Identifying signals of potentially harmful medications in pregnancy: use of the double false discovery rate method to adjust for multiple testing.

AIMS: Surveillance of medication use in pregnancy is essential to identify associations between first trimester medications and congenital anomalies (CAs). Medications in the same Anatomical Therapeutic Chemical classes may have similar effects. We aimed to use this information to improve the detection of potential teratogens in CA surveillance data. METHODS: Data on 15 058 malformed fetuses with first trimester medication exposures from 1995-2011 were available from EUROmediCAT, a network of European CA registries. For each medication-CA combination, the proportion of the CA in fetuses with the medication was compared to the proportion of the CA in all other fetuses in the dataset. The Australian classification system was used to identify high-risk medications in order to compare two methods of controlling the false discovery rate (FDR): a single FDR applied across all combinations, and a double FDR incorporating groupings of medications. RESULTS: There were 28 765 potential combinations (523 medications × 55 CAs) for analysis. An FDR cut-off of 50% resulted in a reasonable effective workload, for which single FDR gave rise to eight medication signals (three high-risk medications) and double FDR 50% identified 16 signals (six high-risk). Over a range of FDR cut-offs, double FDR identified more high-risk medications as signals, for comparable effective workloads. CONCLUSIONS: The double FDR method appears to improve the detection of potential teratogens in comparison to the single FDR, while maintaining a low risk of false positives. Use of double FDR is recommended in routine signal detection analyses of CA data

Social work and the penal state

The Criminal Justice System (CJS) has historically been a key site of social work intervention. Wacquant (2008, 2009a and 2009b) argues that the growth of social insecurity and the expansion of the penal state are endogenous features of the neo-liberal political project. The key premises of neo-liberalism have been accepted by parties of both the left and the right. Wacquant identifies that the “doxa” of the penal state such as “prison works” “zero tolerance” and “broken windows” have been widely accepted in an uncritical fashion. This shift alongside an increase in inequality had led to increasing social anxiety and mistrust. One manifestation of these trends is the “decline of the rehabilitative ideal” (Garland, 2001). Offenders, who were once generally viewed as marginalised individuals in need of social and welfare support are now regarded as sites of risk. The USA has led a penal arms race, in which, the use of imprisonment has grown significantly. In Europe, England and Wales has followed this trend most closely. Whilst acknowledging that penal policy is the result of a complex inter-relationship between social, cultural and historical factors, there are lessons to be learnt from the US experience. These include the impact of race and class inequalities as manifest in the CJS. The act of imprisonment is arguably an act of state violence and alongside the impact on individuals, communities and families, it has huge symbolic significance and value. The expansion of the penal state: the increasing numbers, poor conditions and the over-representation of minority groups mean that it should be a core social work concern. The paper outlines the ways, in which, risk and managerialism have sidelined core social work values in the CJS. It concludes that developments in the USA, particularly the decision in Brown v. Plata highlight a way out of the current impasse. Penal policy and conditions can only be reformed if the inherent dignity of offenders is rediscovered and placed at its centre

Researching trust in the police and trust in justice: a UK perspective

This paper describes the immediate and more distant origins of a programme of comparative research that is examining cross-national variations in public trust in justice and in the police. The programme is built around a module of the fifth European Social Survey, and evolved from a study funded by the European Commission. The paper describes the conceptual framework within which we are operating – developed in large measure from theories of procedural justice. It reviews some of the methodological issues raised by the use of sample surveys to research issues of public trust in the police, public perceptions of institutional legitimacy and compliance with the law. Finally it gives a flavour of some of the early findings emerging from the programme

A tale of two capitalisms: preliminary spatial and historical comparisons of homicide rates in Western Europe and the USA

This article examines comparative homicide rates in the United States and Western Europe in an era of increasingly globalized neoliberal economics. The main finding of this preliminary analysis is that historical and spatial correlations between distinct forms of political economy and homicide rates are consistent enough to suggest that social democratic regimes are more successful at fostering the socio-cultural conditions necessary for reduced homicide rates. Thus Western Europe and all continents and nations should approach the importation of American neo-liberal economic policies with extreme caution. The article concludes by suggesting that the indirect but crucial causal connection between political economy and homicide rates, prematurely pushed into the background of criminological thought during the ‘cultural turn’, should be returned to the foreground

How Personality Became Treatable:The Mutual Constitution of Clinical Knowledge and Mental Health Law

In recent years, personality disorders – psychiatric constructs understood as enduring dysfunctions of personality – have come into ever-greater focus for British policymakers, mental health professionals and service-users. Disputes have focussed largely on highly controversial attempts by the UK Department of Health to introduce mental health law and policy (now enshrined within the 2007 Mental Health Act of England and Wales). At the same time, clinical framings of personality disorder have dramatically shifted: once regarded as untreatable conditions, severe personality disorders are today thought of by many clinicians to be responsive to psychiatric and psychological intervention. In this article, I chart this transformation by means of a diachronic analysis of debates and institutional shifts pertaining to both attempts to change the law, and understandings of personality disorder. In so doing, I show how mental health policy and practice have mutually constituted one another, such that the aims of clinicians and policymakers have come to be closely aligned. I argue that it is precisely through these reciprocally constitutive processes that the profound reconfiguration of personality disorder from being an obdurate to a plastic condition has occurred; this demonstrates the significance of interactions between law and the health professions in shaping not only the State’s management of pathology, but also perceptions of its very nature

Imprisonment and internment: Comparing penal facilities North and South

Recent references to the ‘warehouse prison’ in the United States and the prisión-depósito in Latin America seem to indicate that penal confinement in the western hemisphere has converged on a similar model. However, this article suggests otherwise. It contrasts penal facilities in North America and Latin America in terms of six interrelated aspects: regimentation; surveillance; isolation; supervision; accountability; and formalization. Quantitatively, control in North American penal facilities is assiduous (unceasing, persistent and intrusive), while in Latin America it is perfunctory (sporadic, indifferent and cursory). Qualitatively, North American penal facilities produce imprisonment (which enacts penal intervention through confinement), while in Latin America they produce internment (which enacts penal intervention through release). Closely entwined with this qualitative difference are distinct practices of judicial involvement in sentencing and penal supervision. Those practices, and the cultural and political factors that underpin them, represent an interesting starting point for the explanation of the contrasting nature of imprisonment and internment

Hierarchical models in the analysis of trends in prevalence of congenital anomalies and risks associated with first trimester medications.

PhDAbstract Background Early identification of risk factors, in particular first trimester teratogenic medications, for congenital anomalies (CAs) is essential. Despite similarities between different CAs and between different medications, current surveillance methods in Europe examine each CA and each medication separately. This thesis aims to investigate whether the use of hierarchical statistical methods combining information in groups can improve CA surveillance methods. Methods EUROCAT is a European network of population-based CA registries, with EUROmediCAT comprising those registries with additional information on medication use in pregnancy. Trends in CAs from 2003-2012 in 18 EUROCAT registries (n=81,147) were analysed using Poisson regression models considering each CA separately and using hierarchical models combining related subgroups. First trimester medication exposures from 1995-2011 in 13 EUROmediCAT registries (n=15,058) were analysed. Firstly, groupings of medications and/or CAs were considered when determining the statistical significance of each medication-CA combination, using False Discovery Rate (FDR) procedures to adjust for multiple testing. Secondly, Bayesian hierarchical models were applied to directly model the group effects. The Australian classification system for prescribing medicines in pregnancy was used to independently identify “high risk” medications. The number of “high risk” medications identified by the FDR methods and Bayesian models were compared. Results For analysis of trends, grouping EUROCAT CA subgroups using hierarchical models did not provide additional information over that obtained from independent analyses of each subgroup. The double FDR method grouping medications by ATC3 level codes performed better than other FDR methods. Use of Bayesian hierarchical models did not produce enough of an improvement to justify the increased effort of implementing such models.This work was supported by the Medical Research Council [Award reference: 1504916] and the Wolfson Institute of Preventive Medicine

Creating spaces for change:engaging civil society to harness change in criminal justice practice

In a context of neoliberal penality, crime is falling yet prison populations continue to rise. Governments profess to recognise the problem yet have had little impact on underlying trends in criminal justice practice. This paper reports on a Scottish initiative to try and disrupt this cycle through broadening the base for deliberation upon justice matters to include civil society. In so doing we sought to build upon an emerging civic engagement evident in the wake of the 2014 Independence Referendum. Our premise was that to effect change requires that we look beyond policy fixes to the values and the socio-cultural drivers that take practice in particular directions. We conclude with a reflection on the obstacles to change

Associations between commuting modes and risk of 16 site-specific cancers in the UK Biobank

Background: The choice of transport mode may influence cancer risk by affecting physical activity level, sedentary behaviour, and exposure to environmental pollution. This study investigated the associations between commuting modes and 16 site-specific cancers in the UK Biobank. Methods: The UK Biobank is a prospective cohort study involving about 500 000 participants. Information on transport modes was collected at recruitment, and incident cancer cases were identified through linkage to national cancer registries. Multivariable Cox proportional hazards models were used. Results: There were 252 334 employed participants included, and 15 828 incident cancer cases were identified over a median follow-up of 11.7 years. Compared to the car-only mode, cycling (exclusively or combined with any other modes) was associated with a lower risk of colon [hazard ratio (HR): 0.72; 95% confidence interval: 0.53–0.96], renal (HR: 0.60; 0.38–0.96), and stomach (HR: 0.27; 0.10–0.71) cancers. Walking (exclusively or combined with any motorized mode) was associated with a lower risk of renal (HR: 0.67; 0.49–0.92) and liver (HR: 0.55; 0.31–0.98) cancers. Public transport users were less engaged in other physical activities, and its use was associated with a higher risk of bladder cancer (HR: 1.39; 1.01–1.90). Conclusions: Active commuting, even combined with motorized modes, is associated with a lower risk of some common cancers

From offender to victim-oriented monitoring : a comparative analysis of the emergence of electronic monitoring systems in Argentina and England and Wales

The increasingly psychological terrain of crime and disorder management has had a transformative impact upon the use of electronic monitoring technologies. Surveillance technologies such as electronic monitoring ‑ EM, biometrics, and video surveillance have flourished in commercial environments that market the benefits of asocial technologies in managing disorderly behavior and which, despite often chimerical crime prevention promises, appeal to the ontologically insecure social imagination. The growth of EM in criminal justice has subsequently taken place despite, at best, equivocal evidence that it protects the public and reduces recidivism. Innovative developments in Portugal, Argentina and the United States have re-imagined EM technologies as more personalized devices that can support victims rather than control offenders. These developments represent a re-conceptualization of the use of the technology beyond the neoliberal prism of rational choice theories and offender-oriented thinking that influenced first generation thinking about EM. This paper identifies the socio-political influences that helped conceptualize first generation thinking about EM as, firstly, a community sentence and latterly, as a technique of urban security. The paper reviews attempts to theorize the role and function of EM surveillance technologies within and beyond criminal justice and explores the contribution of victimological perspectives to the use of EM 2.0