and criminology scholars. Three of the editors, Dr Elaine Barclay, Dr John Scott and Associate Professor Russell Hogg, are associated with the Centre for Rural Crime at the University of New England. Professor Joseph F. Donnermeyer is the International Research Co-ordinator for the Rural Crime Centre and is a leading US scholar on rural crime at Ohio State University.

The Moral Economy of Everyday Crime: Markets, Consumers and Citizens

Between the crimes in the suites and the crimes in the streets lies the mostly unexplored terrain within which we find crimes of ‘everyday life’. Not all of these are formally illegal, but all are generally seen as morally dubious. Most of the crimes of everyday life are committed in the contemporary marketplace, and by those who think of themselves (and are mostly considered by others) as respectable citizens. We contextualize normative orientations that are conducive to such types of behaviour using a framework that links E. P. Thompson’s (1963) concept of the ‘moral economy’ with Institutional Anomie Theory (Messner and Rosenfeld 1994, 2007). Findings from a comparative survey study in three economic change regions (England and Wales, Western and Eastern Germany) show that a syndrome of market anomie comprising distrust, fear and cynical attitudes toward law increases the willingness of respectable citizens to engage in illegal and unfair practices in the marketplace.

The SAGE Handbook of Criminological Research Methods

Conducting research into crime and criminal justice carries unique challenges. This Handbook focuses on the application of 'methods' to address the core substantive questions that currently motivate contemporary criminological research. It maps a canon of methods that are more elaborated than in most other fields of social science, and the intellectual terrain of research problems with which criminologists are routinely confronted. Drawing on exemplary studies, chapters in each section illustrate the techniques (qualitative and quantitative) that are commonly applied in empirical studies, as well as the logic of criminological enquiry. Organized into five sections, each prefaced by an editorial introduction, the Handbook covers: • Crime and Criminals • Contextualizing Crimes in Space and Time: Networks, Communities and Culture • Perceptual Dimensions of Crime • Criminal Justice Systems: Organizations and Institutions • Preventing Crime and Improving Justice Edited by leaders in the field of criminological research, and with contributions from internationally renowned experts, The SAGE Handbook of Criminological Research Methods is set to become the definitive resource for postgraduates, researchers and academics in criminology, criminal justice, policing, law, and sociology.