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AbstractShall we ever catch up in rapid transit construction? No, unless we build decentralizing lines or limit building operations and the extent to which land can be used.

Introduces William B. Hawkins, son of a former governor of NC, who wishes to enter the Academy; Turner was a student under Partridge at West Point, 1813-1814.

Mr. Collins would like his son, William Collins, to return home to North Carolina.

For a particular subgroup of individuals with severe paraphilic disorders and a high risk of sexual recidivism, the combination of sex drive–reducing medications and psychotherapy is a promising treatment approach. The present quasi-experimental study aims at comparing differences in clinical characteristics and dynamic risk factors between persons receiving (+TLM, n = 38) versus not receiving (−TLM, n = 22) testosterone-lowering medications (TLMs). Individuals receiving TLM were more frequently diagnosed with paraphilic disorders. Neither the criminal history nor average risk scores differed between the two groups. In the +TLM, Stable-2007 scores showed a stronger decrease after TLM treatment was started. This accounted especially for the general and sexual self-regulation subscales. Individual variations in risk, however, were not predicted by TLM but were significantly related to treatment duration and Psychopathy Checklist–Revised (PCL-R) Factor I. Paraphilic patients with problems in self-regulatory abilities seem to profit most from pharmacological sex drive–reducing treatment. Furthermore, therapists seem to underestimate deviant sexual fantasies in medicated patients.

The Explicit and Implicit Sexual Interest Profile (EISIP) is a multimethod measure of sexual interest in children and adults. It combines indirect latency-based measures such as the Implicit Association Test (IAT), Viewing Time (VT), and explicit self-report measures. This study examined test–retest reliability and absolute temporal agreement of the EISIP over a 2-week interval in persons who were convicted of sexual offenses against children ( n = 33) and nonoffending controls ( n = 48). Test–retest reliability of the aggregated EISIP measures was high across the whole sample ( rtt = .90, intraclass correlation coefficient [ICC] = .90) with the IAT yielding the lowest retest correlations ( rtt = .66, ICC = .66). However, these indicators of relative reliability only quantify the temporal stability of individual differences within the group, not the detectability of individual change. Absolute temporal agreement as assessed via Bland–Altman plots ranged from one fourth to three thirds of a standardized unit in the sexual preference scores. This implies that individual change has to exceed medium to large standardized effect sizes to be distinguishable from spontaneous temporal variation in the EISIP measures. Overall, scores of combined measures were largely superior to single measures in terms of both absolute and relative reliability.

Child sexual abuse occurring in a child- or youth-serving institution or organization has attracted great public and scientific attention. In light of the particular personal and offense-related characteristics of men who have abused children within such an institution or organization, it is of special importance to evaluate the predictive performance of currently applied risk assessment instruments in this offender population. Therefore, the present study assessed the risk ratings and predictive performance of four risk assessment instruments and one instrument assessing protective factors concerning any, violent and sexual recidivism in child sexual abusers working with children (CSA-W) in comparison with extra-familial child sexual abusers (CSA-E) and intra-familial child sexual abusers (CSA-I). The results indicate that CSA-W mostly recidivate with a sexual offense. Although all included risk measures seem to function with CSA-W, the Static-99 seems to be the instrument that performs best in predicting sexual recidivism in CSA-W. CSA-W had the most protective factors measured with the Structured Assessment of PROtective Factors (SAPROF). While the SAPROF could not predict desistance from recidivism in CSA-W, it predicted desistance from any recidivism in all CSA. As CSA-W frequently hold many indicators for pedophilic sexual interests but only a few for antisocial tendencies, it can be suggested that CSA-W are at an increased risk for sexual recidivism and thus risk measures especially designed for sexual recidivism work best in CSA-W. Nevertheless, CSA-W also hold many protective factors; however, their impact on CSA-W is not clear yet and needs further study.

Inequitable healthcare access, experiences and outcomes across ethnic groups are of concern across many countries. Progress on this agenda appears limited in England given the apparently strong legal and policy framework. This disjuncture raises questions about how central government policy is translated into local services. Healthcare commissioning organisations are a potentially powerful influence on services, but have rarely been examined from an equity perspective. We undertook a mixed method exploration of English Primary Care Trust (PCT) commissioning in 2010–12, to identify barriers and enablers to commissioning that addresses ethnic healthcare inequities, employing:- in-depth interviews with 19 national Key Informants; documentation of 10 good practice examples; detailed case studies of three PCTs (70+ interviews; extensive observational work and documentary analysis); three national stakeholder workshops. We found limited and patchy attention to ethnic diversity and inequity within English healthcare commissioning. Marginalization of this agenda, along with ambivalence, a lack of clarity and limited confidence, perpetuated a reinforcing inter-play between individual managers, their organisational setting and the wider policy context. Despite the apparent contrary indications, ethnic equity was a peripheral concern within national healthcare policy; poorly aligned with other more dominant agendas. Locally, consideration of ethnicity was often treated as a matter of legal compliance rather than integral to understanding and meeting healthcare needs. Many managers and teams did not consider tackling ethnic healthcare inequities to be part-and-parcel of their job, lacked confidence and skills to do so, and questioned the legitimacy of such work. Our findings indicate the need to enhance the skills, confidence and competence of individual managers and commissioning teams and to improve organizational structures and processes that support attention to ethnic inequity. Greater political will and clearer ...

Background - Addressing health inequalities remains a prominent policy objective of the current UK government, but current NHS reforms involve a significant shift in roles and responsibilities. Clinicians are now placed at the heart of healthcare commissioning through which significant inequalities in access, uptake and impact of healthcare services must be addressed. Questions arise as to whether these new arrangements will help or hinder progress on health inequalities. This paper explores the perspectives of experienced healthcare professionals working within the commissioning arena; many of whom are likely to remain key actors in this unfolding scenario. Methods - Semi-structured interviews were conducted with 42 professionals involved with health and social care commissioning at national and local levels. These included representatives from the Department of Health, Primary Care Trusts, Strategic Health Authorities, Local Authorities, and third sector organisations. Results - In general, respondents lamented the lack of progress on health inequalities during the PCT commissioning era, where strong policy had not resulted in measurable improvements. However, there was concern that GP-led commissioning will fare little better, particularly in a time of reduced spending. Specific concerns centred on: reduced commitment to a health inequalities agenda; inadequate skills and loss of expertise; and weakened partnership working and engagement. There were more mixed opinions as to whether GP commissioners would be better able than their predecessors to challenge large provider trusts and shift spend towards prevention and early intervention, and whether GPs' clinical experience would support commissioning action on inequalities. Though largely pessimistic, respondents highlighted some opportunities, including the potential for greater accountability of healthcare commissioners to the public and more influential needs assessments via emergent Health & Wellbeing Boards. Conclusions - There is doubt about the ability of GP commissioners to take clearer action on health inequalities than PCTs have historically achieved. Key actors expect the contribution from commissioning to address health inequalities to become even more piecemeal in the new arrangements, as it will be dependent upon the interest and agency of particular individuals within the new commissioning groups to engage and influence a wider range of stakeholders.