Public Deliberations, Discursive Participation and Citizen Engagement: A Review of the Empirical Literature

Many theorists have long extolled the virtues of public deliberation as a crucial component of a responsive and responsible democracy. Building on these theories, in recent years practitioners - from government officials to citizen groups, nonprofits, and foundations - have increasingly devoted time and resources to strengthening citizen engagement through deliberative forums. Although empirical research has lagged behind theory and practice, a body of literature has emerged that tests the presumed individual and collective benefits of public discourse on citizen engagement. We begin our review of this research by defining public deliberation ; we place it in the context of other forms of what we call discursive participation while distinguishing it from other ways in which citizens can voice their individual and collective views on public issues.We then discuss the expectations, drawn from deliberative democratic theory, regarding the benefits (and, for some, pitfalls) assumed to derive from public deliberation. The next section reviews empirical research as it relates to these theoretical expectations.We conclude with recommendations on future directions for research in this area

DPST ; 81-141-31

This report presents the computer programs used at the Savanah River Laboratory to produce National Uranium Resource Evaluation program reports

Preventable emergency hospital admissions among adults with intellectual disability : comparisons with the general population in England

Purpose Adults with intellectual disabilities (ID) experience poorer physical health and healthcare quality, but there is limited information on the scope for reducing emergency hospital admissions. We describe overall and preventable emergency admissions for adults with ID compared to the general population and assess differences in primary care management before admission for two common Ambulatory Care Sensitive conditions (ACSCs). Methods We used electronic records to study a matched cohort of 16,666 adults with ID and 113,562 age, sex and practice matched controls from 343 English family practices. Incident rate ratios (IRR) from conditional Poisson regression are analysed for all emergency and preventable (ACSC) emergency admissions. Primary care management of lower respiratory (LRTI) and urinary tract (UTI) infections, as exemplar ACSCs, prior to admission are compared in unmatched analysis between adults with and without ID. Results The overall rate for emergency admissions for adults with ID versus controls was 182 vs. 68 per 1000/year (IRR=2.82, 95%CI: 2.66–2.98). ACSCs accounted for 33.7% of emergency admissions compared to 17.3% in controls (IRR=5.62, 5.14-6.13); adjusting for comorbidity, smoking and deprivation did not explain the difference (IRR=3.60, 3.25–3.99). Despite adults with ID being at nearly five times higher risk for admissions from LRTI and UTI, they have similar primary care utilisation, investigation and management preceding admission, as the general population. Conclusion Adults with ID are at high risk of preventable emergency admissions. Identifying improvements for detection and management of ACSCs in primary care, including lower respiratory and urinary tract infections, could reduce hospitalisations

Genetic diversity in Cypripedium calceolus (Orchidaceae) with a focus on north-western Europe, as revealed by plastid DNA length polymorphisms

Background and Aims Cypripedium calceolus, although widespread in Eurasia, is rare in many countries in which it occurs. Population genetics studies with nuclear DNA markers on this species have been hampered by its large nuclear genome size. Plastid DNA markers are used here to gain an understanding of variation within and between populations and of biogeographical patterns. Methods Thirteen length-variable regions (microsatellites and insertions/deletions) were identified in non-coding plastid DNA. These and a previously identified complex microsatellite in the trnL-trnF intergenic spacer were used to identify plastid DNA haplotypes for European samples, with sampling focused on England, Denmark and Sweden. Key Results The 13 additional length-variable regions identified were two homopolymer (polyA) repeats in the rps16 intron and a homopolymer (polyA) repeat and ten indels in the accD-psa1 intergenic spacer. In accD-psa1, most of these were in an extremely AT-rich region, and it was not possible to design primers in the flanking regions; therefore, the whole intergenic spacer was sequenced. Together, these new regions and the trnL-trnF complex microsatellite allowed 23 haplotypes to be characterized. Many were found in only one or a few samples (probably due to low sampling density), but some commoner haplotypes were widespread. Most of the genetic variation was found within rather than between populations (83 vs. 18%, respectively). Two haplotypes occurred from the Spanish Pyrenees to Sweden. Conclusions Plastid DNA data can be used to gain an understanding of patterns of genetic variation and seed-mediated gene flow in orchids. Although these data are less information-rich than those for nuclear DNA, they present a useful option for studying species with large genomes. Here they support the hypothesis of long-distance seed dispersal often proposed for orchid

Health characteristics and consultation patterns of people with intellectual disability: a cross-sectional database study in English general practice.

BACKGROUND: People with intellectual disability (ID) are a group with high levels of healthcare needs; however, comprehensive information on these needs and service use is very limited. AIM: To describe chronic disease, comorbidity, disability, and general practice use among people with ID compared with the general population. DESIGN AND SETTING: This study is a cross-sectional analysis of a primary care database including 408 English general practices in 2012. METHOD: A total of 14 751 adults with ID, aged 18-84 years, were compared with 86 221 age-, sex- and practice-matched controls. Depending on the outcome, prevalence (PR), risk (RR), or odds (OR) ratios comparing patients with ID with matched controls are shown. RESULTS: Patients with ID had a markedly higher prevalence of recorded epilepsy (18.5%, PR 25.33, 95% confidence interval [CI] = 23.29 to 27.57), severe mental illness (8.6%, PR 9.10, 95% CI = 8.34 to 9.92), and dementia (1.1%, PR 7.52, 95% CI = 5.95 to 9.49), as well as moderately increased rates of hypothyroidism and heart failure (PR>2.0). However, recorded prevalence of ischaemic heart disease and cancer was approximately 30% lower than the general population. The average annual number of primary care consultations was 6.29 for patients with ID, compared with 3.89 for matched controls. Patients with ID were less likely to have longer doctor consultations (OR 0.73, 95% CI = 0.69 to 0.77), and had lower continuity of care with the same doctor (OR 0.77, 95% CI = 0.73 to 0.82). CONCLUSION: Compared with the general population, people with ID have generally higher overall levels of chronic disease and greater primary care use. Ensuring access to high-quality chronic disease management, especially for epilepsy and mental illness, will help address these greater healthcare needs. Continuity of care and longer appointment times are important potential improvements in primary care

Mortality Among Adults With Intellectual Disability in England: Comparisons With the General Population.

OBJECTIVES: To describe mortality among adults with intellectual disability in England in comparison with the general population. METHODS: We conducted a cohort study from 2009 to 2013 using data from 343 general practices. Adults with intellectual disability (n = 16 666; 656 deaths) were compared with age-, gender-, and practice-matched controls (n = 113 562; 1358 deaths). RESULTS: Adults with intellectual disability had higher mortality rates than controls (hazard ratio [HR] = 3.6; 95% confidence interval [CI] = 3.3, 3.9). This risk remained high after adjustment for comorbidity, smoking, and deprivation (HR = 3.1; 95% CI = 2.7, 3.4); it was even higher among adults with intellectual disability and Down syndrome or epilepsy. A total of 37.0% of all deaths among adults with intellectual disability were classified as being amenable to health care intervention, compared with 22.5% in the general population (HR = 5.9; 95% CI = 5.1, 6.8). CONCLUSIONS: Mortality among adults with intellectual disability is markedly elevated in comparison with the general population, with more than a third of deaths potentially amenable to health care interventions. This mortality disparity suggests the need to improve access to, and quality of, health care among people with intellectual disability. (Am J Public Health. Published online ahead of print June 16, 2016: e1-e8. doi:10.2105/AJPH.2016.303240)

Risk of infection in type 1 and type 2 diabetes compared with the general population: a matched cohort study

OBJECTIVE We describe in detail the burden of infections in adults with diabetes within a large national population cohort. We also compare infection rates between patients with type 1 and type 2 diabetes mellitus (T1DM and T2DM). RESEARCH DESIGN AND METHODS A retrospective cohort study compared 102,493 English primary care patients aged 40–89 years with a diabetes diagnosis by 2008 (n = 5,863 T1DM and n = 96,630 T2DM) with 203,518 age-sex-practice–matched control subjects without diabetes. Infection rates during 2008–2015, compiled from primary care and linked hospital and mortality records, were compared across 19 individual infection categories. These were further summarized as any requiring a prescription or hospitalization or as cause of death. Poisson regression was used to estimate incidence rate ratios (IRRs) between 1) people with diabetes and control subjects and 2) T1DM and T2DM adjusted for age, sex, smoking, BMI, and deprivation. RESULTS Compared with control subjects without diabetes, patients with diabetes had higher rates for all infections, with the highest IRRs seen for bone and joint infections, sepsis, and cellulitis. IRRs for infection-related hospitalizations were 3.71 (95% CI 3.27–4.21) for T1DM and 1.88 (95% CI 1.83–1.92) for T2DM. A direct comparison of types confirmed higher adjusted risks for T1DM versus T2DM (death from infection IRR 2.19 [95% CI 1.75–2.74]). We estimate that 6% of infection-related hospitalizations and 12% of infection-related deaths were attributable to diabetes. CONCLUSIONS People with diabetes, particularly T1DM, are at increased risk of serious infection, representing an important population burden. Strategies that reduce the risk of developing severe infections and poor treatment outcomes are under-researched and should be explored

Managing Extreme Heat and Smoke: A Focus Group Study of Vulnerable People in Darwin, Australia

Extreme heat and poor air quality arising from landscape fires are an increasing global concern driven by anthropogenic climate change. Previous studies have shown these environmental conditions are associated with negative health outcomes for vulnerable people. Managing and adapting to these conditions in a warming climate can present substantial difficulties, especially in climates already challenging for human habitation. This study was set in the tropical city of Darwin, Australia. We recruited individuals from population groups vulnerable to outdoor hazards: outdoor workers, teachers and carers, and sportspeople, to participate in focus group discussions. We aimed to gain an understanding of the impacts of extreme heat and poor air quality and how individuals perceived and managed these environmental conditions. We identified a number of key themes relating to impacts on health, work and activity, and adaptive behaviors, while identifying gaps in policy and infrastructure that could improve the lives and protect the health of vulnerable people living, working, and playing in this region. In addition, these outcomes potentially provide direction for other regions with similar environmental challenges. Extreme heat and poor air quality place an additional burden on the lives of people in high-risk settings, such as outdoor workers, teachers and carers, and sportspeople