Back to the future? Diabetes, HIV, and the boundaries of public health

The control of infectious diseases has traditionally fallen to public health and the clinical care of chronic diseases to private medicine. In New York City, however, the Department of Health and Mental Hygiene (DOHMH) has recently sought to expand its responsibilities in the oversight and management of chronic-disease care. In December 2005, in an effort to control epidemic rates of diabetes, the DOHMH began implementing a bold new plan for increased disease surveillance through electronic, laboratory-based reporting of A1C test results (a robust measure of blood-sugar levels). The controversy A1C reporting produced was relatively contained, but when Dr. Thomas Frieden, New York City health commissioner, called for the state to begin tracking viral loads and drug resistance among patients with HIV, both the medical community and a wider public took notice and have started to grapple with the meaning of expanded surveillance. In the context of the past century of medical surveillance in America, we analyze the current debates, focusing first on diabetes and then HIV. We identify the points of contention that arise from the city's proposed blend of public health surveillance, disease management, and quality improvement and suggest an approach to balancing the measures' perils and promises.     

Waxing grave about adipocere: soft tissue change in an aquatic context

When postmortem environmental conditions are "just right," according to the "Goldilocks Phenomenon," soft tissues (and associated fatty acids) are converted into and preserved as adipocere. To better understand this conversion process and the development of adipocere three human cadavers were immersed in outside, water-filled pits for over 3 months to observe adipocere formation in an underwater context simulating actual field conditions. Recordings of environmental conditions showed that temperatures were between 21 degrees C and 45 degrees C, a range sufficient for the growth of Clostridium perfringens. Chemical analysis of liquid and tissue samples revealed an increase in palmitic acid and decrease in oleic acid. This study tracked the remarkable gross morphological changes that can occur in human bodies subjected to an aquatic postmortem environment. The results support the "Goldilocks Phenomenon" and substantiate previous findings that the presence of bacteria and water is crucial for adipocere to form.     

Assessing the victim-offender overlap among Puerto Rican youth

Purpose

Knowledge about offenders and knowledge about victims has traditionally been undertaken without formal consideration of the overlap among the two. A small but growing research agenda has examined the extent of this overlap. At the same time, there has been a minimal amount of research regarding offending and victimization among minority youth, and this is most apparent with respect to Hispanics, who have been increasing in population in the United States.

Materials &; Methods

This study explores the joint, longitudinal overlap between offending and victimization among a sample of Puerto Rican youth from the Bronx, New York.

Results

Results indicate: (1) an overlap between offending and victimization that persists over time, (2) a considerable overlap in the number, type, direction, and magnitude of the effect of individual, familial, peer, and contextual factors on both offending and victimization, (3) some of the factors related to offending were only relevant at baseline and not for the growth in offending but that several factors were associated with the growth in victimization, and (4) various risk factors could not explain much of the overlap between offending and victimization.

Conclusions

Theoretical, policy, and future research directions are addressed.     

Therapeutic jurisprudence: A framework for evidence-informed health care policymaking

Translation of evidence-based practice (EBP) into health care policy is of growing importance, with discussions most often focused on how to fund and otherwise promote EBP through policy (i.e., at system level, beyond the bedside). Less attention has been focused on how to ensure that such policies - as enacted and implemented, and as distinguished from the practices underlying policies - do not themselves cause harm, or at least frustrate accomplishment of "therapeutic" goals of EBP. On a different front, principles of therapeutic jurisprudence (TJ) in law have been developed, most prominently in certain areas of law (e.g., mental health and family law), to support more collaborative, less traumatic advocacy and conflict resolution. This paper draws on current applications of TJ and translates such into a therapeutic approach to health care policymaking that moves beyond promotion of EBP in policy. Health care policy itself may be viewed as an intervention that impacts health, positively or not. The goal is to offer a framework for health care policymaking grounded in TJ principles that does not focus on which evidence is "right" for policy use, but rather how we can better understand how consequences of policy, intended or not, affect the well-being of populations. Such framework thus moves policymaking from an either/or debate to a data- and human-driven process. Utilizing TJ framing questions, policies can be developed and evaluated through open dialogue among diverse voices at the table, including - like interventions - the "patients" or, here, targets of such policies. Collectively, they clarify how ends sought - to enhance (or at least not impair) health - can best be achieved through policy when needed, recognizing that as an intervention, there are limits to and boundaries on the usefulness of policy.     

Politics of Law and the Lacanian Real

The paper explores the role of Jacques Lacan’s Ethics of Psychoanalysis in debates in law and legal philosophy. It proceeds by considering a debate between Slavoj Žižek and Judith Butler over Lacan’s concept of the real, which forms part of a larger discussion over the future of democracy and the rule of law (Butler et al. 2000). Through reference to discussions of the relationship between law and ethics based on the Antigone tragedy, I argue that the difference between Žižek and Butler’s positions should not be understood in terms of the correctness of their reading of Lacan, but in terms of the political commitments that inform their respective interpretations. I explain the implications of this debate over one of Lacan’s most enigmatic concepts, thereby showing how Lacan’s theory can be used to rethink the politics of law in light of the increased emphasis on ethics in contemporary legal debates.     

REPRESENTATION DISPARITIES AND IMPARTIALITY: AN EMPIRICAL ANALYSIS OF PARTY PERCEPTION OF FEAR,PREPARATION, AND SATISFACTION IN DIVORCE MEDIATION WHEN ONLY ONE PARTY HAS COUNSEL

While other authors have regarded both the presence and the absence of attorneys in family law mediation as cause for concern, little attention has been given to the questions raised when one party is represented and the other is pro se. This article presents data on mediating parties' premediation concerns, fears, and feelings of preparedness, as well as their postmediation satisfaction with the mediation process. The mediating parties are grouped based on each couple's representation status, for example, both represented by attorneys, both pro se, or one attorney‐represented party and one pro se party (mixed representation cases). The data show that mixed representation cases are the most likely to report concern, fear, and unpreparedness. Mixed‐representation cases also reported the lowest levels of satisfaction after the mediation. Some implications for mediation practice are discussed, as are suggestions for future research.     

Trace DNA Sampling Success from Evidence Items Commonly Encountered in Forensic Casework

Trace DNA analysis is a significant part of a forensic laboratory's workload. Knowing optimal sampling strategies and item success rates for particular item types can assist in evidence selection and examination processes and shorten turnaround times. In this study, forensic short tandem repeat (STR) casework results were reviewed to determine how often STR profiles suitable for comparison were obtained from “handler” and “wearer” areas of 764 items commonly submitted for examination. One hundred and fifty‐five (155) items obtained from volunteers were also sampled. Items were analyzed for best sampling location and strategy. For casework items, headwear and gloves provided the highest success rates. Experimentally, eyeglasses and earphones, T‐shirts, fabric gloves and watches provided the highest success rates. Eyeglasses and latex gloves provided optimal results if the entire surfaces were swabbed. In general, at least 10%, and up to 88% of all trace DNA analyses resulted in suitable STR profiles for comparison.     

“I was prepared for the worst I guess”: stayers’ and leavers’ perceptions of their Title IV-E education

ABSTRACT

Child welfare workforces across the nation are experiencing high turnover and have for decades. The chronic cost of turnover makes efforts to increase retention crucial. The Title IV-E education stipend program is one way that many states employ to improve their child welfare worker tenure. Through qualitative interviews, this study examines Title IV-E graduates’ experiences and perceptions of preparedness for working in child welfare agencies. Examining how the responses of stayers and leavers differ and assessing similarities collectively can inform educational and agency enhancements to improve services, as well as worker competence and retention.