Developing consensus on hospital prescribing indicators of potential harms amenable to decision support

Aim: To develop a list of prescribing indicators specific for the hospital setting that would facilitate the prospective collection of high severity and/or high frequency prescribing errors, which are also amenable to electronic clinical decision support (CDS). Method: A three-stage consensus technique (electronic Delphi) was carried out with 20 expert pharmacists and physicians across England. Participants were asked to score prescribing errors using a 5-point Likert scale for their likelihood of occurrence and the severity of the most likely outcome. These were combined to produce risk scores, from which median scores were calculated for each indicator across the participants in the study. The degree of consensus between the participants was defined as the proportion that gave a risk score in the same category as the median. Indicators were included if a consensus of 80% or more was achieved. Results: A total of 80 prescribing errors were identified by consensus as being high or extreme risk. The most common drug classes named within the indicators were antibiotics (n=13), antidepressants (n=8), nonsteroidal anti-inflammatory drugs (n=6), and opioid analgesics (n=6).The most frequent error type identified as high or extreme risk were those classified as clinical contraindications (n=29/80). Conclusion: 80 high risk prescribing errors in the hospital setting have been identified by an expert panel. These indicators can serve as the basis for a standardised, validated tool for the collection of data in both paperbased and electronic prescribing processes, as well as to assess the impact of electronic decision support implementation or development.

Time and retribution

Retributivists believe that punishment can be deserved, and that deserved punishment is intrinsically good. They also believe that certain crimes deserve certain quantities of punishment. On the plausible assumption that the overall amount of any given punishment is a function of its severity and duration, we might think that retributivists (qua retributivists) would be indifferent as to whether a punishment were long and light or short and sharp, provided the offender gets the overall amount of punishment he deserves. In this paper I argue against this, showing that retributivists should actually prefer shorter and more severe punishments to longer, gentler options. I show this by focusing on, and developing a series of interpretations of, the retributivist claim that not punishing the guilty is bad, focussing on the relationship between that badness and time. I then show that each interpretation leads to a preference for shorter over longer punishment.

Information and punitiveness: trial reconstruction in Ireland

Purpose – The purpose of this paper is to report results from a rape trial reconstruction in Ireland. Design/methodology/approach – A studio audience of 100 members of the Irish public were selected to attend a TV programme by the Republic of Ireland’s national broadcasting organisation. This involved the examination of the sentencing of a rape case. The audience’s sentencing preferences were measured at the outset, when they had been given only summary information about the case, and later, when full details had been disclosed. Findings – Previous research examining changes in public attitudes to crime and punishment has shown that deliberation, including the provision of new information and discussion with others and experts, tends to decrease public punitiveness and increase public leniency towards sentencing. An experiment in Ireland, however, showed that providing information does not invariably and necessarily moderate punitive attitudes. This paper presents the results, and offers some explanations for the anomalous outcome. Research limitations/implications – The pre/post design, in which the audience served as their own controls, is a weak one, and participants may have responded to what they took to be the agenda of the producers. Due to the quality of the sample, the results may not be generalisable to the broader Irish population. Practical implications – Policy makers should recognise that the public is not uniformly punitive for all crimes. There is good research evidence to show that the apparent public appetite for tough punishment is illusory, and is a function of the way that polls measure public attitudes to punishment. Sentencers and those responsible for sentencing policy would benefit from a fuller understanding of the sorts of cases which illicit strong punitive responses from the public, and the reasons for this response. However any such understanding should not simply translate into responsiveness to the public’s punitive sentiments – where these exist. Innovative survey methods – like this experiment – which attempt to look beyond the top-of-the-head opinions by providing information and opportunities for deliberation should be welcomed and used more widely. Originality/value – There have been limited research studies which reports factors which may increase punitiveness through the provision of information and deliberation.

Regurgitated bodies: presenting and representing trauma in 'The Act of Killing'

Focusing on The Act of Killing, this chapter examines how an “ethics of realism” operates on three key cinematic arenas: genre, authorship and spectatorship. As far as genre is concerned, the film’s realist commitment emerges from where it is least expected, namely from Hollywood genres, such as the musical, the film noir and the western, which are used as documentary, that is to say, as a fantasy realm where perpetrators can confess to their crimes without restraints or fear of punishment, but which nonetheless retains the evidentiary weight of the audiovisual medium. Authorship, in turn, translates as Oppenheimer’s unmistakable auteur signature through his role of self-confessed “infiltrator” who disguises as a sympathiser of the criminals in order to gain first-hand access to the full picture of their acts. One of them, the protagonist Anwar Congo, is clearly affected by post-traumatic stress disorder, and his repetitive reliving of his killings is made to flare up in front of the camera so as to bring back the dead to the present time in their material reality, through his own body, including a harrowing scene of the actor’s unpredictable and uncontrollable retching as he re-enacts the killing of his victims through strangulation. Finally, in the realm of spectatorship, the usual process of illusionistic identification on the part of the spectator is turned onto its head by means of disguising these criminals as amateur filmmakers, led to shoot, act within, and then watch their own film within the film so as to force them to experience beyond any illusion the suffering they had caused.

Treason, felony and Lollardy: a common petition in the hand of Richard Osbarn, Clerk of the Chamber of the Guildhall 1400–c. 1437

This article examines a common petition presented in the English parliament of 1425 requesting that those imprisoned for long periods for the crimes of treason, felony and Lollardy might be brought to trial. On the basis of palaeographical and orthographical evidence, this petition is demonstrated to be written by Richard Osbarn, clerk of the chamber of the London Guildhall between 1400 and 1437. The implications of this discovery throw new light on the way petitions were formulated, suggesting that the scribes of petitions played a greater role than previously thought, and in some cases identified with the complaint itself.

Decomposition in tropical forests: a pan-tropical study of the effects of litter type, litter placement and mesofaunal exclusion across a precipitation gradient

1. Litter decomposition recycles nutrients and causes large fluxes of carbon dioxide into the atmosphere. It is typically assumed that climate, litter quality and decomposer communities determine litter decay rates, yet few comparative studies have examined their relative contributions in tropical forests. 2. We used a short-term litterbag experiment to quantify the effects of litter quality, placement and mesofaunal exclusion on decomposition in 23 tropical forests in 14 countries. Annual precipitation varied among sites (760-5797 mm). At each site, two standard substrates (Raphia farinifera and Laurus nobilis) were decomposed in fine- and coarse-mesh litterbags both above and below ground for approximately 1 year. 3. Decomposition was rapid, with >95% mass loss within a year at most sites. Litter quality, placement and mesofaunal exclusion all independently affected decomposition, but the magnitude depended upon site. Both the average decomposition rate at each site and the ratio of above- to below-ground decay increased linearly with annual precipitation, explaining 60-65% of among-site variation. Excluding mesofauna had the largest impact on decomposition, reducing decomposition rates by half on average, but the magnitude of decrease was largely independent of climate. This suggests that the decomposer community might play an important role in explaining patterns of decomposition among sites. Which litter type decomposed fastest varied by site, but was not related to climate. 4. Synthesis. A key goal of ecology is to identify general patterns across ecological communities, as well as relevant site-specific details to understand local dynamics. Our pan-tropical study shows that certain aspects of decomposition, including average decomposition rates and the ratio of above- to below-ground decomposition are highly correlated with a simple climatic index: mean annual precipitation. However, we found no relationship between precipitation and effects of mesofaunal exclusion or litter type, suggesting that site-specific details may also be required to understand how these factors affect decomposition at local scales.

Crimes financeiros e política criminal : estudo de acórdãos do TRF da 3ª Região sobre os crimes de gestão fraudulenta e gestão temerária no período de 2001 a 2010

Este trabalho visa produzir conhecimento sobre como o Tribunal Regional Federal da 3ª Região tem decidido sobre dois dos principais crimes afetos à administração das instituições financeiras: gestão fraudulenta e gestão temerária. Trata-se de delitos criticados pela doutrina em razão das falhas de definição dos tipos, desde a edição da Lei 7.492, em 1986. Além disso, a sua previsão legislativa possui características que os aproximam do paradigma do direito penal do risco, ou seja: são crimes de perigo abstrato, que tutelam bem jurídico supra-individual, praticados por administradores detentores do dever de probidade na condução das instituições frente aos riscos inerentes à dinâmica do sistema financeiro. A adoção desse paradigma é controversa na doutrina penal por implicar a flexibilização de garantias do Estado Democrático de Direito sob a perspectiva do paradigma do direito penal tradicional. Diante disso, adota-se a metodologia de análise de conteúdo de decisões para se responder a dois problemas de pesquisa: (1) Quais os critérios adotados pelo Tribunal para a configuração dos crimes? (2) As decisões aproximam-se de algum paradigma de direito penal? As hipóteses objeto de teste são: (1) que o Tribunal considera principalmente a prática da conduta sem analisar a sua potencialidade lesiva sob uma perspectiva ex ante; e, (2) que esse discurso de imputação de responsabilidade aproxima as decisões do paradigma do direito penal do risco, considerados, em contexto, outros elementos presentes nas decisões. Na primeira parte, é feita uma introdução metodológica; na segunda, estabelece-se o referencial teórico; na terceira e na quarta, realizam-se as análises dos resultados quantitativos e qualitativos obtidos com a sua discussão; por fim, procede-se à conclusão, levantando-se novo problema a ser investigado.

A nova sistemática da Lei dos Crimes Hediondos: aspectos polêmicos à luz das mudanças legislativas e jurisprudenciais

Este trabalho se propõe a analisar de forma crítica a nova sistemática da Lei dos Crimes Hediondos, após as modificações legislativas e jurisprudências que ocorreram desde sua criação até os dias de hoje. A problemática deste estudo se pautou na análise de um abrandamento da Lei dos Crimes Hediondos, principalmente a partir da decisão do Supremo Tribunal Federal, que declarou inconstitucional o artigo da lei que previa que o cumprimento da pena nos crimes hediondos deveria ser no regime integralmente fechado. Para comprovar a referida tese, foi imprescindível trazer o cenário da criação da lei e sua rigorosidade, depois as modificações feitas através de lei e posicionamento jurisprudencial, e por último sua situação atual. Feita a análise crítica, ficou comprovado que houve um abrandamento do tratamento dos crimes hediondos sim, mesmo ainda havendo rigorosidade se comparado com o dos crimes comuns. Além também de concluir que o objetivo da lei não deve ser acabar com a criminalidade, mas sim se transformar numa Política Criminal de resposta a sociedade e de rigorosidade no tratamento dos crimes considerados como mais graves.

Inimigos públicos: crimes corporativos e necrocorporações

As corporações estão presentes em todos os lugares e em quase todos os aspectos de nossas vidas, porém, elas podem ser perigosas para a sociedade, protagonizando ações com impactos negativos para consumidores, trabalhadores, meio ambiente e comunidades. Nesta tese, lançamos nosso olhar sobre o lado sombrio das corporações, explorando dois crimes corporativos cometidos no Brasil por duas corporações transnacionais da indústria química, uma indústria predominada por grandes corporações operando em forma de oligopólios, dentro de um setor altamente estratégico por produzir insumos para a produção da maioria dos bens de consumo. Nosso objetivo é compreender os crimes corporativos para além da perspectiva funcionalista predominante na literatura sobre o tema. Para tanto, realizamos uma pesquisa qualitativa, com base na perspectiva crítica, focalizando dois casos ocorridos há mais de quatro décadas, no Brasil. Para reunir material empírico, entrevistamos ex-trabalhadores e trabalhadores das corporações protagonistas dos crimes, ex-moradores da comunidade atingida pelos crimes e especialistas, como advogados e profissionais da saúde, que se envolveram nos casos. As entrevistas foram do tipo narrativa, tendo sido gravadas e, posteriormente, transcritas para análise. Além das entrevistas, reunimos diversos documentos sobre os casos, como a cobertura jornalística, relatórios técnicos, sentenças e acórdãos. Analisamos o material empírico buscando reconhecer que os crimes corporativos ocorreram como uma extensão das organizações e de seu modo de organizar, e não como infortúnio ou efeitos colaterais não intencionais. Como principais resultados, desenvolvemos os conceitos de necrocorporação e crimes corporativos contra a vida. Nossa análise estendeu-se sobre as articulações engendradas pelas corporações; a produção da morte; e o poder, o consentimento e a resistência. Em ambos os casos analisados, os crimes foram cometidos na busca pelos objetivos corporativos, provocando a morte e doenças, bem como outros danos irreversíveis ao meio ambiente e à comunidade. Nossos resultados apontam para a necessidade de uma mudança no modo de pensar quanto às relações entre governos, sociedade e corporações, iniciando-se pela dissolução desse modelo de organização de negócios.

Need and opportunity: what are the main security threats to the pharmaceuticals industry in Latin America?

Os preços altos de produtos farmacêuticos patenteados sempre têm sido uma polêmica na América Latina. Considerando as disparidades económicas na região e a falta histórica do desenvolvimento, muitas vezes os preços altos servem como barreiras contra o acesso aos medicamentos essenciais. Por um lado, as companhias farmacêuticas dizem que os preços elevados são necessários para financiar os processos de pesquisa e desenvolvimento e para gerar um retorno do investimento lucrativo. Por outro lado, os consumidores, tanto privados como públicos, dizem que os preços altos têm resultado em uma falta histórica de medicamentos baratos. Neste debate, ambos lados têm realizado uma série de manobras e contramanobras que têm exposto algumas das vulnerabilidades do setor. Utilizando vários métodos de análise e entrevistas com profissionais no setor, este projeto analisa as vulnerabilidades do setor para determinar o risco, ao mesmo tempo tentando a responder à pergunta: Quais são as ameaças principais na segurança da indústria farmacêutica na América Latina? Justificação deste projeto é o aumento dos crimes relacionados aos produtos farmacêuticos na última década, que têm exposto os pacientes a um número de riscos mais alto. Uma compreensão das ameaças principais é necessária para melhor mitigar o risco, garantir a integridade de produtos e preservar a saúde pública.

A percepção dos peritos criminais federais que atuam em crimes financeiros sobre as competências necessárias para o exercício de suas atividades

O objetivo desta pesquisa foi apreender a percepção dos peritos criminais federais da área financeira, que atuam na Polícia Federal, sobre as competências necessárias para o exercício de suas atividades. Para tanto, realizou-se a pesquisa, cujos sujeitos foram os próprios peritos criminais federais da área financeira, em duas fases distintas: (a) a primeira compreendeu a realização de entrevistas com profissionais experientes e representando diversas características desejáveis para o estudo; buscou-se a opinião de peritos que já foram gestores, que já foram lotados em mais de uma unidade e que possuíssem pelo menos cinco anos de experiência, sobre as competências mais importantes para o desempenho das atividades; (b) a segunda fase compreendeu um levantamento junto a uma amostra de 86 peritos, que correspondeu a 43% do universo pesquisado. Nessa fase, foi aplicado um questionário fechado, por meio da Internet, envolvendo questões que abordavam 41 competências, técnicas e comportamentais, identificadas na primeira fase da pesquisa. Isso proporcionou material que permitiu apreender a percepção dos peritos sobre as competências mais importantes para o desempenho de suas atividades e também sobre o seu grau de domínio dessas competências. Na análise dos resultados, focada no confronto entre as competências técnicas e competências comportamentais, comparou-se as respostas apresentadas por diferentes categorias dos peritos, como faixa etária, região geográfica de lotação, tempo de experiência, sexo e área de formação acadêmica.

Technology adoption and effects of transfers across locations

This paper develops a two-period model with heterogeneous agents to analyze the e¤ects of transfers across locations on convergence, growth and welfare. The model has two important features. First, locations are asymmetric as it is assumed that there are more specialized occupations in the more developed one. Second, the returns on the investment to acquire new technology depend positively on the level of each region’s knowledge and on the level of the world knowledge assumed to be available to all. In one hand, the poor region has a disadvantage as it has a lower stock of knowledge. On the other hand, it has the advantage of not having yet exploited a greater stock of useable knowledge available in the world. Hence, there are two possible cases. When the returns are greater in the poor region, we obtain the following results: (i) the rich location grows slower; (ii) the transfers to the poor location enhances the country’s growth rate; and (iii) there is a positive amount of transfers to the poor region that is welfare improving. When the returns are greater in the rich region, the …rst two results are reversed and transfers to the rich region are welfare improving. In both cases, the optimal amount of transfer increases with the level of income disparity across regions and is not dependent on the level of the country’s economic development (measured by its income per capita). Barriers to the adoption of new technology available in the world can constrain the convergence process as it harms in greater length the poor region. The results do not change whether migration is allowed or not.

International civil society actors in Genetically Modificied Organisms as a field of struggle: a neo-gramscian study in Brazil and the United Kingdom

Since the international financial and food crisis that started in 2008, strong emphasis has been made on the importance of Genetically Modified Organisms (GMOs) (or “transgenics”) under the claim that they could contribute to increase food productivity at a global level, as the world population is predicted to reach 9.1 billion in the year 2050 and food demand is predicted to increase by as much as 50% by 2030. GMOs are now at the forefront of the debates and struggles of different actors. Within civil society actors, it is possible to observe multiple, and sometime, conflicting roles. The role of international social movements and international NGOs in the GMO field of struggle is increasingly relevant. However, while many of these international civil society actors oppose this type of technological developments (alleging, for instance, environmental, health and even social harms), others have been reportedly cooperating with multinational corporations, retailers, and the biotechnology industry to promote GMOs. In this thesis research, I focus on analysing the role of “international civil society” in the GMO field of struggle by asking: “what are the organizing strategies of international civil society actors, such as NGOs and social movements, in GMO governance as a field of struggle?” To do so, I adopt a neo-Gramscian discourse approach based on the studies of Laclau and Mouffe. This theoretical approach affirms that in a particular hegemonic regime there are contingent alliances and forces that overpass the spheres of the state and the economy, while civil society actors can be seen as a “glue” to the way hegemony functions. Civil society is then the site where hegemony is consented, reproduced, sustained, channelled, but also where counter-hegemonic and emancipatory forces can emerge. Considering the importance of civil society actors in the construction of hegemony, I also discuss some important theories around them. The research combines, on the one hand, 36 in-depth interviews with a range of key civil society actors and scientists representing the GMO field of struggle in Brazil (19) and the UK (17), and, on the other hand, direct observations of two events: Rio+20 in Rio de Janeiro in 2012, and the first March Against Monsanto in London in 2013. A brief overview of the GMO field of struggle, from its beginning and especially focusing in the 1990s when the process of hegemonic formation became clearer, serves as the basis to map who are the main actors in this field, how resource mobilization works, how political opportunities (“historical contingencies”) are discovered and exploited, which are the main discourses (“science” and “sustainability” - articulated by “biodiversity preservation”, “food security” and “ecological agriculture”) articulated among the actors to construct a collective identity in order to attract new potential allies around “GMOs” (“nodal point”), and which are the institutions and international regulations within these processes that enable hegemony to emerge in meaningful and durable hegemonic links. This mapping indicates that that the main strategies applied by the international civil society actors are influenced by two central historical contingencies in the GMO field of struggle: 1) First Multi-stakeholder Historical Contingency; and 2) “Supposed” Hegemony Stability. These two types of historical contingency in the GMO field of struggle encompass deeper hegemonic articulations and, because of that, they induce international civil society actors to rethink the way they articulate and position themselves within the field. Therefore, depending on one of those moments, they will apply one specific strategy of discourse articulation, such as: introducing a new discourse in hegemony articulation to capture the attention of the public and of institutions; endorsing new plural demands; increasing collective visibility; facilitating material articulations; sharing a common enemy identity; or spreading new ideological elements among the actors in the field of struggle.

PSEUDO: uma análise sociocognitiva sobre insinceridades, mentiras e crimes de fraude

The objective of this work is to analyze the phenomenon of lying, highlighting some uses and social consequences. Lies are a ubiquitous phenomenon, and in many cases they even promote social harmony. Furthermore, telling lies is an expression of individuality: it is the expression of relative autonomy that the subject has towards their social environment allowing them to defend their most personal interests. The work also aims to examine the concept of habitus applied to the social production of lies. Thus, the liars produce their lies aiming to obtain certain effects on their audiences. There are certain social cognitive principles that structure the kind of lie that is usually told to the public. Finally, the perpetrators of crimes of fraud and other deceptive practices may suffer a criminal prosecution because the damage they cause affects important social values recognized by the state, and are not restricted to the victim‟s chagrin. In the most common forms of fraud, the crooks make tempting offers to victims exploiting some of their standardized behaviors and reactions. To understand the fragility of the victims to scams is an attempt to understand how a social phenomenon as usual as is the lie can still surprise and cause perplexity