Taking the right course: The possibilities and challenges of offering alternatives to prosecution for drivers detected using mobile phones while driving.

There is a considerable body of literature that outlines the dangers of mobile phone use by drivers. However, there is very little research that explores the role and effectiveness of attempts to tackle this specific road user problem. Generally, normative motives are more likely to generate compliance with traffic law, and are more likely to be developed through approaches which focus on engagement and education. There would seem to be little potential for them to be developed through the use of penalty points and fines, which rely on more instrumental logic. Nonetheless, the decision was made in the UK in recent years to cease offering 'courses' (inputs to detected phone-using drivers offered as an alternative to prosecution) for mobile phone offences. This decision was made despite a lack of evidence one way or another about their effectiveness in tackling both handheld mobile phone use and handsfree mobile phone distraction - a form of distraction not explicitly covered in law. This research project aimed to explore driver education as an alternative to prosecution for mobile phone use while driving offences, focusing on perceptions and experiences of one particular educational intervention. This paper draws on 46 semi-structured interviews with those involved in delivering a specific intervention aimed at reducing handheld mobile phone use by drivers that was previously offered as an alternative to prosecution in the UK; the police officers identifying offenders for referral to such courses, those delivering the intervention, drivers attending the course as an alternative to prosecution and members of the public attending the course as general education. Four key themes, with underpinning subthemes, emerged; 1) Police officer discretion and control over entry into the criminal justice system 2) Police-public interactions, 3) Course experiences, and 4) Post-course considerations. Firstly, police officer discretion is an important determinant of criminal justice system outcome, based on subjective rather than legal decisions about whether or not to report drivers for an offence. Secondly, police officers negotiate encounters with road users using the avoidance of prosecution as a way of diffusing difficult conversations, sometimes by offering a course as a preferable alternative to prosecution, sometimes by encouraging handsfree phone use. Thirdly, course attendance provides an opportunity to develop both normative alignment through increased understanding of police work, and to appreciate a range of instrumental consequences associated with mobile phone use. Both self-reportedly impacted upon mobile phone use while driving. Finally, post-course considerations emphasised a focus on who should be offered courses as an alternative to prosecution, focusing upon desires for both punitive and rehabilitative responses to mobile phone using drivers.

A case of raised CA 19-9 in a patient with desmoplastic fibroblastoma of the upper limb.

Carbohydrate antigen 19-9 (CA 19-9) is a tumor marker widely accepted as the most useful blood test in diagnosing and monitoring pancreatic cancer. However, CA 19-9 may also be raised in other conditions such as colorectal, hepatic, lung, and ovarian carcinoma as well as benign conditions such as hepatobiliary and pulmonary diseases. CA 19-9 is rarely elevated above 200 U/ml in benign conditions with values exceeding 1000 U/ml being highly suggestive of malignancy. The mechanism of secretion in both malignant and benign conditions remains unclear. Desmoplastic fibroblastoma (DF) is a benign soft tissue tumor. CA 19-9 has not been reported in association with DF previously. We present a case of raised serum CA 19-9 in a 71-year-old male attributed solely to DF in his left cubital fossa. The patient's CA 19-9 level rose from 56 U/ml at the time of presentation to 3763.8 U/ml over a period of 9 months. Post-DF excision, the CA 19-9 level decreased to 1464 U/ml at 1 month, 162.3 U/ml at 2.5 months, and 24U/ml, within normal range, at 7 months post-surgery. CA 19-9 levels continued to remain at 24 U/ml 1.5 years post-tumor excision. The CA 19-9 level in this patient was highly elevated which is unusual in association with a benign tumor. The rate of decrease in CA 19-9 level post-excision was in keeping with that reported after pancreatic cancer resections. This is the first case of DF in association with raised CA 19-9.

Prospective, multicentre, randomized controlled trial of bladder filling prior to trial of void on the timing of discharge.

BACKGROUND: The objective of this study was to investigate whether bladder filling with saline prior to trial of void (TOV) was safe and whether it reduced time to discharge compared with standard TOV in the urology inpatient setting for patients post-transurethral resection of prostate, bladder neck incision or an admission with urinary retention. METHODS: Prospective, multicentre, randomized controlled trial at Hawkes Bay and Waikato hospitals with local ethics committee approval. All consecutive, consented patients requiring TOV were randomized into filling and control groups. The filling groups were filled with normal saline prior to TOV (up to 500 mL or first sensation of fullness). The control group had their catheter removed at 06.00 hours without filling. Time taken between catheter removal and discharge was recorded in minutes. Complications were recorded. RESULTS: Fifty-two patients were recruited and randomized with 27 and 25 patients in the filling and control groups, respectively. The mean time taken from catheter removal to discharge was 300.6 min in the filling group and 340.1 min in the control group. The filling group reduced the time to discharge by 39.5 min (P = 0.304). Furthermore, 2/27 and 2/25 patients in the filling and control groups, respectively, developed urinary retention after TOV and required re-catheterization prior to discharge. CONCLUSION: Bladder filling prior to TOV showed a non-statistically significant reduction in the time to discharge of 39.5 min. Despite the fact that bladder filling is a safe and cheap procedure, it cannot be recommended for use in an attempt to reduce time to discharge in an inpatient setting.