A discrete choice experiment investigating preferences for funding drugs used to treat orphan diseases: an exploratory study

Policy debate about funding criteria for drugs used to treat rare, orphan diseases is gaining prominence. This study presents evidence from a discrete choice experiment using a convenience sample of university students to investigate individual preferences regarding public funding for drugs used to treat rare diseases and common diseases. This pilot study finds that: other things equal, the respondents do not prefer to have the government spend more for drugs used to treat rare diseases; that respondents are not willing to pay more per life year gained for a rare disease than a common disease; and that respondents weigh relevant attributes of the coverage decisions (e.g. costs, disease severity and treatment effectiveness) similarly for both rare and common diseases. The results confirm the importance of severity and treatment effectiveness in preferences for public funding. Although this is the first study of its kind, the results send a cautionary message regarding the special treatment of orphan drugs in coverage decision-making.     

Back from the future: did the LETR really prepare us for the future?

The eagerly awaited outcomes of the Legal Education and Training Review provide a richness of data on the nature and content of legal education which is invaluable for legal education researchers. However, it is argued here that in so far as the Review was concerned with context and with preparing providers of legal services for a more challenging future, it neglected or understated some key issues. The extent of change in terms of the growth in the unregulated sector and in the way services are delivered, along with significant change in the way legal education and training itself is provided were perhaps all underestimated. Importantly, it is argued that the regulatory framework of the EU and its current developments and controversies were barely touched on yet not only is that framework directly relevant but it also has much to offer in terms of experience and ideas.     

Untangling Social and Political Capital in Latin American Democracies

Robert Putnam extolled the virtue of social capital by arguing that social networks, civil society, and trust contribute to democracy. Subsequent research, however, identified a weakness in the social capital “model” in its underspecification of the mechanisms by which social capital affects political systems. This article proposes the concept of political capital as a likely product of social capital that links civil society participants to the political system. The article tests this two‐stage model of social capital and political capital and their effects on democratization using survey data from eight Latin American nations. Results find that civil society engagement in 2004 affected political capital variables, which, in turn, had positive effects on system‐level democracy measures in 2010. The article thus shows that political capital serves as an intervening variable between social capital and democracy and democratization.     

Massive systemic fat embolism detected by postmortem imaging and biopsy*

Postmortem computed tomography (pmCT) and pmCT angiography (pmCTA) provide a minimally invasive method to determine the cause of death. Postmortem image-guided biopsy allows for precise sampling of histological specimens. This case study describes the findings of lethal systemic fat embolism (FE) on whole-body unenhanced pmCT, pmCTA, and image-guided biopsy, with autopsy and histopathologic correlation. Unenhanced pmCT revealed a distinct fat level on top of sedimented layers of corpuscular blood particles and serum in the arterial system and pulmonary trunk. Subsequent pmCTA showed reproducible results, and image-guided biopsy confirmed fatal FE. pm CT/pmCTA combined with image-guided biopsy established the cause of death as right heart failure as a result of systemic fatal FE prior to autopsy. All imaging findings were consistent with traditional autopsy and histological specimens. This unique case demonstrates new imaging findings in massive, fatal FE and highlights that postmortem imaging, supplemented by image-guided biopsy, may detect the cause of death prior to traditional autopsy.     

Exposure to intimate partner violence, peer relations, and risk for internalizing behaviors: a prospective longitudinal study

The present study examines the quality of peer relations as a mediator between exposure to IPV (intimate partner violence) and internalizing behaviors in a sample of 129 preadolescents and adolescents (ages 10-18), who were interviewed via telephone as part of a multigenerational, prospective, longitudinal study. Relational victimization is also examined as a moderator of IPV exposure on internalizing behaviors. Results demonstrate a significant association of exposure to severe IPV and internalizing behaviors. Relational victimization is found to moderate the effects of exposure to severe IPV on internalizing behaviors. The present findings suggest that the effects of exposure to IPV had a particularly important effect on the risk for internalizing problems if the adolescent also experienced relational victimization. Conversely, the receipt of prosocial behaviors buffer against the effects of IPV exposure on internalizing symptoms in teen girls.     

Adverse Childhood Experiences (ACE) Within a Social Disadvantage Framework: Distinguishing Unique, Cumulative, and Moderated Contributions to Adult Mental Health

The deleterious impact of adverse childhood experiences (ACE) may be confounded with frequently co-occurring social disadvantage. In this analysis we test the effects of ACE on adult mental health within a social disadvantage framework, using a population-based survey (n?=?7,444; mean age?=?55.2 years) from Washington State. We also examined the protective effects of socioemotional support, and the distinct and combined contribution of the measured ACE factors. Results demonstrated sustained impact of ACE on mental health many decades later, even net of social disadvantage and demographic contributors. Protective factors provided both direct and moderating influences, potentially masking the elevated effects of ACE for those with few resources. Toxicity examination of ACE items evinced differential effects of ACE experiences on mental health. These results demonstrate that interventions ameliorating the effects of ACE and bolstering protective resources such as socioemotional support may be effective toward augmenting mental health even late in life.     

Towards community‐based monitoring in Manitoba's hog industry

Abstract: Rapid changes in the hog industry in Manitoba have resulted in a gap in the province's resource and environmental policy regime. Concerns about potential, uncertain environmental impacts and an outdated regulatory framework led to a moratorium on new hog industry operations and a provincial hearing. Based on extensive literature, documentary and legislative reviews, this article explores the role of monitoring, and the potential for community‐based monitoring specifically, to address these policy issues. Given the non‐point nature of the pollution in question, the social and economic conditions in southern Manitoba and the strengths of community‐based monitoring initiatives, this approach is a promising solution. Furthermore, the existing legal framework provides an existing grounding through which the program could be vested with authority. Sommaire: Des changements rapides dans l'industrie porcine au Manitoba ont entraîné un fossé entre la politique des ressources et celle de l'environnement de la province. Les inquiétudes au sujet d'éventuelles conséquences environnementales et d'un cadre de réglementation dépassé ont conduit à un moratoire sur les nouvelles opérations dans l'industrie porcine et à une audience provinciale. En s'appuyant sur une importante documentation et sur des études documentaires et législatives, cet article approfondit le rôle de la surveillance, et plus particulièrement le rôle possible de la surveillance communautaire, pour s'attaquer à ces questions de politiques. Étant donné la nature non ponctuelle de la pollution en question, les conditions sociales et économiques dans le sud du Manitoba et la force des initiatives communautaires, cette approche est une solution prometteuse. En outre, le cadre juridique actuel fournit une base existante qui permettrait au programme d'être investi d'une certaine autorité.     

Interstate Communication Among State Legislators Regarding Energy Policy Innovation

This study, using survey data of legislators in six states,examines the prevalence of cross-state cue-taking. The findingsregarding the sources of policy ideas are similar to those reportedin studies of agency officials. Regionalism is most important,although a few states are recognized as national leaders. Supportfor innovative energy policies among state legislators was positivelyrelated to two variables: the extent to which one engaged incue-taking and the degree to which the respondents were supportiveof external communication. A comparison of the six states showsthat extensive interstate communication is not a necessary conditionfor legislative support of innovative policies; an orientationsupportive of external cue-taking is sufficient.