Barriers to the operation of mental health legislation in Australian emergency departments: a qualitative analysis

This study aimed to describe the perceived barriers faced by emergency clinicians in utilising mental health legislation in Australian hospital emergency departments. A semi-structured interview methodology was used to assess what barriers emergency department doctors and nurses perceive in the operation of mental health legislation. Key findings from the interview data were drawn in accordance with the most commonly represented themes. A total of 36 interviews were conducted with 20 members of the Australasian College for Emergency Medicine and 16 members of the College for Emergency Nursing Australasia representing the various Australian jurisdictions. Most concerning to clinicians were the effects of access block and overcrowding on the appropriate use of mental health legislation, and the substandard medical care that mental health patients received as a result of long periods in the emergency department. Many respondents were concerned about the lack of applicability of mental health legislation to the emergency department environment, variation in legislation between States and Territories causing problems for clinicians working interstate, and a lack of knowledge and training in mental health legislation. Many felt that clarification of legislative issues around duty of care and intoxicated or violent patients was required. The authors conclude that access block has detrimental effects on emergency mental health care as it does in other areas of emergency medicine. Consideration should be given to uniform national mental health legislation to better serve the needs of people with mental health emergencies.     

Partisan Activism and Access to Welfare in Lebanon

How do welfare regimes function when state institutions are weak and ethnic or sectarian groups control access to basic services? This paper explores how people gain access to basic services in Lebanon, where sectarian political parties from all major religious communities are key providers of social assistance and services. Based on analyses of an original national survey (n?=?1,911) as well as in-depth interviews with providers and other elites (n?=?175) and beneficiaries of social programs (n?=?135), I make two main empirical claims in the paper. First, political activism and a demonstrated commitment to a party are associated with access to social assistance; and second, higher levels of political activism may facilitate access to higher levels or quantities of aid, including food baskets and financial assistance for medical and educational costs. These arguments highlight how politics can mediate access to social assistance in direct ways and add new dimensions to scholarly debates about clientelism by focusing on contexts with politicized religious identities and by problematizing the actual goods and services exchanged.     

Unsuspected hereditary hemochromatosis at forensic autopsy: its presentation, confirmation, and implications

Hereditary hemochromatosis (HH) is one of the most common genetic disorders and may present clinically in a variety of ways. The most common presentation is micronodular cirrhosis with possible associated diabetes. However, HH may also present with cardiac dysfunction and sudden death. The confirmation of unsuspected HH at autopsy is complicated by the growing number of genetic abnormalities, which are not detected by current commercial genetic testing for C282Y and H63D mutations. Consequently, quantitative liver iron studies on fresh or paraffin embedded liver is recommended in confirming HH. The importance of detection and confirmation of HH cannot be overemphasized given the need to screen surviving family members in preventing organ damage of asymptomatic individuals. We present a case of a 38-year-old white woman with micronodular cirrhosis secondary to unsuspected HH that was confirmed by a quantitative liver iron study. The possible presentation of cardiac sudden death from HH, confirmation issues and implications of a HH diagnosis for surviving family members are also discussed.     

Immigrants en banlieue et politiques publiques municipales : le cas lavallois (Québec,Canada)

Abstract: The growing number of new immigrants settling in suburban communities has caused researchers and policy‐makers to shift their focus from large cities to the communities that surround them, thereby side‐swiping several stereotypes commonly associated with “white” and “wealthy” suburban cities in North America. My article responds to this recent interest by proposing an analysis of the public policies that apply to immigrants and ethno‐cultural minorities in Laval, north of Montreal. The article establishes that Laval has had a policy in place since the early 1990s, with a specific institutional configuration that changes over time. I discerned two institutional configurations shaping two distinct sequences for this policy. The first sequence (1990–2003) involved an institutional configuration that shut down the channels for the representation of the interests of immigrants and ethno‐cultural minorities on the municipal level, and the second sequence (2003–2009) was marked by the regionalization of the shutdown of the mediation channels for the representation of these interests. In each sequence, the shutdown of the mediation channels is illustrated in three areas of this public policy: intergovernmental agreements, the recognition of associations, and affirmative action in the municipal public service.     

Progress Toward the Determination of Correct Classification Rates in Fire Debris Analysis II: Utilizing Soft Independent Modeling of Class Analogy (SIMCA)

A multistep classification scheme was used to detect and classify ignitable liquid residues in fire debris into the classes defined by the ASTM E1618‐10 standard method. The total ion spectra (TIS) of the samples were classified by soft independent modeling of class analogy (SIMCA) with cross‐validation and tested on fire debris. For detection of ignitable liquid residue, the true‐positive rate was 94.2% for cross‐validation and 79.1% for fire debris, with false‐positive rates of 5.1% and 8.9%, respectively. Evaluation of SIMCA classifications for fire debris relative to a reviewer's examination led to an increase in the true‐positive rate to 95.1%; however, the false‐positive rate also increased to 15.0%. The correct classification rates for assigning ignitable liquid residues into ASTM E1618‐10 classes were generally in the range of 80–90%, with the exception of gasoline samples, which were incorrectly classified as aromatic solvents following evaporative weathering in fire debris.     

Establishing Tobacco Origin from Pollen Identification: An Approach to Resolving the Debate

Previous research into pollen content of tobacco resulted in a debate. We address this debate and determine that pollen analysis may be able to assist with identifying geographical origin of tobacco. However, the value of any results should be assessed on a case‐by‐case regional basis until sufficient database information is available for an objective interpretation to be undertaken on a global basis. As a first step toward developing comparative data for South America, we analyzed a tobacco sample from Brazil in an effort to identify signature taxa from the state of Minas Gerais. We also assessed the role of honey additives to tobacco to assess this issue. Comparing the data to previously published data, we conclude that pollen signatures can distinguish broad geographic areas. We conclude that this forensic interpretation framework needs to be developed in context of the National Academy of Sciences recommendations for tightening methods in forensic science.     

Policy Advocacy in Hard Times: The Impact of Economic Performance on Gendering Executive Attention

Securing executive attention for new policy demands is notoriously difficult as governmental agendas are crowded by established or ‘core’ policy issues. This article investigates whether it is harder for new and costly policy issues to reach the government agenda when the economy is performing badly. It examines whether, and the extent to which, costly gender equality issues regarding women’s access to the labour market, equal treatment at work and care activities, are more likely to achieve executive attention when the economy is performing well. Using the Comparative Policy Agendas database, a systematic, quantitative analysis is conducted of when and why policies promoting sex equality in the division of labour reach executive agendas. The findings confirm that advocacy for costly gender equality measures is easier to make in times of economic growth. It is also found that female representation in parliament strengthens advocacy for executive attention and reduces friction on policy agenda change.     

Inconsistency in 9 mm bullets measured with non-destructive X-ray computed tomography

Fundamental to any ballistic armour standard is the reference projectile that is to be defeated. Typically, for certification, consistency of bullets is assumed. Therefore, practical variations in bullet jacket dimensions can have far reaching consequences. Traditionally, internal dimensions could only be analysed by cutting bullets which rules out any subsequent ballistic assessment. Therefore, the use of a non-destructive X-ray computed tomography (CT) method is explored in this paper. A set of 10 bullets (9 mm DM11) was taken for analysing both intra and inter bullet jacket thickness variation. CT measurements of jacket thickness were validated with high resolution scanning electron microscope (SEM) images. An image based analysis methodology has been developed to extract the jacket thickness map and the centre of gravity. Thickness variations of the order of 200 μm were found commonly across all the bullets along the length and an angular variation of up to 100 μm was found in a few bullets. Jacket thickness and centre of gravity were also calculated for the same bullets after impact and the variations between the pre- and post-impacted bullets were compared, by establishing a common physical reference. The results show that the proposed CT scanning approach and subsequent image analysis method can bring out the statistical variations in bullet geometry pre- and post impact effectively.