Getting out what we put in: productivity of the English National Health Service

Many countries are incorporating direct measures of non-market outputs in the national accounts. For any particular output to be included there has to be data about it for two adjacent periods. This is problematic because the classification of non-market outputs is often subject to wholesale revision. We outline the challenges associated with classification changes and propose a solution. To illustrate we construct output and input indices and estimate productivity growth of the English National Health Service (NHS) for the period 2003-2004 to 2007-2008. Our index of output growth incorporates all care provided to NHS patients and captures improvements in survival rates, waiting times and disease management. We find that more patients are being treated and the quality of the care they receive has been improving. We implement our approach to dealing with changes as to how health services are defined and show what effect this has on estimates of output growth. Our index of input growth captures all labour, intermediate and capital inputs into health service production and we improve on how capital has been measured in the past. Inputs have increased over time but there has also been a slowdown since 2005-2006, primarily the result of a levelling off in staff recruitment and less reliance on the use of agency staff. Productivity is assessed by comparing output growth with growth in inputs, the net effect being constant productivity growth between 2003-2004 and 2007-2008.     

Sudden death as a complication of bacterial endocarditis

Three cases are reported to demonstrate the range of possible lesions and wide variation in lethal mechanisms that may be found in cases of unexpected death subsequently shown to be due to bacterial endocarditis. Case 1: A 36-year-old man was found dead on his bedroom floor surrounded by drug paraphernalia. At autopsy, acute myocardial ischemia was present caused by coronary artery ostial occlusion complicating acute bacterial endocarditis of the aortic valve. Case 2: A 54-year-old man with chronic renal failure was found dead in bed at home. At autopsy, a left middle cerebral artery territory cerebral infarct was present due to septic embolization from bacterial endocarditis involving the aortic valve. Case 3: A 23-year-old man was found collapsed in a pool of blood. At autopsy, upper airway hemorrhage from an arteriobronchial fistula was present caused by septic pulmonary infarction from previous endocarditis of a congenital ventricular septal defect. This report demonstrates that bacterial endocarditis may still be a cause of sudden and unexpected death presenting to forensic mortuaries and that the underlying mechanisms may involve complex sequences of pathological changes that compromise vascular function.     

The urban context: a place to eliminate health disparities and build organizational capacity

This study seeks to examine the process of building the capacity to address health disparities in several urban African American neighborhoods. An inter-organizational network consisting of a research university, community members, community organizations, media partners, and foundations was formed to develop a community-based intervention designed to provide health promotion and disease prevention strategies for type 2 diabetes and hypertension. In-depth qualitative interviews (n = 18) with foundation executives and project directors, civic organization leadership, community leaders, county epidemiologist, and university partners were conducted. Our study contextualizes a process to build a public health partnership using cultural, community, organizational, and societal factors necessary to address health disparities. Results showed 5 important factors to build organizational capacity: leadership, institutional commitment, trust, credibility, and inter-organizational networks. These factors reflected other important organizational and community capacity indicators such as: community context, organizational policies, practices and structures, and the establishment of new commitments and partnerships important to comprehensively address urban health disparities. Understanding these factors to address African American health disparities will provide lessons learned for health educators, researchers, practitioners, foundations, and communities interested in building and sustaining capacity efforts through the design, implementation, and maintenance of a community-based health promotion intervention.     

Emergent authority and expert knowledge: Psychiatry and criminal responsibility in the UK

In the UK context, the rise of the discipline and practice of forensic psychiatry is intimately connected with the concurrent development of principles and practices relating to criminal responsibility. In this article, we seek to chart the relationship between psychiatry and the principles and practices of criminal responsibility in the UK over the early modern, modern and late modern periods. With a focus on claims about authority and expert knowledge around criminal responsibility, we suggest that these claims have been in a state of perpetual negotiation and that, as a result, claims to authority over and knowledge about criminal non-responsibility on the part of psychiatrists and psychiatry are most accurately understood as emergent and contingent. The apparent formalism of legal discourse has tended to conceal the extent to which legal policy has been preoccupied with maintaining the primacy of lay judgments in criminal processes of evaluation and adjudication. While this policy has been somewhat successful in the context of the trial – particularly the murder trial – it has been undermined by administrative procedures surrounding the trial, including those that substitute treatment for punishment without, or in spite of, a formal determination of criminal responsibility.     

Would John Stuart Mill have Regulated Pornography?

John Stuart Mill dominates contemporary pornography debates where he is routinely invoked as an authoritative defence against regulation. This article, by contrast, argues that a broader understanding of Mill's ethical liberalism, his utilitarianism, and his feminism casts doubt over such an assumption. New insights into Mill's approach to sex, sexual activity, and the regulation of prostitution reveal an altogether more nuanced and activist approach. We conclude that John Stuart Mill would almost certainly have accepted certain forms of pornography regulation and, in this light, we argue that Mill can provide the foundation for new, liberal justifications of some forms of pornography regulation.     

“He did everything he possibly could for me”: medical malpractice claimants’ experiences of lawyer–client relations

Lawyers are obliged to act in the interests of their clients, however, it is not clear how lawyers should do this in practice. Should lawyers follow their clients' instructions without deviation, should they actively manage their clients' expectations, or as many studies suggest, do lawyers place their own interests first? This paper examines how lawyers interact with medical malpractice claimants. It reveals that lawyers take a client-aligned approach, where lawyers acknowledge their client's goals, but do not necessarily do what the client says. We argue that this approach is made necessary by legal and organisational constraints which limit the ability of lawyers to produce the types of outcomes that their clients want.     

Modeling the Referral Decision in Sexual Assault Cases: An Application of Random Forests

This paper examines the decision to refer a sexual assault case for prosecution using a sample of 730 reported sexual assaults in which the victim received a medical/forensic examination. The decision to refer a case for prosecution was modeled using an algorithmic modeling technique, Random Forests. The key advantages of this modeling approach include its superiority in predicting case outcomes and its ability to easily uncover nonlinear relationships. Key results indicate that the likelihood of referral increased when sperm was found and documented, when the victim could identify the suspect, and as the severity of nongenital injury increased. Neither the presence nor the severity of genital injury impacted the decision to refer a case for prosecution. On the whole, suspect and report characteristics had the largest impact on referring cases for prosecution, with victim characteristics having little influence.     

Scavenging behavior of Lynx rufus on human remains during the winter months of Southeast Texas

Animal-scavenging alterations on human remains can be mistaken as human criminal activity. A 32-day study, documenting animal scavenging on a human cadaver, was conducted at the Southeast Texas Applied Forensic Science facility, Sam Houston State University, Huntsville, Texas. A Stealth Cam Rogue IR was positioned near the cadaver to capture scavenging activity. An atypical scavenger, the bobcat, Lynx rufus, was recorded feeding on the cadaver. Scavenging by bobcats on human remains is not a predominant behavior and has minimal documentation. Scavenging behaviors and destruction of body tissues were analyzed. Results show that the bobcat did not feed on areas of the body that it does for other large animal carcasses. Results also show the bobcat feeds similarly during peak and nonpeak hours. Understanding the destruction of human tissue and covering of the body with leaf debris may aid forensic anthropologists and pathologists in differentiating between nefarious human activity and animal scavenging.     

Personal identification by the comparison of facial profiles: testing the reliability of a high-resolution 3D-2D comparison model

Identification from video surveillance systems is frequently requested in forensic practice. The "3D-2D" comparison has proven to be reliable in assessing identification but still requires standardization; this study concerns the validation of the 3D-2D profile comparison. The 3D models of the faces of five individuals were compared with photographs from the same subjects as well as from another 45 individuals. The difference in area and distance between maxima (glabella, tip of nose, fore point of upper and lower lips, pogonion) and minima points (selion, subnasale, stomion, suprapogonion) were measured. The highest difference in area between the 3D model and the 2D image was between 43 and 133 mm(2) in the five matches, always greater than 157 mm(2) in mismatches; the mean distance between the points was greater than 1.96 mm in mismatches, <1.9 mm in five matches (p < 0.05). These results indicate that this difference in areas may point toward a manner of distinguishing "correct" from "incorrect" matches.