Back to the future? Diabetes, HIV, and the boundaries of public health

The control of infectious diseases has traditionally fallen to public health and the clinical care of chronic diseases to private medicine. In New York City, however, the Department of Health and Mental Hygiene (DOHMH) has recently sought to expand its responsibilities in the oversight and management of chronic-disease care. In December 2005, in an effort to control epidemic rates of diabetes, the DOHMH began implementing a bold new plan for increased disease surveillance through electronic, laboratory-based reporting of A1C test results (a robust measure of blood-sugar levels). The controversy A1C reporting produced was relatively contained, but when Dr. Thomas Frieden, New York City health commissioner, called for the state to begin tracking viral loads and drug resistance among patients with HIV, both the medical community and a wider public took notice and have started to grapple with the meaning of expanded surveillance. In the context of the past century of medical surveillance in America, we analyze the current debates, focusing first on diabetes and then HIV. We identify the points of contention that arise from the city's proposed blend of public health surveillance, disease management, and quality improvement and suggest an approach to balancing the measures' perils and promises.     

Waxing grave about adipocere: soft tissue change in an aquatic context

When postmortem environmental conditions are "just right," according to the "Goldilocks Phenomenon," soft tissues (and associated fatty acids) are converted into and preserved as adipocere. To better understand this conversion process and the development of adipocere three human cadavers were immersed in outside, water-filled pits for over 3 months to observe adipocere formation in an underwater context simulating actual field conditions. Recordings of environmental conditions showed that temperatures were between 21 degrees C and 45 degrees C, a range sufficient for the growth of Clostridium perfringens. Chemical analysis of liquid and tissue samples revealed an increase in palmitic acid and decrease in oleic acid. This study tracked the remarkable gross morphological changes that can occur in human bodies subjected to an aquatic postmortem environment. The results support the "Goldilocks Phenomenon" and substantiate previous findings that the presence of bacteria and water is crucial for adipocere to form.     

Validation of Ultrastructural Analysis of Mitochondrial Deposits in Cardiomyocytes as a Method of Detecting Early Acute Myocardial Infarction in Humans*

Abstract: In the present study, ultrastructural analysis of mitochondrial deposits (black dots within mitochondria) as a method for the detection of early acute myocardial infarction (AMI) was evaluated. In 24 patients with AMI and six controls, analysis was performed in the heart of infarcted patients and noninfarcted controls. In the infarction area in lactate dehydrogenase (LDH)‐diagnosed AMI, the percentage of positive mitochondria was significantly higher compared to corresponding heart tissue in control patients and compared to noninfarcted areas within these patients. Also in patients with a clinically diagnosed AMI but no LDH decoloration, a significant higher percentage of positive mitochondria was found in the left ventricle compared to controls and noninfarcted areas. In patients with AMI, an increase in mitochondria with deposits was found in the infarction area compared to controls and noninfarcted tissue within the same patient, suggesting that electron microscopical changes in mitochondria can be used for the diagnosis of AMI less than 3 h old.     

Root Morphology and Anatomical Patterns in Forensic Dental Identification: A Comparison of Computer‐Aided Identification with Traditional Forensic Dental Identification*

Abstract: An online forensic dental identification exercise was conducted involving 24 antemortem–postmortem (AM–PM) dental radiograph pairs from actual forensic identification cases. Images had been digitally cropped to remove coronal tooth structure and dental restorations. Volunteer forensic odontologists were passively recruited to compare the AM–PM dental radiographs online and conclude identification status using the guidelines for identification from the American Board of Forensic Odontology. The mean accuracy rate for identification was 86.0% (standard deviation 9.2%). The same radiograph pairs were compared using a digital imaging software algorithm, which generated a normalized coefficient of similarity for each pair. Twenty of the radiograph pairs generated a mean accuracy of 85.0%. Four of the pairs could not be used to generate a coefficient of similarity. Receiver operator curve and area under the curve statistical analysis confirmed good discrimination abilities of both methods (online exercise = 0.978; UT‐ID index = 0.923) and Spearman’s rank correlation coefficient analysis (0.683) indicated good correlation between the results of both methods. Computer‐aided dental identification allows for an objective comparison of AM–PM radiographs and can be a useful tool to support a forensic dental identification conclusion.     

Assessing the victim-offender overlap among Puerto Rican youth

Purpose

Knowledge about offenders and knowledge about victims has traditionally been undertaken without formal consideration of the overlap among the two. A small but growing research agenda has examined the extent of this overlap. At the same time, there has been a minimal amount of research regarding offending and victimization among minority youth, and this is most apparent with respect to Hispanics, who have been increasing in population in the United States.

Materials &; Methods

This study explores the joint, longitudinal overlap between offending and victimization among a sample of Puerto Rican youth from the Bronx, New York.

Results

Results indicate: (1) an overlap between offending and victimization that persists over time, (2) a considerable overlap in the number, type, direction, and magnitude of the effect of individual, familial, peer, and contextual factors on both offending and victimization, (3) some of the factors related to offending were only relevant at baseline and not for the growth in offending but that several factors were associated with the growth in victimization, and (4) various risk factors could not explain much of the overlap between offending and victimization.

Conclusions

Theoretical, policy, and future research directions are addressed.     

When does the Apple Fall from the Tree? Static Versus Dynamic Theories Predicting Intergenerational Transmission of Convictions

Criminal behavior of parents substantially affects the criminal behavior of children. Little is known, however, about how crime is transmitted from one generation to the next. In order to test two possible explanations against each other, we pose the question whether the timing of the criminal acts of fathers is important for children’s chances of committing crime. Static theories predict that it is the number of delinquent acts performed by fathers that is important, and that the particular timing does not affect the child’s chance of committing crime. Dynamic theories state that the timing is important, and children have a greater chance of committing crime in the period after fathers have committed delinquent acts. Results show that the total number of convictions of a father is indeed very important, but also the exact timing is key to understanding intergenerational transmission of crime. In the year a father is convicted the chance his child is also convicted increases substantially and it decays in subsequent years. This decay takes longer the more crimes father has committed. Our results show that some of the assumptions of the static theories at least need to be adjusted.     

Therapeutic jurisprudence: A framework for evidence-informed health care policymaking

Translation of evidence-based practice (EBP) into health care policy is of growing importance, with discussions most often focused on how to fund and otherwise promote EBP through policy (i.e., at system level, beyond the bedside). Less attention has been focused on how to ensure that such policies - as enacted and implemented, and as distinguished from the practices underlying policies - do not themselves cause harm, or at least frustrate accomplishment of "therapeutic" goals of EBP. On a different front, principles of therapeutic jurisprudence (TJ) in law have been developed, most prominently in certain areas of law (e.g., mental health and family law), to support more collaborative, less traumatic advocacy and conflict resolution. This paper draws on current applications of TJ and translates such into a therapeutic approach to health care policymaking that moves beyond promotion of EBP in policy. Health care policy itself may be viewed as an intervention that impacts health, positively or not. The goal is to offer a framework for health care policymaking grounded in TJ principles that does not focus on which evidence is "right" for policy use, but rather how we can better understand how consequences of policy, intended or not, affect the well-being of populations. Such framework thus moves policymaking from an either/or debate to a data- and human-driven process. Utilizing TJ framing questions, policies can be developed and evaluated through open dialogue among diverse voices at the table, including - like interventions - the "patients" or, here, targets of such policies. Collectively, they clarify how ends sought - to enhance (or at least not impair) health - can best be achieved through policy when needed, recognizing that as an intervention, there are limits to and boundaries on the usefulness of policy.     

An Integrated Model of Legal and Moral Reasoning and Rule-Violating Behavior: The Role of Legal Attitudes

Legal socialization theory predicts that attitudes mediate the relation between legal reasoning and rule-violating behavior [Cohn, E. S., & White, S. O. (1990). Legal Socialization: A Study of Norms and Rules. New York: Springer-Verlag]. Moral development theory predicts that moral reasoning predicts rule-violating behavior directly as well as indirectly [Blasi, A. (1980). Bridging moral cognition and moral action: A critical review of the literature. Psychological Bulletin, 88, 1–45]. We present and test an integrated model of rule-violating behavior drawing on both theories in a longitudinal study of middle school and high school students. Students completed questionnaires three times during the course of 1 year at 6-month intervals. Legal and moral reasoning, legal attitudes, and rule-violating behavior were measured at times one, two, and three respectively. Structural equation models revealed that while moral and legal reasoning were directly and indirectly related to rule-violating behavior among high school students, legal reasoning bore no direct relation to rule-violating behavior among middle school students. The implications for an integrated model of reasoning and rule-violating behavior are discussed.     

Politics of Law and the Lacanian Real

The paper explores the role of Jacques Lacan’s Ethics of Psychoanalysis in debates in law and legal philosophy. It proceeds by considering a debate between Slavoj Žižek and Judith Butler over Lacan’s concept of the real, which forms part of a larger discussion over the future of democracy and the rule of law (Butler et al. 2000). Through reference to discussions of the relationship between law and ethics based on the Antigone tragedy, I argue that the difference between Žižek and Butler’s positions should not be understood in terms of the correctness of their reading of Lacan, but in terms of the political commitments that inform their respective interpretations. I explain the implications of this debate over one of Lacan’s most enigmatic concepts, thereby showing how Lacan’s theory can be used to rethink the politics of law in light of the increased emphasis on ethics in contemporary legal debates.