Risk, Regulation and the Reintegration of Sexual Offenders

Media reporting of and public concern about sexual offending, particularly relating to children, affects and reflects political, policy and organisational responses to those convicted of such crimes. The development of regulatory policies on sexual offending has taken place within a highly emotive and overtly politicized public and policy discourse. This chapter charts the various ways in which the risks imagined or posed by sexual offenders have been conceptualised within public discourses and regulated and managed under the legislative and organisational ‘risk paradigm.’ Ultimately, it argues that risk-based responses to sexual offending are at best uncertain in their effects and at worst counterproductive, in that they often reduce the potential for successful reintegration. In seeking to look ‘beyond risk’, the chapter also explores the usefulness of restorative and related practices in supporting sex offender reintegration aimed at the primary and secondary levels of harm prevention.

New genetic loci link adipose and insulin biology to body fat distribution

Body fat distribution is a heritable trait and a well-established predictor of adverse metabolic outcomes, independent of overall adiposity. To increase our understanding of the genetic basis of body fat distribution and its molecular links to cardiometabolic traits, here we conduct genome-wide association meta-analyses of traits related to waist and hip circumferences in up to 224,459 individuals. We identify 49 loci (33 new) associated with waist-to-hip ratio adjusted for body mass index (BMI), and an additional 19 loci newly associated with related waist and hip circumference measures (P < 5 × 10(-8)). In total, 20 of the 49 waist-to-hip ratio adjusted for BMI loci show significant sexual dimorphism, 19 of which display a stronger effect in women. The identified loci were enriched for genes expressed in adipose tissue and for putative regulatory elements in adipocytes. Pathway analyses implicated adipogenesis, angiogenesis, transcriptional regulation and insulin resistance as processes affecting fat distribution, providing insight into potential pathophysiological mechanisms.

Genetic studies of body mass index yield new insights for obesity biology

Obesity is heritable and predisposes to many diseases. To understand the genetic basis of obesity better, here we conduct a genome-wide association study and Metabochip meta-analysis of body mass index (BMI), a measure commonly used to define obesity and assess adiposity, in up to 339,224 individuals. This analysis identifies 97 BMI-associated loci (P < 5 × 10(-8)), 56 of which are novel. Five loci demonstrate clear evidence of several independent association signals, and many loci have significant effects on other metabolic phenotypes. The 97 loci account for ∼2.7% of BMI variation, and genome-wide estimates suggest that common variation accounts for >20% of BMI variation. Pathway analyses provide strong support for a role of the central nervous system in obesity susceptibility and implicate new genes and pathways, including those related to synaptic function, glutamate signalling, insulin secretion/action, energy metabolism, lipid biology and adipogenesis.

Meeting the Needs of Vulnerable Young Men: A Study of Service Provider Views

This article uses a qualitative approach to elicit the views of 31 professionals who provide services to vulnerable young men. The findings reveal six key themes following focus group interviews: (i) the importance of masculinity in explaining problematic behaviour; (ii) the misuse of alcohol and drugs; (iii) alienation and social isolation; (iv) concerns about suicide and self-harm; (v) the quality of existing services; and (vi) recommendations for changes to services. Service providers generally acknowledged the social context in explaining these behaviours and argued for enhanced services and a more developed skills base in working with vulnerable young men. 

Harmful transgressions qua moral transgressions: A deflationary view

One important issue in moral psychology concerns the proper characterization of the folk understanding of the relationship between harmful transgressions and moral transgressions. Psychologist Elliot Turiel and associates have claimed with a broad range of supporting evidence that harmful transgressions are understood as transgressions that are authority independent and general in scope, which, according to them, characterizes these transgressions as moral transgressions. Recently, many researchers questioned the position advocated by the Turiel tradition with some new evidence. We entered this debate proposing an original, deflationary view in which perceptions of basic-rights violation and injustice are fundamental for the folk understanding of harmful transgressions as moral transgressions in Turiel’s sense. In this article, we elaborate and refine our deflationary view, while reviewing the debate, addressing various criticisms raised against our perspective, showing how our perspective explains the existent evidence, and suggesting new lines of inquiry.

Beyond Attribution: Responsibility of Armed Non-State Actors for Reparations in Northern Ireland, Colombia and Uganda

This chapter explores the responsibility of armed non-state actors for reparations to victims. Traditionally international law has focused on the responsibility of the state, and more recently the responsibility of convicted individuals before the International Criminal Court, to provide reparations for international crimes. Yet despite the prevalence of internal armed conflict over the past few decades, there responsibility of armed groups for reparations has been neglected in international law. Although there is a tentative emerging basis for armed groups to provide reparations under international law, such developments have not yet crystallized into hard law. However, when considering the more substantive practice of states in Northern Ireland, Colombia and Uganda, a greater effort can be discerned in ensuring that such organizations are responsible for reparations. This paper finds that not only can armed non-state actors be held collectively responsible for reparations, but due to the growing number of internal armed conflict they can play an important role in ensuring the effectiveness of reparations in remedying victims’ harm. Yet, finding armed groups responsible for reparations is no panacea for accountability, due to the nature of armed conflicts, responsibility may not be distinct, but overlapping and joint, and such groups may face difficulties in meeting their obligations, thus requiring a holistic approach and subsidiary role for the state.

THE SAAF STUDY: evaluation of the Safeguarding Children Assessment and Analysis Framework (SAAF), compared with management as usual, for improving outcomes for children and young people who have experienced, or are at risk of, maltreatment: study protocol for a randomised controlled trial

Background: Serious case reviews and research studies have indicated weaknesses in risk assessments conducted by child protection social workers. Social workers are adept at gathering information but struggle with analysis and assessment of risk. The Department for Education wants to know if the use of a structured decision-making tool can improve child protection assessments of risk.

Methods/design: This multi-site, cluster-randomised trial will assess the effectiveness of the Safeguarding Children Assessment and Analysis Framework (SAAF). This structured decision-making tool aims to improve social workers' assessments of harm, of future risk and parents' capacity to change. The comparison is management as usual.

Inclusion criteria: Children's Services Departments (CSDs) in England willing to make relevant teams available to be randomised, and willing to meet the trial's training and data collection requirements.

Exclusion criteria: CSDs where there were concerns about performance; where a major organisational restructuring was planned or under way; or where other risk assessment tools were in use.

Six CSDs are participating in this study. Social workers in the experimental arm will receive 2 days training in SAAF together with a range of support materials, and access to limited telephone consultation post-training. The primary outcome is child maltreatment. This will be assessed using data collected nationally on two key performance indicators: the first is the number of children in a year who have been subject to a second Child Protection Plan (CPP); the second is the number of re-referrals of children because of related concerns about maltreatment. Secondary outcomes are: i) the quality of assessments judged against a schedule of quality criteria and ii) the relationship between the three assessments required by the structured decision-making tool (level of harm, risk of (re) abuse and prospects for successful intervention).

Discussion: This is the first study to examine the effectiveness of SAAF. It will contribute to a very limited literature on the contribution that structured decision-making tools can make to improving risk assessment and case planning in child protection and on what is involved in their effective implementation.

Low Fidelity Simulation as a Mechanism to Enhance Midwifery Students’ Confidence in Relation to Emergency Obstetric Training

Simulation offers a safe opportunity for students to practice clinical procedures without exposure and risk of harm to real patients (Partin et al, 2011). Simulation is recognised to increase students’ confidence in their ability to make critical decisions (McCaughey and Traynor, 2010). Within Queen’s University Belfast, simulation for obstetric emergency training based on the ethos of ‘Practical Obstetric Multi-Professional Training[PROMPT]’ (Draycott et al, 2008) has been developed for midwifery students and is now uniquely embedded within the pre-registration curriculum. An important aspect of the PROMPT training is the use of low fidelity simulation as opposed to high tech support (Crofts et al, 2008). Studies have reflected that low fidelity simulation can be an effective tool for promoting student confidence (Tosterud, 2013; Hughes et al, 2013). Students are given the opportunity to experience obstetric emergencies within a safe environment and evaluation has indicated that students feel safe and have an increase in confidence and self-efficacy. The immediacy of the feedback offered by simulated situations encourages an exploration of beliefs and attitudes, particularly with peers, promoting a deeper sense of learning (Stoneham and Feltham, 2009).This paper will discuss why low fidelity simulation can effectively enhance the student experience and promote self-efficacy.

Predictors of adherence to treatment in bronchiestasis

Objectives

We aimed to determine if beliefs about treatment, clinical factors and quality of life predicted adherence to treatment in patients with bronchiectasis.

Methods

We recruited participants with confirmed bronchiectasis to a one-year study. We calculated adherence to treatment using medication possession ratios and self-report. Baseline Beliefs about Medicines, clinical, demographic and Quality of Life Questionnaire-Bronchiectasis data were collected. We used logistic regression to determine predictors of adherence to treatment during the subsequent year.

Results

Seventy-five participants were recruited. Beliefs about harm, age and total number of prescribed medications were predictors of adherence to inhaled antibiotics. Concerns about medication, age and Quality of Life Questionnaire-Bronchiectasis Treatment Burden were predictors of adherence to other respiratory medicines. Beliefs about necessity of airway clearance and age were predictors of adherence to airway clearance.

Conclusion

Beliefs about treatment, age, number of prescribed medications and perceived treatment burden predicted subsequent adherence in bronchiectasis, thereby, providing potential targets for future interventions in this population. Clinicians can use these data to identify patients with bronchiectasis who might be at risk of non-adherence i.e. those who are younger, have concerns about medications, who do not think airway clearance is necessary or who are prescribed numerous medications.

Bringing sounds into use: Thinking of sounds as materials and a sketch of auditory affordances

We live in a richly structured auditory environment. From the sounds of cars charging towards us on the street to the sounds of music filling a dancehall, sounds like these are generally seen as being instances of things we hear but can also be understood as opportunities for action. In some circumstances, the sound of a car approaching towards us can provide critical information for the avoidance of harm. In the context of a concert venue, sociocultural practices like music can equally afford coordinated activities of movement, such as dancing or music making. Despite how evident the behavioral effects of sound are in our everyday experience, they have been sparsely accounted for within the field of psychology. Instead, most theories of auditory perception have been more concerned with understanding how sounds are passively processed and represented or how they convey information of world, neglecting how this information can be used for anything. Here, we argue against these previous rationalizations, suggesting instead that information is instantiated through use and, therefore, is an emergent effect of a perceiver’s interaction with their environment. Drawing on theory from psychology, philosophy and anthropology, we contend that by thinking of sounds as materials, theorists and researchers alike can get to grips with the vast array of auditory affordances that we purposefully bring into use when interacting with the environment.

Nuclear disasters and health: lessons learned, challenges, and proposals

Past nuclear disasters, such as the atomic bombings in 1945 and major accidents at nuclear power plants, have highlighted similarities in potential public health effects of radiation in both circumstances, including health issues unrelated to radiation exposure. Although the rarity of nuclear disasters limits opportunities to undertake rigorous research of evidence-based interventions and strategies, identification of lessons learned and development of an effective plan to protect the public, minimise negative effects, and protect emergency workers from exposure to high-dose radiation is important. Additionally, research is needed to help decision makers to avoid premature deaths among patients already in hospitals and other vulnerable groups during evacuation. Since nuclear disasters can affect hundreds of thousands of people, a substantial number of people are at risk of physical and mental harm in each disaster. During the recovery period after a nuclear disaster, physicians might need to screen for psychological burdens and provide general physical and mental health care for many affected residents who might experience long-term displacement. Reliable communication of personalised risks has emerged as a challenge for health-care professionals beyond the need to explain radiation protection. To overcome difficulties of risk communication and provide decision aids to protect workers, vulnerable people, and residents after a nuclear disaster, physicians should receive training in nuclear disaster response. This training should include evidence-based interventions, support decisions to balance potential harms and benefits, and take account of scientific uncertainty in provision of community health care. An open and joint learning process is essential to prepare for, and minimise the effects of, future nuclear disasters.

Doing Gendered Time: The Harms of Women's Imprisonment

This chapter focuses on women’s imprisonment in the context of gendered punishment inflicted by the State. It considers the gender-specific consequences of incarceration for women prisoners and the potential of gender-responsive alternatives to custodial sentences. Following a brief historical overview, it traces the rise and consolidation of women’s incarceration in UK jurisdictions, noting the significance of devolution on the prison systems of Scotland and Northern Ireland. In examining the impact of neo-liberal policies and globalisation on women’s imprisonment, it draws comparisons with other advanced democratic states. Analysing the rationale underpinning the disproportionate rise in women’s incarceration, particularly in the UK and the USA the chapter identifies the persistent tensions between retributivism/ incapacitation and reformism/rehabilitation. Drawing on international research demonstrating the complex needs and vulnerabilities of women and girl prisoners, the chapter reveals the gendered harm experienced within penal regimes and the recent development - and limitations - of official gender-specific policies and practices. The emergence of distinct but related political discourses on ‘risk’ and ‘responsibilisation’ as applied to women in conflict with the law, and their consequent criminalisation, is critiqued in the contexts of structural disadvantage, gender discrimination and institutionalised racism. Within these oppressive dynamics often severe deprivations are inflicted on women’s acts of resistance both inside prison and in their communities post-release, further confining the potential of individual and collective agency. Finally, the chapter proposes fundamental change through establishing women-centred alternatives to prison, alongside policies committed to decarceration, while working towards securing the abolition of women’s imprisonment.