Chronic disease and the shifting focus of public health: is prevention still a political lightweight?

Why is it so politically difficult to obtain government investment in public health initiatives that are aimed at addressing chronic disease? This article examines the structural disadvantage faced by those who advocate for public health policies and practices to reduce chronic disease related to people's unhealthy lifestyles and physical environments. It identifies common features that make it difficult to establish and maintain initiatives to prevent or reduce costly illness and physical suffering: (1) public health benefits are generally dispersed and delayed; (2) benefactors of public health are generally unknown and taken for granted; (3) the costs of many public health initiatives are concentrated and generate opposition from those who would pay them; and (4) public health often clashes with moral values or social norms. The article concludes by discussing the importance of a new paradigm, "health in all policies," that targets the enormous health and economic burdens associated with chronic conditions and asserts a need for new policies, practices, and participation beyond the confines of traditional public health agencies and services.     

Markets and targets in the English National Health Service: is there a role for behavioral economics?

Over the past twenty years, the emphasis of reform attempts to improve efficiency within the English National Health Service (NHS) has oscillated between markets and targets. Both strategies are informed by standard economic theory but thus far have achieved varying degrees of success. Behavioral economics is currently in vogue and offers an alternative (or, in some cases, a complement) to standard economic theory on what motivates human behavior. There are many aspects to behavioral economics, but space constraints allow just three to be considered here: identity, loss aversion, and hyperbolic discounting. An attempt is made in this article to speculate on the extent to which these three concepts can explain the success or otherwise of the NHS market and target policies of the last two decades, and some suggestions are offered as to how policies might be usefully designed in the future. Arguably the key points are that people are more likely to be motivated if they identify with the ethos of the policy; the threat of losses will often provoke more of a response than the promise of gains; and the "immediate moment" matters enormously to individuals, so policies that require human action should be designed to make that moment as enjoyable (or as pain free) as possible.     

Male and female juveniles arrested for murder: a comprehensive analysis of U.S. data by offender gender

Murders committed by juveniles remain a serious concern in the United States. Most studies on juvenile homicide offenders (JHOs) have used small samples and have concentrated on male offenders. As a result, little is known about female JHOs and how they differ from their male counterparts on a national level. This study utilized the Supplementary Homicide Report (SHR) database to examine more than 40,000 murders committed by male and female juvenile offenders from 1976 to 2005. This research effort, the most expansive to date, replicated previous findings with respect to gender differences using bivariate and multivariate analyses. As predicted, six variables used to test eight hypotheses with respect to male and female JHOs in single-victim incidents were significant (victim age, victim-offender relationship, murder weapon, offender count, victim gender, and homicide circumstance). Regression analysis revealed that all variables remained significant when entered into the model. This article concludes with a discussion of our findings and directions for future research.     

The Characterization of 3,4-Dimethylmethcathinone (3,4-DMMC)

Analogs and derivatives of traditional illicit drugs are ever increasing in variety and creativity. Staying abreast of the new developments is a constant challenge for every forensic laboratory. Recently, a seizure from Australian Customs Service presented our laboratory with the designer cathinone 3,4-dimethylmethcathinone (3,4-DMMC). Gas chromatography/mass spectrometry (GC/MS), liquid chromatography/mass spectrometry (LC/MS), nuclear magnetic resonance (NMR) spectroscopy, infrared (IR) spectroscopy, and ultraviolet (UV) spectrophotometry were employed to analyze the spectroscopic characteristics of this cathinone. As an analog, 3,4-DMMC exhibits similar if not identical IR and UV profiles to mephedrone (4-MMC) and methcathinone; however, the retention time from GC is unique as expected, and the electron impact fragmentation pattern is consistent with the fragmentation pattern of other cathinones. The chemical shifts of the carbons and hydrogens were assigned by both one- and two-dimensional NMR techniques, while the molecular weight was confirmed by LC/MS.     

Analysis of Gunshot Residue and Associated Materials—A Review

Abstract: A comprehensive review of the scientific literature on gunshot residue (GSR) is presented. Aspects of both inorganic and organic GSR are discussed, from formation and distribution, to sample collection, preparation, and analysis using a variety of techniques. The interpretation of GSR results is also considered including issues surrounding the contamination, distribution, and transfer of GSR. Potential problems with ulterior sources of GSR like particles have been reported in the literature. For example, particles from environmental and occupational sources have been highlighted as exhibiting similar chemical and morphological characteristics to GSR. These findings are put into context with regard to interpreting samples. A move toward a “case by case” approach is argued to be more preferable to a “formal” classification system where possible. The analysis of both inorganic and organic compositions of residue samples as well as morphological considerations is considered to be a more ideal approach to GSR analysis, whereever practicable.     

The Swiss: A Political Nation?

Abstract: Proponents of constitutional patriotism advocate the promotion of a political national identity. Whether a national identity founded on common political values is viable, however, remains a matter of dispute. The Swiss nation is one of the few empirical cases cited by those who argue that a political national identity can be a sufficient guarantor of institutional stability and social coherence; indeed, Switzerland is widely regarded as a prototype of the political nation. The aim of our analysis is to empirically test this claim. In doing so, we rely on classical typologies of national identity. We propose to use a more finely graded typology than the usual dichotomies, however – one which allows for combined types – and to focus on individual perceptions of national identity at the mass‐ and elite‐levels. The empirical analysis of whether the Swiss nation can correctly be classified as a political nation draws on data from mass and MP surveys. Our conclusion is that the Swiss imagine their nation in both political and cultural terms, and the essence of their cultural identity is Swiss linguistic pluralism and regional diversity.     

Outcomes in a low secure unit: pre-admission and post-discharge comparisons

Empirical research seldom reports on clinical outcomes within low secure services. By comparing outcome measures prior to admission and following discharge this study aimed to investigate the care pathways of patients admitted to a low secure unit (LSU). The study was conducted in an LSU and consisted of 70 patients (54 male, 16 female). Data were collected retrospectively and analysed in relation to placement security (upon admission and discharge) and admissions to hospital. Results revealed that admissions to hospital and time spent in hospital decreased post-discharge in comparison with pre-admission. Forensic patients were found to have fewer admissions than civil patients prior to LSU admission. Some differences were also observed within gender and Mental Health Act (MHA) section status for placement security. The findings demonstrated that following treatment in a LSU, care pathways may be less restrictive than prior to admission. Further, more robust research on the outcomes of LSUs is required.     

Social and economic impact of the commercialization of the Argus II artificial retina in the United States

Each year, the United States invests about $45 billion in research conducted by federal researchers within federal laboratories. These efforts generate extensive social benefits when results are transferred to the private sector. It is important that we effectively quantify the economic and societal impact of federal technology transfer activities to inform taxpayers and policymakers about the value of public investments in this form of research. The Argus II device, an artificial retina commercialized in the United States by Second Sight in 2013, provides a rich example of how private sector innovation can be enhanced by research collaborations with federal labs and academia. Over the 25-year journey from idea to product, Second Sight carried out research and development collaborations with six Department of Energy national laboratories and seven universities. The case of Argus II also offers valuable insight into (1) how private industry, academia, and government can work together to bring socially beneficial innovations to fruition and (2) the tradeoffs inherent in these public–private collaborations. In this paper, we use a Markov model to estimate the realized and potential future social benefits associated with Argus II. We provide an interactive tool that can be used to replicate our findings and modify assumptions using updated patient information as it becomes available. We also provide insight into the aspects of federal involvement surrounding the development of Argus II that contributed to its successful commercialization and discuss other spillover benefits from these public–private collaborations.