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Improving the quality of care on psychiatric inpatient wards has been a major focus in recent mental health policy, a recurrent criticism being that contact between staff and patients is limited in time and therapeutic value. Change is unlikely to be achieved without recruitment and retention of a high quality and well-motivated work force.
The NHS commissioned national inpatient mental health staff morale study is intended to inform service planning and policy by delivering evidence on the morale of the inpatient mental health workforce and the clinical, organisational, architectural and human resources factors that influence it.
100 wards in 17 area ‘Trusts’ are participating in the study, in addition to 40 community teams. The study will take place over two years, and has 6 modules:
1. A quantitative questionnaire for all staff in participating wards and
2. A comparison group in 20 community mental health teams and 20 crisis teams.
3. Case studies of 10 wards scoring in the top and bottom quartile for indicators of morale.
4. Repeated questionnaires for 20 wards in the second year to investigate how morale changes over time.
5. Staff who leave the wards in the course of the first year will be asked their reasons for leaving.
6. Links between rates of staff sickness and morale will be investigated.
Questionnaires have been distributed to 3,500 staff with a response rate of 65%, results from which will be presented in 2009.
Clozapine is a second-generation antipsychotic, it. has been used in bipolar disorder refractory since 1989. Its use has been shown to reduce symptom severity in patients with manic and mixed-state episodes. The aim of this paper is to systematically review data published in 2014 to evaluate the effectiveness of clozapine in BD
the Medline database was searched for 2014 publications using the following keywords: ‘clozapine’; ‘refractory bipolar disorder’; ‘ effectiveness’; ‘ side effects’.
Medline search returned 110 results. Manual inspection of abstracts allowed selecting six papers for further review.
The first meta-analysis of the efficacy of clozapine in the treatement of refractory bipolar disorder, published in2014,showed the effectiveness and safety of rapid clozapine titration by decreasing the need for psychotropic co-medications, and reducing the number of psychiatric hospitalization. Other papers suggested that this molecule present adverse reaction associated with problems in clinical and biological tolerance which explains its abondan.
clozapine used at low dose is a molecule of future in the treatment of bipolar disorder and recent publication showed that its side effects join the other second generation antipsychotics
Multispectral imaging – the acquisition of spatially contiguous imaging data in a modest number (~3–16) of spectral bandpasses – has proven to be a powerful technique for augmenting panchromatic imaging observations on Mars focused on geologic and/or atmospheric context. Specifically, multispectral imaging using modern digital CCD photodetectors and narrowband filters in the 400–1100 nm wavelength region on the Mars Pathfinder, Mars Exploration Rover, Phoenix, and Mars Science Laboratory missions has provided new information on the composition and mineralogy of fine-grained regolith components (dust, soils, sand, spherules, coatings), rocky surface regions (cobbles, pebbles, boulders, outcrops, and fracture-filling veins), meteorites, and airborne dust and other aerosols. Here we review recent scientific results from Mars surface-based multispectral imaging investigations, including the ways that these observations have been used in concert with other kinds of measurements to enhance the overall scientific return from Mars surface missions.
The rocky shores of the north-east Atlantic have been long studied. Our focus is from Gibraltar to Norway plus the Azores and Iceland. Phylogeographic processes shape biogeographic patterns of biodiversity. Long-term and broadscale studies have shown the responses of biota to past climate fluctuations and more recent anthropogenic climate change. Inter- and intra-specific species interactions along sharp local environmental gradients shape distributions and community structure and hence ecosystem functioning. Shifts in domination by fucoids in shelter to barnacles/mussels in exposure are mediated by grazing by patellid limpets. Further south fucoids become increasingly rare, with species disappearing or restricted to estuarine refuges, caused by greater desiccation and grazing pressure. Mesoscale processes influence bottom-up nutrient forcing and larval supply, hence affecting species abundance and distribution, and can be proximate factors setting range edges (e.g., the English Channel, the Iberian Peninsula). Impacts of invasive non-native species are reviewed. Knowledge gaps such as the work on rockpools and host–parasite dynamics are also outlined.
Background: Cervical sponylotic myelopathy (CSM) may present with neck and arm pain. This study investiagtes the change in neck/arm pain post-operatively in CSM. Methods: This ambispective study llocated 402 patients through the Canadian Spine Outcomes and Research Network. Outcome measures were the visual analogue scales for neck and arm pain (VAS-NP and VAS-AP) and the neck disability index (NDI). The thresholds for minimum clinically important differences (MCIDs) for VAS-NP and VAS-AP were determined to be 2.6 and 4.1. Results: VAS-NP improved from mean of 5.6±2.9 to 3.8±2.7 at 12 months (P<0.001). VAS-AP improved from 5.8±2.9 to 3.5±3.0 at 12 months (P<0.001). The MCIDs for VAS-NP and VAS-AP were also reached at 12 months. Based on the NDI, patients were grouped into those with mild pain/no pain (33%) versus moderate/severe pain (67%). At 3 months, a significantly high proportion of patients with moderate/severe pain (45.8%) demonstrated an improvement into mild/no pain, whereas 27.2% with mild/no pain demonstrated worsening into moderate/severe pain (P <0.001). At 12 months, 17.4% with mild/no pain experienced worsening of their NDI (P<0.001). Conclusions: This study suggests that neck and arm pain responds to surgical decompression in patients with CSM and reaches the MCIDs for VAS-AP and VAS-NP at 12 months.
Disease surveillance in wildlife populations presents a logistical challenge, yet is critical in gaining a deeper understanding of the presence and impact of wildlife pathogens. Erinaceus coronavirus (EriCoV), a clade C Betacoronavirus, was first described in Western European hedgehogs (Erinaceus europaeus) in Germany. Here, our objective was to determine whether EriCoV is present, and if it is associated with disease, in Great Britain (GB). An EriCoV-specific BRYT-Green® real-time reverse transcription PCR assay was used to test 351 samples of faeces or distal large intestinal tract contents collected from casualty or dead hedgehogs from a wide area across GB. Viral RNA was detected in 10.8% (38) samples; however, the virus was not detected in any of the 61 samples tested from Scotland. The full genome sequence of the British EriCoV strain was determined using next generation sequencing; it shared 94% identity with a German EriCoV sequence. Multivariate statistical models using hedgehog case history data, faecal specimen descriptions and post-mortem examination findings found no significant associations indicative of disease associated with EriCoV in hedgehogs. These findings indicate that the Western European hedgehog is a reservoir host of EriCoV in the absence of apparent disease.
In North America, the raccoon-associated variant of rabies virus (RRV) is of special concern, given its relatively rapid spread throughout the eastern USA and its potential public health impact due to high raccoon host densities in urban areas. Northward expansion of this epizootic included an outbreak in the Canadian province of Quebec in 2006–2009 due to trans-border spread from the State of Vermont. To inform a more proactive approach to future control efforts, this study uses phylogenetic analyses to explore the role of geography and alternative carnivore hosts in the dynamics of RRV spread within Vermont. Specifically, we sought to examine whether striped skunks, a species frequently infected by RRV, could be part of the maintenance host community. Whole genome sequencing of 160 RRV samples from Vermont and neighbouring US states were used for fine-scale phylogeographic analyses. Results, together with the complete surveillance record of raccoon rabies since its entry into Vermont in 1994, document incursions by two distinct viral lineages and identify topographical features of the landscape which have significantly influenced viral spread, resulting in a complex distribution pattern of viral variants throughout the state. Results of phylogenetic cluster analysis and discrete state reconstruction contained some evidence of skunk-to-skunk and skunk-to-raccoon transmission but overall failed to support a role for skunks as alternative maintenance hosts.
As part of further investigations into three linked haemorrhagic fever with renal syndrome (HFRS) cases in Wales and England, 21 rats from a breeding colony in Cherwell, and three rats from a household in Cheltenham were screened for hantavirus. Hantavirus RNA was detected in either the lungs and/or kidney of 17/21 (81%) of the Cherwell rats tested, higher than previously detected by blood testing alone (7/21, 33%), and in the kidneys of all three Cheltenham rats. The partial L gene sequences obtained from 10 of the Cherwell rats and the three Cheltenham rats were identical to each other and the previously reported UK Cherwell strain. Seoul hantavirus (SEOV) RNA was detected in the heart, kidney, lung, salivary gland and spleen (but not in the liver) of an individual rat from the Cherwell colony suspected of being the source of SEOV. Serum from 20/20 of the Cherwell rats and two associated HFRS cases had high levels of SEOV-specific antibodies (by virus neutralisation). The high prevalence of SEOV in both sites and the moderately severe disease in the pet rat owners suggest that SEOV in pet rats poses a greater public health risk than previously considered.
OBJECTIVES/SPECIFIC AIMS: Compare effectiveness of a patient case-based, interactive teaching approach that included optional student genotyping with traditional didactic teaching strategies for increasing students’ knowledge and ability to effectively use pharmacogenomic data in clinical decision making. METHODS/STUDY POPULATION: The UF College of Pharmacy offers a required Personalized Medicine (PM) course for pharmacy students as well as an elective course, Clinical Applications of Personalized Medicine (CAPM). Students dual enrolled in the PM and elective CAPM courses comprised the intervention (INT) group, with interactive patient case-based teaching and the option to undergo personal genotyping, whereas students enrolled in PM alone comprised the control (CTR) group, which primarily used a traditional didactic teaching format and did not include personal genotyping. Both groups completed a pre- and post-course patient case-based test (15 questions/1 point each) to evaluate their knowledge and abilities to apply genotype and other patient-specific data to drug therapy recommendations. Pre- and post-course test scores for knowledge were compared between the INT and CTR groups using the Student t-test. RESULTS/ANTICIPATED RESULTS: In total, 52 students completed surveys (INT group, n=21; CTR group, n=31). Race was similar between groups, but there were fewer females in the INT compared with CTR group (8 vs. 22, p=0.02). Pre-course knowledge scores did not differ between INT and CTR groups (6.8±2.2 vs. 6.3±1.6 respectively, p=0.34), however, post-course scores were significantly higher in the INT Versus CTR group (10.0±2.3 vs. 7.5±1.7, p<0.0001). DISCUSSION/SIGNIFICANCE OF IMPACT: There have been significant advancements in the clinical applications of pharmacogenomic and genomic data, however, barriers to routine clinical adoption of genomic medicine persist. Developing education and training methods that equip practitioners to effectively translate genomic data into evidence-based clinical recommendations has been identified as a key strategy to overcome such barriers. Our data suggest that a personalized medicine course that employs patient-centered, case-based teaching strategies and includes optional personal genotyping for students compared with traditional didactic instruction improves students’ knowledge and abilities to apply pharmacogenomic data in practice-based scenarios. These results can inform future strategies for educating healthcare professionals on the clinical use of pharmacogenomic and genomic data.
The fact that crime and disorder are concentrated at a few places is interesting and deserves an explanation. It is also interesting that places show up in other criminological theories and in other disciplines. And it is useful to understand the methods for studying places. However, a primary reason we are interested in high-crime places is that it might be possible to do something about crime by addressing these places. We are convinced that focusing on places can substantially reduce crime and disorder. Our conviction is not a matter of faith, but is based on over twenty-five years of accumulating evidence.
This chapter summarizes the research evidence examining whether focusing on crime places reduces crime. We first discuss a broad range of place-based prevention strategies examined by Eck and Guerrette (2012). This review provides strong evidence for a place-based approach to crime prevention. We then turn to a specific form of place-based crime prevention – hot spots policing (Sherman and Weisburd 1995). Again, we have a strong body of evidence supporting a place-based approach. Having reviewed hot spots policing, we turn to the importance of place managers and third parties in controlling problem places. We then examine an extension of the third-party approach to argue that a place-based approach to crime may free crime control policy from the police monopoly. Then we describe how a place-based approach to crime could be incorporated in community corrections to improve probation and parole outcomes. Finally, we review the larger body of research on the potential threat of crime displacement, and its opposite, the diffusion of crime control benefits. Consistently, the evidence described in this chapter clearly shows the substantial utility of a place-based approach for reducing crime.
SITUATIONAL CRIME PREVENTION AT PLACES
In Chapter 3 we argued for the importance of social disorganization theories for understanding crime places. This is an area where basic research suggests promise (e.g., see Weisburd et al. 2012; Weisburd et al. 2014), but where there is little evidence of effectiveness of specific practices. Such evidence is beginning to be developed, but we can say little at this juncture. In contrast, the evidence regarding opportunity reduction and crime has grown systematically over the last few decades.
Take a moment to imagine a crime occurring – perhaps a street robbery or a bag snatch. When you do this, it is difficult not to visualize the crime occurring in a particular setting or place. So, you might imagine a dark street corner with dim street lighting or seating in the outside area of a public bar. It seems intuitively sensible to analyze and understand crime at this unit of analysis – in other words, to investigate how criminals behave and crime concentrates at small microplaces. However, engaging in such microlevel analysis has tended to be a more recent criminological undertaking, and there are still many fruitful avenues to explore in terms of advancing both our knowledge and the sophistication of the methods that we use in this research area.
In this chapter, we raise and endeavor to answer a number of questions concerning the appropriate scale of analysis of criminological enquiry. To do this, we will start by defining what we mean by place and how this differs from other geographic concepts. Next, we highlight what has become the key catalyst for the criminology of place – the tremendous concentration of crime at microgeographic units of analysis. The strong and consistent concentration of crime at addresses, street segments, and other microgeographic units across cities is key to understanding why it is important to study the criminology of place and why it has such strong policy implications. We then turn to some additional statistical benefits of studying crime at microgeographic units that have to do with what is often termed “spatial interaction effects.” Finally, we examine problems that crime and place researchers will need to consider, and recommend some future directions for research exploring crime concentration at places.
PLACE AND SPACE
Geographic concepts are sometimes used in criminological research without a clear understanding of their meaning. Place and space are two such concepts. The subtle difference between them is important to keep in mind, as they can be a guide to establishing a carefully constructed study and influence the interpretation of findings. Furthermore, as will become apparent later in this chapter, a confusion of these concepts can mislead the reader in the interpretation of an argument. For example, it is important to keep in mind that place does not necessarily mean small units of analysis, nor does space necessarily refer to large areas.
Over the last two decades, there has been increased interest in the distribution of crime and other antisocial behavior at lower levels of geography. The focus on micro geography and its contribution to the understanding and prevention of crime has been called the 'criminology of place'. It pushes scholars to examine small geographic areas within cities, often as small as addresses or street segments, for their contribution to crime. Here, the authors describe what is known about crime and place, providing the most up-to-date and comprehensive review available. Place Matters shows that the study of criminology of place should be a central focus of criminology in the twenty-first century. It creates a tremendous opportunity for advancing our understanding of crime, and for addressing it. The book brings together eighteen top scholars in criminology and place to provide comprehensive research expanding across different themes.
This chapter explores the importance of place in theory and research in both mainstream criminology and other disciplines. As we noted in earlier chapters, traditional criminology has focused primarily on understanding why people commit crime. This focus on criminality has generally inhibited study of microgeographies and their role in producing crime. However, more recently there has been a trend toward integrating microgeographic places into traditional theorizing about criminality. In the first part of the chapter we discuss this trend, focusing on some recent innovations in understanding criminality that have incorporated place-based perspectives. In the second part of the chapter we focus on how other disciplines have influenced thinking in this area, focusing in particular on contributions in psychology, economics, and public health. Finally, we explore how trends in other disciplines might influence future directions of study in the criminology of place.
THE GROWING ROLE OF MICROGEOGRAPHIC PLACES IN TRADITIONAL THEORIZING OF CRIMINALITY
As we noted in Chapter 1, places, at least at a macro level, played a key part in the development of criminology in the nineteenth and early twentieth centuries. But despite the role of place in crime in empirical study in Europe and theoretical development in the Chicago School through social disorganization theory, microgeographic places were mostly ignored. This was not because early criminologists failed to recognize the role of place in crime. Crime occurs in specific environments, and this was apparent to observers of the crime problem. Nonetheless, as we noted in Chapter 1, early criminologists did not see “crime places” – small discrete areas within communities – as a relevant focus of criminological study. This was the case, in part, because crime opportunities provided by places were assumed to be so numerous as to make concentration on specific places of little utility for theory or policy. What is the point of focusing theory or research on the opportunities offered by specific places if such opportunities can be found throughout the urban context?
Moreover, criminologists did not see the utility in focusing in on situational opportunities when criminal motivation was the key to understanding crime rates. Criminologists traditionally assumed that situational factors played a relatively minor role in explaining crime as compared with the “driving force of criminal dispositions” (Clarke and Felson 1993, 4; Trasler 1993).
In the previous chapter, we showed that crime is concentrated at very small geographic units, substantially smaller than neighborhoods, and that these concentrations, on average, are relatively stable. This is true whether examining high- or low-crime neighborhoods. Although high-crime places do cluster, they seldom form a homogeneous block of high-crime places. Rather, interspersed within concentrations of high-crime places are many low- and modest-crime places.
Why is crime concentrated in a relatively small number of places? Standard criminology has not asked this question, largely because standard criminology focuses on criminality and implicitly assumes that the density of offenders explains crime density. Recognition that place characteristics matter is the starting point for this chapter. We look at two perspectives on crime place characteristics. We use the term “perspective” because each type of explanation is comprised of multiple theories linked by a common orientation. The first perspective arises from opportunity theories of crime. The second perspective arises from social disorganization theories of crime.
We begin by contrasting two ways of thinking about how a place becomes a crime hot spot and suggest that the process by which high-crime places evolve must involve place characteristics. In the next sections, we examine opportunity and social disorganization explanations. In the final section of the chapter, we examine possible ways researchers might link these two perspectives.
PROCESSES THAT CREATE CRIME PLACES
Before we look for explanations of why places become hot spots of crime it is important to consider two processes that might lead to such an outcome. Criminologists have generally proposed two generic models to account for the processes that lead to variation in place susceptibility to crime. One model suggests that places may start with reasonably similar risks of an initial criminal attack, but once attacked the risk of a subsequent attack on the place rises. Over time, places diverge in their crime risk, and consequently in their crime counts. This temporal contagion model is also known as a boost model (see Chapter 2) or a state-dependence model. It puts the emphasis on offenders’ willingness to return to a previously successful crime site (Johnson et al. 2007; Townsley et al. 2000). It suggests that irrespective of initial crime risk the occurrence of a crime will lead to changes in risk of crime at a place.
We began this book by noting that criminologists have largely ignored the involvement of microgeographic places in crime. Mainstream criminologists have focused on “who done it?” and not “where done it?” (Sherman 1995). At least for the last century the key inquiries of crime and the key prevention approaches have looked to doing something about criminal motivation (Sutherland 1947; Reiss 1981). Why people commit crime has been the main focus of criminology (Brantingham and Brantingham 1990; Weisburd 2002), and catching and processing offenders has been the main focus of crime prevention (Weisburd 2008). In contrast, the criminology of place (Sherman et al. 1989; Weisburd et al. 2012), which began to develop in the 1980s and 1990s (Brantingham and Brantingham 1981; 1984; Eck 1994; Eck and Weisburd 1995; Roncek and Bell 1981; Weisburd and Green 1995a), provides an alternative vision of how we can understand crime and the crime problem. Like the emergence of community criminology during the same period (Bursik 1988; Morenoff et al. 2001; Sampson 2008; Sampson et al. 1997) the criminology of place has offered a new set of mechanisms for crime study and a new set of methods for doing something about the crime problem.
Theory has been a driving force in criminological study, and as we note below, we think that more not less attention to theory is important for advancing the criminology of place. However, theories are about something and try to explain something. When we change the unit of analysis, we are changing the target for theory. The criminology of place proposes a new target. It focuses on places, rather than people. Its goal is to explain the criminal involvement of microgeographic units rather than trying to explain the criminal involvement of people. This does not mean we ignore the role of individuals in the crime problem. But it does mean that we begin our inquiries with the place and see the individuals as only one part of the crime equation at places.
We have illustrated in the preceding chapters the extent to which theory, method, and empirical evidence about crime places have been developing over the last three decades. In this concluding chapter, we want to draw from our review of what is known some key themes that we think our work has identified, and key questions that still need to be answered.