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Civilly committed sexually violent persons (SVPs) are a select group of individuals designated as high risk for future sexual violence. Despite risk reduction in older age, SVP programs are seeing aging client populations, with many individuals remaining committed after age 60 (60+). Recent research found a sexual recidivism rate of 7.5% for 60+ individuals released from an SVP civil commitment program. The current paper follows up by examining reasons why individuals remain committed after age 60. It compares SVPs discharged after age 60 to those who are 60+ but remain civilly committed. Results of bivariate analyses reveal older SVPs who remain committed have significantly higher actuarial risk scores and are more likely to be of minority race. Multivariate logistic regression analyses found actuarial risk scores (Static-99R) predicted continued commitment, after controlling for other relevant variables. Barriers to community reintegration and suggestions for multi-disciplinary case management for older SVPs are discussed.

Introduction: Hospital pharmacists' have traditionally focused on the manufacture and supply of medicines. However, the increasing complexity and range of medicines and a greater awareness of medication errors has facilitated a change towards a patient-centred role. Given this movement, it is surprising that a search of the published literature shows very little research that evaluated patients' views of hospital-based pharmacy services. Objective: To explore inpatients' expectations and experiences of hospital-based pharmacy services. Study setting and design: Face-to-face semi-structured interviews with inpatients admitted to acute medical wards of three NHS general hospitals. Principal findings: Seventy-four inpatients were interviewed: 37 were male with average age 73 years (age range of 19 -86 years). The predominate number of participants (62/74, 84%) being in the 65-80 years of age group. Thematic analysis of the data was driven by three themes; patients' expectations of the pharmacist's involvement in their treatment and care, the patients' experiences of any interaction that may have taken place and the patients' evaluation of their interaction with the pharmacist. Conclusions: There was a dichotomy of expectations and opinions from patients about the role of hospital pharmacists and the services being provided. As pharmacists' roles are developing towards a patient-orientated model in which pharmacists have direct contact with patients and their care, it is important to ensure that patients are aware of these developments to help them maximize the benefit they derive from their country's health-care system.

This chapter introduces some of the forms and practices of experiential education and raises some challenging questions about the role that pedagogy plays in institutions of higher learning.

Objective. This research was designed to validate a brief measure of self-esteem in sexual offenders: the Short Self-Esteem Scale (SSES). Method. The SSES was administered to 1,376 adult males serving a prison sentence for a sexual offence, and 40 non-offending males. Results. The internal consistency and test–retest reliability of the measure were excellent. The measure was able to discriminate between different types of sexual offender, and between sexual offenders with differing levels of static risk. The instrument's sensitivity to sexual offender treatment intervention was also demonstrated. Conclusions. The SSES is a useful screening tool for self-esteem deficits in sexual offenders. However it cannot identify problematic high self-esteem and it does not differentiate between types or domains of self-esteem.

Purpose. The effectiveness of prison-based cognitive-behavioural treatment programmes was evaluated using reconviction as the outcome measure. Method. Reconviction rates were compared between two groups of adult male offenders who were serving a custodial sentence of 2 years or more in Her Majesty's Prison Service, England and Wales. The treatment group (N =667) consisted of offenders who had voluntarily participated in one of two treatment programmes that targeted 'cognitive deficits' related to offending behaviour. The comparison group (N =1,801) was made up of offenders who had not participated in the treatment programme but were “matched” to the treatment group on a number of empirically relevant variables. Results. Treatment produced a robust reduction in the probability of reconviction (p < .001) when other relevant variables were controlled for. For treated offenders, the percentage point reduction in reconviction was 14% in medium-lowrisk offenders and 11% in medium-high-risk offenders. Conclusion. These outcome results demonstrate that the principles of effective practice in the field of offender rehabilitation, which were identified through meta-analytical research predominately in North America, can be applied to a UK offender population to similar effect.

Purpose. This study assessed the short-term impact of offending behaviour programmes in relation to certain key features of programme delivery identified by an accreditation system. The aim was to further inform the debate on ‘What Works’ in practice by establishing whether well-delivered programmes are more effective. Method. The sample consisted of 5,255 offenders serving custodial sentences in prisons across England and Wales who completed one of two accredited cognitive skills programmes during the financial year 2001/2002. The relationship between a battery of assessment measures, tutor experience, drop-out rates, audit observations and the quality of programme delivery was explored. Results. A positive short-term impact was observed on the majority of assessment measures across both programmes. Patterns of change were broadly similar across gender, age, and ethnic groupings. This short-term impact of the programmes was significantly greater for a group of high-need prisoners and at those sites where tutors were delivering more frequently. Tutor delivery rates were also found to be related to drop-out rates and the quality of programme delivery. Attempts to establish a relationship between ratings of tutor performance from video-monitoring and the short-term impact of the course were unsuccessful. However, at the programme site level, positive correlations were observed between the quality of delivery and other measures of the site's performance. Conclusion. This study shows that programmes do have a short-term impact and that this is greater for higher-need prisoners and at sites where tutors were delivering more frequently. Furthermore, the accreditation system has highlighted key aspects of programme delivery which do appear to influence the short-term effectiveness of the programmes.

In the first of the two studies reported here, we established that trained judges could reliably identify 18 therapist features that occurred with reasonable frequency. In the second study 17 of these features were examined to determine how well they related to changes in sexual offenders with treatment. Five videotapes from each of five different prison programs were rated for the presence of these 17 features and correlational analyses examined their relationship with changes in 44 measures of treatment targets. The primary findings indicated that empathy and warmth displayed by the therapists and their directive and rewarding behaviours, were the features that most strongly predicted therapeutic benefits. The results are discussed in terms of their clinical and research implications. Copyright © 2002 John Wiley & Sons, Ltd.

Objectives/hypothesis: the aim of our study was the objective assessment of endolymphatic hydrops in asymptomatic ears in unilateral Meniere's disease with a noninvasive electrophysiological test and investigation of significant clinical signs. The null hypothesis was that there would be no signs of endolymphatic hydrops in the asymptomatic ear. Study design: prospective study using the traveling wave velocity test for endolymphatic hydrops. METHODS: The traveling wave velocity test was used in conjunction with standard audiological tests to investigate both ears of 181 Meniere's patients attending the Medical Research Council Institute of Hearing Research in Southampton, United Kingdom. The test uses derived auditory brainstem responses to estimate the velocity of the cochlear traveling wave that is altered in endolymphatic hydrops. Meniere's disease was assessed using Arenberg's five staging criteria. Significant correlations were evaluated using standard statistical methods. Results: of 100 patients with clinically unilateral Meniere's disease, 27% showed evidence of endolymphatic hydrops in their asymptomatic ear. There was a significant correlation between signs of hydrops and the mean air-conduction threshold at 500 Hz. Conclusions: we recommend that a full assessment of incipient disease in the asymptomatic ear in unilateral Meniere's disease should be undertaken before offering any treatment options to patients. Any suspicion of early disease in the asymptomatic ear in unilateral Meniere's disease should lead to full electrophysiological assessment to assess the evidence of endolymphatic hydrops in that ear

Purpose and method. Crime reduction is a central feature of the current Government Home policy. This incorporates a wide variety of initiatives from crime-prevention strategies to o Vending-behaviour programmes. One key performance indicator for assessing crime reduction is reconviction. This article critically analyses the two main sources of criminal history data held in England and Wales from which reconviction is determined: e rst, the O Venders Index (OI), which is accessible to independent researchers; and second, the National Identie cation Service (NIS), available for limited Home O Yce personnel. Criminal history data were compared for 134 sexual o Venders using both sources of data. Results. Overall, there was a poor correlation for o Vence-based criminal history summaries between the two data sources. Further analysis revealed that neither source appeared more reliable, with each source contributing unique and additional information. Sentencing occasion-based summaries, however, showed a strong relationship between the two sources. Five-year reconviction rates for the sample were highest using a combination OI and NIS data than reconviction rates using one source alone. Conclusions. There is no evidence in this study to suggest that the NIS is more reliable than OI. OI users are urged to use sentencing occasion summaries over oVence-based summaries for control group matching purposes as these data appear to be more consistent between the two sources. In the future, when researchers have access to both sources of data, it is recommended that they use a combination of data sets for assessing past criminal history and deriving risk of reconviction in order to provide a more complete picture. A sound knowledge of the limitations of the data source being used is essential for researchers.

Its controversial past notwithstanding, psychopathy has emerged as one of the most important clinical constructs in the criminal justice and mental health systems. One reason for the surge in theoretical and applied interest in the disorder is the development and widespread adoption of reliable and valid methods for its measurement. The Hare PCL-R provides researchers and clinicians with a common metric for the assessment of psychopathy, and has led to a surge in replicable and meaningful findings relevant to the issue of risk for recidivism and violence, among other things. Most of the research thus far has been based on North American samples of offenders and forensic psychiatric patients. We summarize this research and compare it with findings from several other countries, including England and Sweden. We conclude that the ability of the PCL-R to predict recidivism, violence, and treatment outcome has considerable cross-cultural generalizability, and that the PCL-R and its derivatives play a major role in the understanding and prediction of crime and violence.

A lack of empathy is commonly seen as one of the central features of sexual aggression but there is little evidence to justify this assumption. Indeed a recent study, Beckett, Beech, Fisher & Fordham (1994), indicated that convicted child molesters showed more emotional empathy, but less cognitive empathy than a non-offender comparison group. The present study was designed to test the proposition that this finding is not an anomaly but part of a more general trend for empathic emotion to disrupt the learning of accurate perspective taking. Subjects were assessed for levels of cognitive and affective empathy and then their ability to recognize the abusive quality of sexual aggression was evaluated. Paralleling the Beckett et al. finding the present results indicated that recognition of abuse is enhanced by appropriate cognitive skills and habits but disrupted by empathic emotional arousal. The implications of these results for programmes aimed at enhancing victim empathy are discussed. Language: en

Intimacy, loneliness and attribution of blame measures were administered to groups of 25 child molesters, 25 rapists, and 25 non-sex offenders, all incarcerated in an English prison. The results indicated that the child molesters were both more lonely and more lacking in intimacy than were either the rapists or the non-sex offenders. The rapists were more lonely than the non-sex offenders and their intimacy scores were also lower than the non-sex offenders, although this latter difference did not quite achieve acceptable levels of statistical significance. Both groups of sexual offenders attributed more blame to women for the breakdown in a relationship, and the rapists made external attributions and the child molesters made internal attributions for their own problems in relationships. The results are discussed for their theoretical and treatment implications.

At least rhetorically, alternative schools claim to manifest significant changes in the nature of educational experiences. This study utilizes the interactionist or constitutive ethnographic approach to analyze the extent to which the social relations underlying educational encounters were transformed in one innovative program. The author argues that, at the level of the structuring procedures by which participants organized their face-to-face interactions in various contexts, they both reproduced and transformed the conventional social order of schooling.

This article is the result of a three-year study of student interns, which investigated the experiences of newcomers in various work organizations. A learning narrative, it compares internships in two very different work settings: a furniture-making shop and an animal protection league.

Many studies have investigated the relationship of Kohlberg's stages of moral reasoning to criminal behaviour, the consensual finding being that known delinquents tend to use less advanced forms of moral reasoning than control subjects. An assumption common to the majority of these studies is that moral stage relates equivalently to all forms of criminal behaviour. It is argued that this assumption is incompatible with cognitive-developmental theory as elaborated by Kohlberg since the theory implies that developmentally primitive moralities will be associated with delinquent behaviour only to the extent that the behaviour in question is differently evaluated at the different moral stages. On this basis it is hypothesized that preconventional moral reasoning will be associated only with crimes in which the offenders believe they have a good chance of evading punishment. In support of this hypothesis prisoners whose current offence is of this type are shown to use more preconventional moral judgement than either other offenders or non-offenders. Various possible alternative explanations of this finding are discussed.