Household income dynamics: a four-country story

In this article, we analyse the dynamics of household per capita incomes using longitudinal data from Indonesia, South Africa, Spain and Venezuela. We find that in all four countries reported initial income and job changes of the head are consistently the most important variables in accounting for income changes, overall and for initially poor households. We also find that changes in income are more important than changes in household size and that changes in labour earnings are more important than changes in other sources of household income.     

Back to first principles: a new model for the regulation of drug promotion

The US Food and Drug Administration''s (‘FDA’ or the ‘Agency’) current regulatory framework for drug promotion, by significantly restricting the ability of drug manufacturers to communicate important, accurate, up-to-date scientific information about their products that is truthful and non-misleading, runs afoul of the First Amendment and actually runs counter to the Agency''s public health mission. Our article proposes a New Model that represents an initial proposal for a modern, sustainable regulatory framework that comprehensively addresses drug promotion while protecting the public health, protecting manufacturers’ First Amendment rights, establishing clear and understandable rules, and maintaining the integrity of the FDA approval process. The New Model would create three categories of manufacturer communications—(1) Scientific Exchange and Other Exempt Communications, (2) Non-Core Communications, and (3) Core Communications—that would be regulated consistent with the First Amendment and according to the strength of the government''s interest in regulating the specific communications included within each category. The New Model should address the FDA''s concerns related to off-label speech while protecting drug manufacturers’ freedom to engage in truthful and non-misleading communications about their products.     

Parent and Metabolite Opioid Drug Concentrations in Unintentional Deaths Involving Opioid and Benzodiazepine Combinations,,

Effects of benzodiazepines on postmortem opioid parent and parent/metabolite blood concentration ratios were determined for fentanyl‐, hydrocodone‐, methadone‐, or oxycodone‐related accidental deaths. These opioids are partially metabolized by the CYP3A4 enzyme system, which is also affected by diazepam and alprazolam. Opioid/metabolite combinations examined were as follows: fentanyl/norfentanyl, hydrocodone/dihydrocodeine, methadone/EDDP, and oxycodone/oxymorphone. Parent opioid concentrations were analyzed for 877 deaths. Parent/metabolite concentration ratios were analyzed for 349 deaths, excluding cases with co‐intoxicants present known to interfere with opioid elimination. Alprazolam in combination with diazepam significantly decreased median hydrocodone concentrations by 48% (p = 0.01) compared to hydrocodone alone. The methadone parent/metabolite concentration ratio was reduced by 35% in the presence of diazepam compared to methadone alone (p = 0.03). Benzodiazepines did not statistically significantly affect fentanyl or oxycodone concentrations. Possible factors affecting opioid concentrations and possible toxicity development, including any differential effects on specific opioids, should continue to be explored.     

An examination of emergency room physicians' practice of positive and negative defeivsive medicine

Substantial diversity exists in the estimates associated with the practice of defensive medicine. Physicians' efforts to limit legal liability have generally been grouped into risk reduction strategies (positive defensive medicine) and risk avoidance strategies (negative defensive medicine). This article examines the practice of these forms of defensive medicine in a ‘high-risk’ specialty -emergency medicine. A sample of North American emergency medicine. physicians provided data for the study at hand. The results, which failed to substantiate some popularly-held and previously untested suppositions associated with the practice of defensive medicine, point to the danger of making broad generalizations across physician specialities.     

Comparison of Commercial Kits for Recovery and Analysis of Bacterial DNA From Fingerprints

In forensic science, fingerprints are a common source of evidentiary information. However, latent examination is not always successful and trace human DNA cannot always be obtained. Thus, examining the fingerprint microbiome may offer a suitable alternative to more traditional methods of forensic identification. The Zymo Research ZR Bacterial/Fungal DNA MicroPrep™ Kit, Qiagen QIAmp^® DNA Mini Kit, Promega Wizard^® Genomic DNA Purification Kit, and the MPBio FastDNA^® Spin Kit were compared for their ability to yield a sufficient amount of bacterial DNA for next-generation sequencing in order to obtain a microbiome profile. Prints were deposited onto slides, allowed to sit for up to 1 month, and total DNA isolated and quantified using each kit. The kit from Zymo Research yielded the most concentrated DNA sample (0.0084 ng/µL) in the least amount of time as compared to other kits examined. Although this amount of DNA was far below the recommended DNA concentration threshold recommended for next-generation sequencing, a microbiome profile was successfully obtained. As interest in using the microbiome of an individual as a forensic tool continues to increase, there is the possibility that the microbiome of a fingerprint could complement traditional human DNA profiling in the future. This study provides evidence that trace amounts of bacterial DNA from fingerprints is quantifiable and sufficient for microbiome analysis.     

Engaging Adversaries: Myths and Realities in American Foreign Policy

American policy-makers and politicians present specious rationales for abjuring diplomatic engagement with adversarial regimes and actors. The conventional wisdom is that negotiating with adversaries is futile and a form of reward that the enemy will exploit. This tool of statecraft, therefore, should be avoided. However, many of the objections for avoiding diplomacy are suspect when examined closely. In addition, though prominent adversaries like Iran have generally shunned the United States, it has regularly engaged other hostile and adversarial regimes and non-state actors. The selective use of specious reasons contributes to an American foreign policy that often prefers the isolation and containment of ‘rogue states.’ Additionally, myths like the futility of appeasing adversaries have taken hold, and practitioners rarely question it. The post-Cold War American ‘diplomacy allergy’ is often counter-productive and stands in contrast to Cold War pragmatism.