The impact of organisational change on health care delivery to the adult mentally ill

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Triangulation mobility of auto-theft offenders

This research paper presents an examination of the journey to and from crime for autotheft offenders in the UK. For 852 offences, ‘wheel’ distances are calculated for triangles formed by offenders’ home location, theft location, and vehicle disposal location. The study demonstrates typical isosceles mobility triangles; distances travelled to and from home locations are roughly equal, whereas distances between theft and disposal points were shorter. Distances travelled by offenders under 17 years old and offences involving drug and drink were shown to be shorter than comparison groups. Prolifi c offenders tend to travel further, although there is signifi cant variation in this subgroup. Explanations and implications are discussed.

Controlled study into the effectiveness of individual client-centred counselling for young offenders in residential care

This study is toe first documented account in the British Isles of an evaluation of the effectiveness of client-centred counselling with young offenders in secure residential care. It is a test of Rogers' (1957) position on the 'necessary and sufficient' conditions of therapeutic personality change within a counselling relationship. Forty teenage male offenders, the subjects of Training School Orders, were randomly allocated in equal numbers to either an experimental or control group. Boys in the experimental group received weekly individual sessions of client-centred counselling over a seven month period. Boys in the control group received no formal counselling but were shown to have similar intellectual, personality, socio-economic and criminal backgrounds to those in the experimental group. It was hypothesised that counselled subjects would show more positive outcomes than control subjects over a range of measures relating to criminal behaviour and self-conception. The results indicated that the counselled subjects had a significantly lower rate of offending and a srnaller range of offences over a mean follow-up period of 2.5 years. They were also licensed from the institution significantly earlier and spent less time in custody during a one year follow-up after counselling was completed. Self-conception measures gave less clear-cut results. The direction of change towards better adjustment favoured the counselled subjects but the magnitude was often small. Those counselled subjects with most positive behaviour change tended to have significantly improved self-evaluation, less self/ideal self discrepancy and more variation on 'actual' self concept compared to pre-counselling. The results are discussed in the context of client-centred theory, methodological adequacy of the experimental design, and their application to the future treatment of young offenders in secure residential care.

Prophylactic ranitidine treatment in critically ill children - a population pharmacokinetic study

Aims - To characterize the population pharmacokinetics of ranitidine in critically ill children and to determine the influence of various clinical and demographic factors on its disposition. Methods - Data were collected prospectively from 78 paediatric patients (n = 248 plasma samples) who received oral or intravenous ranitidine for prophylaxis against stress ulcers, gastrointestinal bleeding or the treatment of gastro-oesophageal reflux. Plasma samples were analysed using high-performance liquid chromatography, and the data were subjected to population pharmacokinetic analysis using nonlinear mixed-effects modelling. Results - A one-compartment model best described the plasma concentration profile, with an exponential structure for interindividual errors and a proportional structure for intra-individual error. After backward stepwise elimination, the final model showed a significant decrease in objective function value (−12.618; P < 0.001) compared with the weight-corrected base model. Final parameter estimates for the population were 32.1 l h−1 for total clearance and 285 l for volume of distribution, both allometrically modelled for a 70 kg adult. Final estimates for absorption rate constant and bioavailability were 1.31 h−1 and 27.5%, respectively. No significant relationship was found between age and weight-corrected ranitidine pharmacokinetic parameters in the final model, with the covariate for cardiac failure or surgery being shown to reduce clearance significantly by a factor of 0.46. Conclusions - Currently, ranitidine dose recommendations are based on children's weights. However, our findings suggest that a dosing scheme that takes into consideration both weight and cardiac failure/surgery would be more appropriate in order to avoid administration of higher or more frequent doses than necessary.

Interviewing suspected offenders

Poor practices in interrogation and interviewing techniques, including those that the scientific literature suggests are counterproductive in eliciting reliable information, have led to many miscarriages of justice around the world, undermining the reputation and trust of the legal processes and organizations involved. This chapter provides a background and history of interrogation and interviewing, one that includes a description of current models and practices and highlights the fundamental differences in the two primary philosophies in Western countries. The chapter also explores the ultimate purpose of interviewing and interrogation together with the questioning strategies that science suggests are the most effective. It is argued throughout the chapter that modern, scientifically backed, interviewing approaches should be used at all times, no matter the challenge or situation, as a pathway towards both the collection of accurate information and diligent adherence to the standards of international human rights.