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Recent studies have shown that the punitive drug laws enacted in the mid-1970s led to a sharp increase in incarceration only in the mid-1980s, when city police departments started policing street-level drug markets much more intensively. The case study of New York City in the wake of the Rockefeller Drug Laws of 1973 presents an explanation. Only when new policing ideas, popular dissatisfaction with street crime, and the revival of the city's fiscal capacity coalesced as part of a larger project to rebuild urban governance in the aftermath of the fiscal crisis of the 1970s did New York turn toward street-level drug enforcement. An examination of the political history of street-level drug enforcement offers a better understanding of the history of New York's war on drugs, as well as a new chronology of the political dynamics of state rebuilding in the 1980s.
Tropical forest regions in equatorial Africa are threatened with degradation, deforestation and biodiversity loss as a result of land-cover change. We investigated historical land-cover dynamics in unprotected forested areas of the Littoral Region in south-western Cameroon during 1975–2017, to detect changes that may influence this important biodiversity and wildlife area. Processed Landsat imagery was used to map and monitor changes in land use and land cover. From 1975 to 2017 the area of high-value forest landscapes decreased by c. 420,000 ha, and increasing forest fragmentation caused a decline of c. 12% in the largest patch index. Conversely, disturbed vegetation, cleared areas and urban areas all expanded in extent, by 32% (c. 400,000 ha), 5.6% (c. 26,800 ha) and 6.6% (c. 78,631 ha), respectively. The greatest increase was in the area converted to oil palm plantations (c. 26,893 ha), followed by logging and land clearing (c. 34,838 ha), all of which were the major factors driving deforestation in the study area. Our findings highlight the increasing threats facing the wider Littoral Region, which includes Mount Nlonako and Ebo Forest, both of which are critical areas for regional conservation and the latter a proposed National Park and the only sizable area of intact forest in the region. Intact forest in the Littoral Region, and in particular at Ebo, merits urgent protection.
Increasingly, ambulance services offer alternatives to transfer to the emergency department (ED), when this is better for patients. The introduction of electronic health records (EHR) in ambulance services is encouraged by national policy across the United Kingdom (UK) but roll-out has been variable and complex.
Electronic Records in Ambulances (ERA) is a two-year study which aims to investigate and describe the opportunities and challenges of implementing EHR and associated technology in ambulances to support a safe and effective shift to out of hospital care, including the implications for workforce in terms of training, role and clinical decision-making skills.
Our study includes a scoping review of relevant issues and a baseline assessment of progress in all UK ambulance services in implementing EHR. These will inform four in-depth case studies of services at different stages of implementation, assessing current usage, and examining context.
The scoping review identified themes including: there are many perceived potential benefits of EHR, such as improved safety and remote diagnostics, but as yet little evidence of them; technical challenges to implementation may inhibit uptake and lead to increased workload in the short term; staff implementing EHR may do so selectively or devise workarounds; and EHR may be perceived as a tool of staff surveillance.
Our scoping review identified some complex issues around the implementation of EHR and the relevant challenges, opportunities and workforce implications. These will help to inform our fieldwork and subsequent data analysis in the case study sites, to begin early in 2017. Lessons learned from the experience of implementing EHR so far should inform future development of information technology in ambulance services, and help service providers to understand how best to maximize the opportunities offered by EHR to redesign care.
Positron emission tomography (PET) and single photon emission computed tomography (SPECT) brain imaging are widely used as diagnostic tools for suspected dementia but no studies have directly compared participant views of the two procedures. We used a range of methods to explore preferences for PET and SPECT.
Patients and controls (and accompanying carers) completed questionnaires immediately after undergoing PET and SPECT brain scans. Pulse rate data were collected during each scan. Scan attributes were prioritized using a card sorting exercise; carers and controls additionally answered willingness to pay (WTP) questions.
Few differences were found either between the scans or groups of participants, although carers marginally preferred SPECT. Diagnostic accuracy was prioritized over other scan characteristics. Mean heart rate during both scans was lower than baseline heart rate measured at home (p < 0.001).
Most participants viewed PET and SPECT scans as roughly equivalent and did not have a preference for either scan. Carer preference for SPECT is likely to reflect their desire to be with the patient (routine practice for SPECT but not for PET), suggesting that they should be able to accompany vulnerable patients throughout imaging procedures wherever possible. Pulse rate data indicated that brain imaging was no more stressful than a home visit (HV) from a researcher. The data do not support the anecdotal view that PET is a more burdensome procedure and the use of PET or SPECT scans in dementia should be based on diagnostic accuracy of the technique.