A prospective study of pathways to hospital readmission in Canadian forensic psychiatric patients

Individuals admitted to secure care often experience lengthy hospitalizations and are likely to be admitted on more than one occasion. In the context of growing demand and costs associated with secure care, the current study investigates the frequency and reasons for readmission among 87 forensic patients recently discharged into the community. We identify risk factors that are associated with the likelihood of readmission and describe areas of overlap and discordance with the existing literature in civil and forensic samples. Using a prospective design that included patient follow-up interviews and records review, we found that 28% of patients were readmitted on one or more occasions over a 12-month period. Psychiatric decompensation, substance use, and treatment non-adherence were the central reasons prompting readmission. Patients with one or more readmissions were found to have spent significantly more time in the forensic mental health system as compared to patients not readmitted. They were more likely to have a substance use disorder and were estimated to be at higher risk for violence. Results replicate the finding of low rates of serious violence and reoffending among discharged forensic patients, and substantiate the centrality of substance use as a growing and clinically important treatment issue.     

Herceptin, Pharmac and the New Zealand District Health Boards: keeping abreast of the Code of Health and Disability Services Consumers' Rights?

In an era of resource limitations, the problem of matching public expectations with health care provision will always be difficult. In New Zealand there has been recent debate surrounding the potential funding by the Pharmaceutical Management Agency (PHARMAC) of an expensive chemotherapy agent called Herceptin (trastuzumab). Taking the proposed funding options in turn, this article looks at the obligations PHARMAC and the New Zealand District Health Boards might then be subject to with respect to the legislation and the Code of Health and Disability Services Consumers' Rights, and the impact this might have on a health system already subject to resource constraints.     

The Incidental Pundit: Who Talks Politics with Whom,and Why?

Informal discussion plays a crucial role in democracy, yet much of its value depends on diversity. We describe two models of political discussion. The purposive model holds that people typically select discussants who are knowledgeable and politically similar to them. The incidental model suggests that people talk politics for mostly idiosyncratic reasons, as by-products of nonpolitical social processes. To adjudicate between these accounts, we draw on a unique, multisite, panel data set of whole networks, with information about many social relationships, attitudes, and demographics. This evidence permits a stronger foundation for inferences than more common egocentric methods. We find that incidental processes shape discussion networks much more powerfully than purposive ones. Respondents tended to report discussants with whom they share other relationships and characteristics, rather than based on expertise or political similarity, suggesting that stimulating discussion outside of echo chambers may be easier than previously thought.     

Marijuana Odor Perception: Studies Modeled from Probable Cause Cases

The 4th Amendment of the United States Constitution protects American citizens against unreasonable search and seizure without probable cause. Although law enforcement officials routinely rely solely on the sense of smell to justify probable cause when entering vehicles and dwellings to search for illicit drugs, the accuracy of their perception in this regard has rarely been questioned and, to our knowledge, never tested. In this paper, we present data from two empirical studies based upon actual legal cases in which the odor of marijuana was used as probable cause for search. In the first, we simulated a situation in which, during a routine traffic stop, the odor of packaged marijuana located in the trunk of an automobile was said to be detected through the driver's window. In the second, we investigated a report that marijuana odor was discernable from a considerable distance from the chimney effluence of diesel exhaust emanating from an illicit California grow room. Our findings suggest that the odor of marijuana was not reliably discernable by persons with an excellent sense of smell in either case. These studies are the first to examine the ability of humans to detect marijuana in simulated real-life situations encountered by law enforcement officials, and are particularly relevant to the issue of probable cause.     

In Modernism's Wake: Public Administration and Policy in the 21st Century

Hugh T. Miller, Postmodern Public Policy
Goktug Morcol, A New Mind for Policy Analysis: Toward a Post-Newtonian and Postpositivist Epistemology and Methodology
Michael W. Spicer, Public Administration and the State: A Postmodern Perspective