Health Information Technology and the Idea of Informed Consent

During this early stage of HIT adoption, it is critical that we engage in discussions regarding informed consent's proper role in a health care environment in which electronic information sharing holds primary importance. This article discusses current implementation of the doctrine within health information exchange networks; the relationship between informed consent and privacy; the variety of ways that the concept is referenced in discussions of information sharing; and challenges that surround incorporation of the doctrine into the evolving HIT environment. The article concludes by reviewing the purpose behind the traditional obligation to obtain informed consent and the possibility of maintaining its relevance in the new environment.     

CIT in context: the impact of mental health resource availability and district saturation on call dispositions

The goals of Crisis Intervention Team (CIT) programs include improving safety during encounters between police and persons with mental illnesses, diverting persons with mental illnesses away from the criminal justice system, and increasing referral and access to mental health services. CIT is a systemic intervention, and as such, its implementation and effectiveness are influenced by existing practices and infrastructures. However, little research has considered the context in which CIT programs are implemented. In this paper, we present research on CIT in four Chicago police districts that vary in terms of two contextual factors hypothesized to influence the impact of CIT training on how calls involving persons with mental illnesses are resolved. Using data from 112 patrol officers in four Chicago police districts, we consider the impact of mental health services availability and CIT saturation (the percentage of district personnel that are CIT certified). Findings indicate that CIT training increased direction to mental health services primarily in districts with greater availability of mental health services. In districts with low service availability, higher CIT saturation increased direction to mental services. The opposite pattern emerged for contact only or informal call resolution. No effects were found for arrest as a call outcome.     

Race/Ethnic-Specific Homicide Rates in New York City: Evaluating the Impact of Broken Windows Policing and Crack Cocaine Markets

The current study evaluated a range of social influences including misdemeanor arrests, drug arrests, cocaine consumption, alcohol consumption, firearm availability, and incarceration that may be associated with changes in gun-related homicides by racial/ethnic group in New York City (NYC) from 1990 to 1999. Using police precincts as the unit of analysis, we used cross-sectional, time series data to examine changes in Black, White, and Hispanic homicides, separately. Bayesian hierarchical models with a spatial error term indicated that an increase in cocaine consumption was associated with an increase in Black homicides. An increase in firearm availability was associated with an increase in Hispanic homicides. Last, there were no significant predictors for White homicides. Support was found for the crack cocaine hypotheses but not for the broken windows hypothesis. Examining racially/ethnically disaggregated data can shed light on group-sensitive mechanisms that may explain changes in homicide over time.     

Upset over Air Pollution: Analyzing Upset Event Emissions at Petroleum Refineries

The Clean Air Act (CAA) controls routine emissions at petroleum refineries, by creating limits and penalties for excess emissions. The CAA offers provisions for upset events, air emissions released because of unforeseen or unavoidable circumstances, if companies report the emissions and take corrective action. States enforce upset event rules and many states provide exemptions for a variety of circumstances, which may allow upset emissions to become a substantial, yet mostly unregulated source of emissions. We catalog the quantity and type of emissions generated during upset events at 18 Texas petroleum refineries from 2003 to 2008. We find that upset events occur frequently at these facilities and are collectively large in magnitude, emitting a combined total of 75 million lbs of emissions. In a select number of cases, single upset events exceeded annual emissions reported to the Toxics Release Inventory. Future research should assess the accuracy of upset event reporting and impact of upset events on environmental health.     

Application of a pyroprobe to simulate smoking and metabolic degradation of abused drugs through analytical pyrolysis

Smoking of illicit drugs can produce unique metabolic biomarkers. Smoking conditions can be partially modeled via pyrolysis, a process that decomposes a chemical compound by extreme heat. Pyrolytic decomposition was found to be useful as a limited metabolic mimic in that analytical pyrolysis can be used to generate some of the same compounds produced by metabolic degradation. This project focused on the pyrolysis of cocaine and methamphetamine using a pyroprobe coupled with a GC/MS and more generally, potential applications of pyrolysis to forensic toxicology. Common diluents including lidocaine, caffeine, and benzocaine were pyrolyzed in mixtures with cocaine and methamphetamine. Correlations between pyrolytic and metabolic degradations revealed that this method has the capability to produce some of the reported metabolites such as norcocaine and cocaethylene for cocaine, and amphetamine for methamphetamine. The results demonstrate that analytical pyrolysis has the potential to identify some metabolic products and to supplement in vivo and enzymatic studies.     

Not That There’s Anything Wrong with That: The Effect of Personalized Appeals on Marriage Equality Campaigns

An increasingly predominant strategy used by organizations seeking to increase support for gay marriage is to personalize the issue by focusing on individuals in the LGBT community. However, competing theoretical traditions (e.g., Allport??s contact theory, group threat, implicit bias) raise questions about whether this strategy has the desired effect. This paper presents results from an original field experiment conducted in coordination with a marriage equality organization. Callers who self-identified as a member of the LGBT community were less effective in soliciting donations compared to callers who did not self-identify, suggesting that personalization has a negative effect on persuasion efforts. The findings cut against the grain of the Allport (The nature of prejudice, 1954) hypothesis and have important implications for social advocacy organizations in terms of rhetorical and message strategy.     

Law enforcement response to mental health crises: citizen risk factors and preferences for social policy*

Despite having the potential to affect cooperation and support for law enforcement, community preferences for police training are generally unstudied. This paper seeks to understand (1) general community preferences for police training for responding to mental health crises, (2) where the public prioritizes this mental health crisis training relative to racial bias training, and (3) whether these preferences vary depending on respondent demographics and risk factors for police contact. Survey data from a general sample of Portland, Oregon residents (N = 259) shows public support for police training on responding to mental health crises, but the public as a whole is split over whether mental health, or racial bias training, should be prioritized as the best use of police training time. Logistic regression analyses demonstrate three main findings regarding the impact of respondent characteristics on preferences for police training: (1) black respondents appear concerned that, by drawing attention to mental health crises, police will be more limited in their responses to racial bias; (2) respondents facing the greatest, and those with the least, amount of risk in police/citizen encounters are most supportive of mental health crisis training; and (3) mental illness itself does not appear to affect support for police mental health crisis training. These differences in support for training need to be understood before law enforcement can cultivate community support for police officers and their training practices.