Ethical issues in forensic and correctional research

It is surprising that while the literature on ethical issues associated with social science research is burgeoning and becoming increasingly sophisticated very few papers have been written on the ethics of forensic or correctional research. The literature that exists is disappointingly narrow and superficial, and relies on professional ethical codes to a considerable degree. In this paper we present an ethical framework developed by Ward and Syversen to help with ethical decision making in research contexts. We then discuss some of the specific ethical challenges for researchers working in forensic and correctional domains, and consider how best to deal with ethical problems drawing from this framework. Our aim will be to provide researchers with some general ideas of how to proceed in certain situations rather than come up with a final set of answers to every conceivable problem.

Patterns of alcohol use and associated physical and lifestyle characteristics according to new Australian guidelines

Objective: To describe the pattern of alcohol consumption and associated physical and lifestyle characteristics in a population-based sample of Australian men.
Method: A community-based age-stratifi ed random sample of 1420 men (median age 56 years, range 20 – 93) participating in the Geelong Osteoporosis Study, an epidemiological study set in south-eastern Australia. Daily alcohol intake was ascertained from a detailed food frequency questionnaire and categorized according to the Australian National Health and Medical Research Council 2009 guidelines (non-drinkers, greater than zero but ≤ 2 drinks per day, > 2 drinks per day), with a standard drink equivalent to 10 g of ethanol. Anthropometry was measured and lifestyle factors self-reported. Body composition was determined using dual energy absorptiometry. Socio-economic status was categorized according to the Australian Bureau of Statistics data. Results were age standardized to the Australian male population figures.
Results: The median daily ethanol consumption was 12 g (IQR 2 – 29) per day with a range of 0 – 117 g/day. The age-standardized proportion of non-drinkers was 8.7%, 51.5% consumed up to two drinks per day ( ≤ 20 g ethanol/day), and 39.9% exceeded 2 standard drinks per day ( > 20 g ethanol/day). Alcohol consumption was positively associated with cigarette smoking, weight, higher SES and inversely with age and physical activity.
Conclusions: Approximately, 40% of Australian men consume alcohol at levels in excess of current recommendations, which in combination with other risk factors may adversely impact upon health.

I don't know anyone that has two drinks a day : young people, alcohol and the government of pleasure

Problematic alcohol consumption is a major public health, health education and health promotion issue in Australia and internationally. In an effort to better understand young people's drinking patterns and motivations we investigated the cultural drivers of drinking in 14–24 year-old Australians. We interviewed 60 young people in the state of Victoria aged 20–24 about their drinking biographies. At the time of interviewing, the draft guidelines on low-risk drinking were released by the National Health and Medical Research Council, Australia, and we asked our participants what they knew about them and if they thought they would affect their drinking patterns. Their responses indicate that pleasure and sociability are central to young people's drinking cultures which is supported by a range of research. However, O’Malley and Valverde claim that pleasure is silenced and/or deployed strategically in neo-liberal governance discourses about drugs and alcohol such as these guidelines which raises questions about the limits of such discourses to affect changes in drinking patterns.

Health system reform and social capital

The pressures for health system reform have reached a critical stage over the past ten years as our understanding of the determinants of health has increased and deepened. Far from being conjecture and theory, the evidence for a broad range of determinants of health, from the biological and medical through to a broad range of economic and social determinants, has mounted.

Self-reported medication side effects in an older cohort living independently in the community - the Melbourne Longitudinal Study on Health Ageing (MELSHA) : cross-sectional analysis of prevalence and risk factors

Background Medication side effects are an important cause of morbidity, mortality and costs in older people. The aim of our study was to examine prevalence and risk factors for self-reported medication side effects in an older cohort living independently in the community.

Methods The Melbourne Longitudinal Study on Healthy Ageing (MELSHA), collected information on those aged 65 years or older living independently in the community and commenced in 1994. Data on medication side effects was collected from the baseline cohort (n = 1000) in face-to-face baseline interviews in 1994 and analysed as cross-sectional data. Risk factors examined were: socio-demographics, health status and medical conditions; medication use and health service factors. Analysis included univariate logistic regression to estimate unadjusted risk and multivariate logistic regression analysis to assess confounding and estimate adjusted risk.

Results Self-reported medication side effects were reported by approximately 6.7% (67/1000) of the entire baseline MELSHA cohort, and by 8.5% (65/761) of those on medication. Identified risk factors were increased education level, co-morbidities and health service factors including recency of visiting the pharmacist, attending younger doctors, and their doctor's awareness of their medications. The greatest increase in risk for medication side effects was associated with liver problems and their doctor's awareness of their medications. Aging and gender were not risk factors.

Conclusion Prevalence of self-reported medication side effects was comparable with that reported in adults attending General Practices in a primary care setting in Australia. The prevalence and identified risk factors provide further insight and opportunity to develop strategies to address the problem of medication side effects in older people living independently in the community setting.

Risk of falls and motor vehicle collisions in glaucoma

PURPOSE. To investigate the risk of falls and motor vehicle collisions (MVCs) in patients with glaucoma.

METHODS. The sample comprised 48 patients with glaucoma (mean visual field mean deviation [MD] in the better eye = −3.9 dB; 5.1 dB SD) and 47 age-matched normal control subjects, who were recruited from a university-based hospital eye care clinic and are enrolled in an ongoing prospective study of risk factors for falls, risk factors for MVCs, and on-road driving performance in glaucoma. Main outcome measures at baseline were previous self-reported falls and MVCs, and police-reported MVCs. Demographic and medical data were obtained. In addition, functional independence in daily living, physical activity level and balance were assessed. Clinical vision measures included visual acuity, contrast sensitivity, standard automated perimetry, useful field of view (UFOV), and stereopsis. Analyses of falls and MVCs were adjusted to account for the possible confounding effects of demographic characteristics, medications, and visual field impairment. MVC analyses were also adjusted for kilometers driven per week.

RESULTS. There were no significant differences between patients with glaucoma and control subjects with respect to number of systemic medical conditions, body mass index, functional independence, and physical activity level (P > 0.10). At baseline, 40 (83%) patients with glaucoma and 44 (94%) control subjects were driving. Compared with control subjects, patients with glaucoma were over three times more likely to have fallen in the previous year (odds ratio [OR]adjusted = 3.71; 95% CI, 1.14–12.05), over six times more likely to have been involved in one or more MVCs in the previous 5 years (ORadjusted = 6.62; 95% CI, 1.40–31.23), and more likely to have been at fault (ORadjusted = 12.44; 95% CI, 1.08–143.99). The strongest risk factor for MVCs in patients with glaucoma was impaired UFOV selective attention (ORadjusted = 10.29; 95% CI, 1.10–96.62; for selective attention >350 ms compared with ≤350 ms).

CONCLUSIONS. There is an increased risk of falls and MVCs in patients with glaucoma.

Patient and business rules extraction and formalisation using SVN and SBVR for automated healthcare

This paper describes advances in automated health service selection and composition in the Ambient Assisted Living (AAL) domain. We apply a Service Value Network (SVN) approach to automatically match medical practice recommendations to health services based on sensor readings in a home care context. Medical practice recommendations are extracted from National Health and Medical Research Council (NHMRC) guidelines. Service networks are derived from Medicare Benefits Schedule (MBS) listings. Service provider rules are further formalised using Semantics of Business Vocabulary and Business Rules (SBVR), which allows business participants to identify and define machine-readable rules. We demonstrate our work by applying an SVN composition process to patient profiles in the context of Type 2 Diabetes Management.

Accountability and the affective labour of teachers: a Marxist-Vygotskian perspective

This article addresses the issue of affective labour in education in the context of standards-based reforms and accountability. In particular, it focuses on neoliberal strategies of rationalization and control that produce a number of social pathologies, such as alienated teaching and learning and reified social relations between teachers and students. The article turns to affective labour as something that enables teachers to counteract these effects. This argument arises from the analysis of interviews with teachers who continue to generate and sustain the sociality of teaching and learning. Affect directs teachers’ commitment to practice that is governed by feeling, passion and the ethics of care. What gives affective labour such an important position is that it is both outside and beyond accountability and performativity measures. It is identified with the general pedagogical activity that cannot be structured by measuring devices such as students’ test scores or standards. The article concludes with the application of Vygotsky’s ideas about the role of affect in education and argues that affective labour has an expansive power of ontological freedom that cannot be controlled. of ontological freedom that cannot be controlled.

Reduced emergency calls and improved weekend discharge after introduction of a new electronic handover system

Objectives: To measure the frequency and content of electronic handover before and after implementation of the Blue BARRWUE handover system, and to measure its effect on patient safety and hospital efficiency over weekends.

Design, setting and participants: Point-prevalence study comparing outcomes for general medical inpatients present over weekends before implementation (1 May 2008 to 30 April 2009) and after implementation (1 May 2009 to 30 April 2010) of the Blue BARRWUE handover system at Geelong Hospital.

Intervention: Implementation of the Blue BARRWUE handover system and its components (updated working diagnosis, background, alerts, resuscitation status, requests, who to do what and when, updates and executable discharge plan).
Main outcome measures: Presence of any written handover notes or updated working diagnoses in the BOSSnet clinical information system, content of handover notes, frequency of weekend discharges and medical emergency team (MET) calls before and after implementation.

Results: In the 12 months before implementation of the Blue BARRWUE handover system, 976 patients (47.98%) had a handover note in BOSSnet, versus 1646 patients (95.09%) in the 12 months after implementation (P< 0.001; rate ratio [RR], 20.75; 95% CI, 16.33–26.44). Before implementation, 289 patients (14.21%) were discharged over weekends, versus 353 patients (20.39%) after implementation, (P < 0.001; RR, 1.44; 95% CI, 1.25–1.65). MET calls were made for 152 general medical patients before implementation (7.47%), versus 95 general medical patients (5.49%) after implementation (P= 0.01; RR, 0.73; 95% CI, 0.57–0.94).

Conclusions: The Blue BARRWUE system has sustainably improved written handover in our organisation and was associated with improvement in both patient safety and hospital efficiency.

Anxiety disorders : assessment and management in general practice

Background: Anxiety is a normal physiological response to a threat. Anxiety disorders occur when this normal physiological response is associated with high levels of autonomic arousal, erroneous cognitions and dysfunctional coping strategies. Anxiety disorders are highly prevalent and present commonly to general practice. Anxiety disorders are often comorbid with other psychiatric and medical disorders and may be associated with significant morbidity.

Objective: This article describes the diagnosis, assessment and management of anxiety disorders in the general practice setting.

Discussion: Assessment in patients presenting with anxiety symptoms involves excluding a medical cause, identifying features of specific anxiety disorders as well as other coexisting psychiatric disorders, and assessing the degree of distress. Management options include psychoeducation, psychological treatments (particularly cognitive behaviour therapy) and pharmacological treatments. Patients with a diagnosis of an anxiety disorder can access Medicare funded psychological care under a number of Australian government initiatives. Selective serotonin reuptake inhibitors and serotonin norepinephrine reuptake inhibitors are the first line pharmacological agents used to treat anxiety disorders. Regular review is vital to monitor for clinical improvement and more complex presentations may require specialist psychological or psychiatric referral.

Design and analysis of an antenna for wireless energy harvesting in head-mountable DBS device

This paper presents design and simulation of a circular meander dipole antenna at the industrial, scientific, and medical band of 915 MHz for energy scavenging in a passive head-mountable deep brain stimulation device. The interaction of the proposed antenna with a rat body is modeled and discussed. In the antenna, the radiating layer is meandered, and a FR-4 substrate is used to limit the radius and height of the antenna to 14 mm and 1.60 mm, respectively. The resonance frequency of the designed antenna is 915 MHz and the bandwidth of 15 MHz at a return loss of -10 dB in free space. To model the interaction of the antenna with a rat body, two aspects including functional and biological are considered. The functional aspect includes input impedance, resonance frequency, gain pattern, radiation efficiency of the antenna, and the biological aspect involves electric field distribution, and SAR value. A complete rat model is used in the finite difference time domain based EM simulation software XFdtd. The simulated results demonstrate that the specific absorption rate distributions occur within the skull in the rat model, and their values are higher than the standard regulated values for the antenna receiving power of 1W.

Design and analysis of efficient rectifiers for wireless power harvesting in DBS devices

This paper presents an analysis of optimum rectifier circuits for wireless energy harvesting in deep brain stimulation (DBS) devices. Since DBS demands compact and low power consumption devices, small, high conversion efficient, and high output voltage rectifiers need to be developed. The investigation that is presented in this paper is analytical and simulated based. Analysis on a variety of circuit configurations brings more evidence to improve the performance of rectifiers. Analytical parameters influencing the output DC voltage and the efficiency of the rectifiers are described. The operating frequency of the 915 MHz industrial, scientific and medical (ISM) radio band is used in this study. The maximum conversion efficiency of the LC matched half wave rectifier, the Greinacher voltage doubler, the Delon doubler, and the 2-stage voltage multiplier is obtained as 56.34%, 74.45%, 71.48%, and 31.44%, respectively, at the 30 dBm input power level. The corresponding maximum output DC voltages are 6.27 V, 16.83 V, 13.36 V, and 9.20 V. Thus the Greinacher voltage doubler is deemed as the best configuration according to the conversion efficiency and the output voltage measurements.

A parallel-group, randomised controlled trial of a multimedia, self-directed, coping skills training intervention for patients with cancer and their partners: design and rationale

Introduction:

Diabetes and risk of physical disability in adults: a systematic review and meta-analysis

Background
According to previous reports, the risk of disability as a result of diabetes varies from none to double. Disability is an important measure of health and an estimate of the risk of disability as a result of diabetes is crucial in view of the global diabetes epidemic. We did a systematic review and meta-analysis to estimate this risk.

Methods
We searched Ovid, Medline, Embase, Cochrane Library, and Cumulative Index to Nursing and Allied Health Literature up to Aug 8, 2012. We included studies of adults that compared the risk of disability—as measured by activities of daily living (ADL), instrumental activities of daily living (IADL), or mobility—in people with and without any type of diabetes. We excluded studies of subpopulations with specific illnesses or of people in nursing homes. From the studies, we recorded population characteristics, how diabetes was diagnosed (by doctor or self-reported), domain and definition of disability, and risk estimates for disability. We calculated pooled estimates by disability type and type of risk estimate (odds ratio [OR] or risk ratio [RR]).

Results
Our systematic review returned 3224 results, from which 26 studies were included in our meta-analyses. Diabetes increased the risk of mobility disability (15 studies; OR 1·71, 95% CI 1·53—1·91; RR 1·51, 95% CI 1·38—1·64), of IADL disability (ten studies; OR 1·65, 95% CI 1·55—1·74), and of ADL disability (16 studies; OR 1·82, 95% CI 1·63—2·04; RR 1·82, 95% CI 1·40—2·36).

Interpretation
Diabetes is associated with a strong increase in the risk of physical disability. Efforts to promote healthy ageing should account for this risk through prevention and management of diabetes.

Funding
Monash University, Baker IDI Bright Sparks Foundation, Australian Postgraduate Award, VicHealth, National Health and Medical Research Council, Australian Research Council, Victorian Government.